Latent class models for cognitive diagnosis often begin with specification of a matrix that indicates which attributes or skills are needed for each item. Then by imposing restrictions that take this into account, along with a theory governing how subjects interact with items, parametric formulations of item response functions are derived and fitted. Cluster analysis provides an alternative approach that does not require specifying an item response model, but does require an item-by-attribute matrix. After summarizing the data with a particular vector of sum-scores, K-means cluster analysis or hierarchical agglomerative cluster analysis can be applied with the purpose of clustering subjects who possess the same skills. Asymptotic classification accuracy results are given, along with simulations comparing effects of test length and method of clustering. An application to a language examination is provided to illustrate how the methods can be implemented in practice.

Although dietary factors have been examined as potential risk factors for liver cancer, the evidence is still inconclusive. Using a diet-wide association analysis, our research evaluated the associations of 126 foods and nutrients on the risk of liver cancer in a Chinese population. We obtained the diet consumption of 72,680 women in the Shanghai Women’s Health Study using baseline dietary questionnaires. The association between each food and nutrient and liver cancer risk was quantified by Cox regression model. A false discovery rate of 0.05 was used to determine the foods and nutrients which need to be verified. Totally 256 incident liver cancer cases were identified in 1,267,391 person-years during the follow-up duration. At the statistical significance level (P ≤ 0.05), higher intakes of cooked wheaten foods, pear, grape and copper were inversely associated with liver cancer risk, while spinach, leafy vegetables, eggplant and carrots showed the positive associations. After considering multiple comparisons, no dietary variable was associated with liver cancer risk. Similar findings were seen in the stratification, secondary and sensitivity analyses. Our findings observed no significant association between dietary factors and liver cancer risk after considering multiple comparisons in Chinese women. More evidence is needed to explore the associations between diet and female liver cancer occurrence.

Prior to the No Surprises Act (NSA), numerous states passed laws protecting patients from surprise medical bills from out-of-network (OON) hospital-based physicians supporting elective treatment in in-network hospitals. Even in non-emergency situations, patients have little ability to choose physicians such as anaesthesiologists, pathologists or radiologists. Using a comprehensive, multi-payer claims database, we estimated the effect of these laws on hospital-based physician reimbursement, charges, network participation and potential surprise billing episodes. Overall, the state laws were associated with a reduction in anaesthesiology prices and charges, but an increase in pathology and radiology prices. The price effects for each state exhibit substantial heterogeneity. California and New Jersey experienced increases in network participation by anaesthesiologists and pathologists and reductions in potential surprise billing episodes, but, overall, we find little evidence of changes in network participation across all of the states implementing surprise billing laws. Our results suggest that the effects of the NSA may vary across states.

This study examined the sour grapes/sweet lemons rationalization through 2 conditions: ‘attainable’ (sweet lemons) and ‘unattainable’ (sour grapes), reflecting China’s 2019-nCoV vaccination strategy. The aim was to find ways to change people’s beliefs and preferences regarding vaccines by easing their safety concerns and encouraging more willingness to get vaccinated. An online survey was conducted from January 22 to 27, 2021, with 3,123 residents across 30 provinces and municipalities in the Chinese mainland. The direction of belief and preference changed in line with the sour grapes/sweet lemons rationalization. Using hypothetical and real contrasts, we compared those for whom the vaccine was relatively unattainable (‘sour grapes’ condition) with those who could get the vaccine easily (‘sweet lemons’). Whether the vaccine was attainable was determined in the early stage of the vaccine roll-out by membership in a select group of workers that was supposed to be vaccinated to the greatest extent possible, or, by being in the second stage when the vaccine was available to all. The attainable conditions demonstrated higher evaluation in vaccine safety, higher willingness to be vaccinated, and lower willingness to wait and see. Hence, we propose that the manipulation of vaccine attainability, which formed the basis of the application of sour grapes/sweet lemons rationalization, can be utilized as a means to manipulate the choice architecture to nudge individuals to ease vaccine safety concerns, reducing wait-and-see tendencies, and enhancing vaccination willingness. This approach can expedite universal vaccination and its associated benefits in future scenarios resembling the 2019-nCoV vaccine rollout.

Foodborne diseases are ongoing and significant public health concerns. This study analysed data obtained from the Foodborne Outbreaks Surveillance System of Wenzhou to comprehensively summarise the characteristics of foodborne outbreaks from 2012 to 2022. A total of 198 outbreaks were reported, resulting in 2,216 cases, 208 hospitalisations, and eight deaths over 11 years. The findings suggested that foodborne outbreaks were more prevalent in the third quarter, with most cases occurring in households (30.8%). Outbreaks were primarily associated with aquatic products (17.7%) as sources of contamination. The primary transmission pathways were accidental ingestion (20.2%) and multi-pathway transmission (12.1%). Microbiological aetiologies (46.0%), including Vibrio parahaemolyticus, Salmonella ssp., and Staphylococcus aureus, were identified as the main causes of foodborne outbreaks. Furthermore, mushroom toxins (75.0%), poisonous animals (12.5%), and poisonous plants (12.5%) were responsible for deaths from accidental ingestion. This study identified crucial settings and aetiologies that require the attention of both individuals and governments, thereby enabling the development of effective preventive measures to mitigate foodborne outbreaks, particularly in coastal cities.

Choline and betaine are important in the body, from cell membrane components to methyl donors. We aimed to investigate trends in dietary intake and food sources of total choline, individual choline forms and betaine in Chinese adults using data from the China Health and Nutrition Survey (CHNS) 1991–2011, a prospective cohort with a multistage, random cluster design. Dietary intake was estimated using three consecutive 24-h dietary recalls in combination with a household food inventory. Linear mixed-effect models were constructed using R software. A total of 11 188 men and 12 279 women aged 18 years or older were included. Between 1991 and 2011, total choline intake increased from 219·3 (95 % CI 215·1, 223·4) mg/d to 269·0 (95 % CI 265·6, 272·5) mg/d in men and from 195·6 (95 % CI 191·8, 199·4) mg/d to 240·4 (95 % CI 237·4, 243·5) mg/d in women (both P-trends < 0·001). Phosphatidylcholine was the major form of dietary choline, and its contribution to total choline increased from 46·9 % in 1991 to 58·8 % in 2011. Cereals were the primary food source of total choline before 2000, while eggs had ranked at the top since 2004. Dietary betaine intake was relatively steady over time with a range of 134·0–151·5 mg/d in men (P-trend < 0·001) and 111·7–125·3 mg/d in women (P-trend > 0·05). Chinese adults experienced a significant increase in dietary intake of choline, particularly phosphatidylcholine during 1991–2011 and animal-derived foods have replaced plant-based foods as the main food sources of choline. Betaine intake remained relatively stable over time. Future efforts should address the health effects of these changes.

To investigate the associations between dietary patterns and biological ageing, identify the most recommended dietary pattern for ageing and explore the potential mediating role of gut microbiota in less-developed ethnic minority regions (LEMRs). This prospective cohort study included 8288 participants aged 30–79 years from the China Multi-Ethnic Cohort study. Anthropometric measurements and clinical biomarkers were utilised to construct biological age based on Klemera and Doubal’s method (KDM-BA) and KDM-BA acceleration (KDM-AA). Dietary information was obtained through the baseline FFQ. Six dietary patterns were constructed: plant-based diet index, healthful plant-based diet index, unhealthful plant-based diet index, healthy diet score, Dietary Approaches to Stop Hypertension (DASH), and alternative Mediterranean diets. Follow-up adjusted for baseline analysis assessed the associations between dietary patterns and KDM-AA. Additionally, quantile G-computation identified significant beneficial and harmful food groups. In the subsample of 764 participants, we used causal mediation model to explore the mediating role of gut microbiota in these associations. The results showed that all dietary patterns were associated with KDM-AA, with DASH exhibiting the strongest negative association (β = −0·91, 95 % CI (–1·19, −0·63)). The component analyses revealed that beneficial food groups primarily included tea and soy products, whereas harmful groups mainly comprised salt and processed vegetables. In mediation analysis, the Synergistetes and Pyramidobacter possibly mediated the negative associations between plant-based diets and KDM-AA (5·61–9·19 %). Overall, healthy dietary patterns, especially DASH, are negatively associated with biological ageing in LEMRs, indicating that Synergistetes and Pyramidobacter may be potential mediators. Developing appropriate strategies may promote healthy ageing in LEMRs.

Purple nutsedge (Cyperus rotundus L.) is one of the world’s resilient upland weeds, primarily spreading through its tubers. Its emergence in rice (Oryza sativa L.) fields has been increasing, likely due to changing paddy-farming practices. This study aimed to investigate how C. rotundus, an upland weed, can withstand soil flooding and become a problematic weed in rice fields. The first comparative analysis focused on the survival and recovery characteristics of growing and mature tubers of C. rotundus exposed to soil-flooding conditions. Notably, mature tubers exhibited significant survival and recovery abilities in these environments. Based on this observation, further investigation was carried out to explore the morphological structure, nonstructural carbohydrates, and respiratory mechanisms of mature tubers in response to prolonged soil flooding. Over time, the mature tubers did not form aerenchyma but instead gradually accumulated lignified sclerenchymal fibers, with lignin content also increasing. After 90 d, the lignified sclerenchymal fibers and lignin contents were 4.0 and 1.1 times higher than those in the no soil-flooding treatment. Concurrently, soluble sugar content decreased while starch content increased, providing energy storage, and alcohol dehydrogenase activity rose to support anaerobic respiration via alcohol fermentation. These results indicated that mature tubers survived in soil-flooding conditions by adopting a low-oxygen quiescence strategy, which involves morphological adaptations through the development of lignified sclerenchymal fibers, increased starch reserves for energy storage, and enhanced anaerobic respiration. This mechanism likely underpins the flooding tolerance of mature C. rotundus tubers, allowing them to endure unfavorable conditions and subsequently germinate and grow once flooding subsides. This study provides a preliminary explanation of the mechanism by which mature tubers of C. rotundus from the upland areas confer flooding tolerance, shedding light on the reasons behind this weed’s increasing presence in rice fields.

This study aimed to understand the potassium voltage-gated channel KQT-like subfamily, member 1 gene polymorphism in a rural elderly population in a county in Guangxi and to explore the possible relationship between its gene polymorphism and blood sugar. The 6 SNP loci of blood DNA samples from 4355 individuals were typed using the imLDRTM Multiple SNP Typing Kit from Shanghai Tianhao Biotechnology Co. The data combining epidemiological information (baseline questionnaire and physical examination results) and genotyping results were statistically analyzed using GMDR0.9 software and SPSS22.0 software. A total of 4355 elderly people aged 60 years and above were surveyed in this survey, and the total abnormal rate of glucose metabolism was 16·11 % (699/4355). Among them, male:female ratio was 1:1·48; the age group of 60–69 years old accounted for the highest proportion, with 2337 people, accounting for 53·66 % (2337/4355). The results of multivariate analysis showed that usually not doing farm work (OR 1·26; 95 % CI 1·06, 1·50), TAG ≥ 1·70 mmol/l (OR 1·19; 95 % CI 1·11, 1·27), hyperuricaemia (OR 1·034; 95 % CI 1·01, 1·66) and BMI ≥ 24 kg/m2 (OR 1·06; 95 % CI 1·03, 1·09) may be risk factors for abnormal glucose metabolism. Among all participants, rs151290 locus AA genotype, A allele carriers (AA+AC) were 0.70 times more likely (0.54 to 0.91) and 0.82 times more likely (0.70 to 0.97) to develop abnormal glucose metabolism than CC genotype carriers, respectively. Carriers of the T allele at the rs2237892 locus (CT+TT) were 0.85 times more likely to have abnormal glucose metabolism than carriers of the CC genotype (0.72 to 0.99); rs2237897 locus CT gene. The possibility of abnormal glucose metabolism in the carriers of CC genotype, TT genotype and T allele (CT + TT) is 0·79 times (0·67–0·94), 0·74 times (0·55–0·99) and 0·78 times (0·66, 0·92). The results of multifactor dimensionality reduction showed that the optimal interaction model was a three-factor model consisting of farm work, TAG and rs2237897. The best model dendrogram found that the interaction between TAG and rs2237897 had the strongest effect on fasting blood glucose in the elderly in rural areas, and they were mutually antagonistic. Environment–gene interaction is an important factor affecting abnormal glucose metabolism in the elderly of a county in Hechi City, Guangxi.

The Indo-Pacific Warm Pool (IPWP) significantly influences the global hydrological cycle through its impact on atmospheric-oceanic circulation. However, gaining a comprehensive understanding of the hydrologic climate dynamics within the IPWP and its broader effects on the global climate have been hindered by spatial and temporal limitations in paleoclimate records on orbital timescales. In this study, we reconstructed precipitation records (approximated from δ18Osw-ivc) over the past 450 kyr, based on planktonic foraminiferal Mg/Ca and δ18O data obtained from International Ocean Discovery Program Site U1486 in the western tropical Pacific. The δ18Osw-ivc record revealed a generally consistent pattern with precession variations over the past 450 kyr, closely corresponding to changes in boreal summer insolation at the equator. The δ18Osw-ivc record displayed an anti-phased relationship with Chinese speleothem δ18O records on the precession band, with lower precipitation in the western tropical Pacific and higher precipitation in the East Asia summer monsoon region during periods of high Northern Hemisphere summer insolation. This anti-phased correlation primarily resulted from the north-south migration of the Intertropical Convergence Zone (ITCZ), influenced by the interhemispheric insolation contrast. By considering additional δ18Osw-ivc records from various locations within the IPWP region, we identified synchronous precipitation changes within the IPWP on the precession band. The synchronization of precipitation on both margins of the ITCZ’s seasonal range and differences between central and marginal regions of the ITCZ within the IPWP revealed the expansion and contraction of the ITCZ on precession band.

Characterised by the extensive use of obsidian, a blade-based tool inventory and microblade technology, the late Upper Palaeolithic lithic assemblages of the Changbaishan Mountains are associated with the increasingly cold climatic conditions of Marine Isotope Stage 2, yet most remain poorly dated. Here, the authors present new radiocarbon dates associated with evolving blade and microblade toolkits at Helong Dadong, north-east China. At 27 300–24 100 BP, the lower cultural layers contain some of the earliest microblade technology in north-east Asia and highlight the importance of the Changbaishan Mountains in understanding changing hunter-gatherer lifeways in this region during MIS 2.

The femtosecond laser filament-induced air laser plays a significant role for the remote sensing of air pollutants. The spatial distributions of air laser intensity were investigated experimentally in previous studies. However, the mechanism of the air laser propagation properties inside the filament plasma has not been quite clear yet. Moreover, few studies have been dedicated to the reproduction of the air laser profile from nitrogen molecules propagating in the filament plasma based on the numerical simulation method. In this study, the lasing action of the air laser from the transition of the first negative (0,0) band of nitrogen ions at 391 nm was simulated during the femtosecond laser filamentation. The beam profile of the air laser changes from a Gaussian or super-Gaussian shape to an outer ring structure by increasing the filament length or nitrogen ion density, which is in accord with the previous experimental result. A multiple-diffraction effect has been proposed to clarify the mechanism of the outer rings beam pattern formation, which is induced by the dynamical interaction between the lasing effect and diffraction effect of the air laser propagating inside the filament plasma. In addition, the amplified air laser power as a function of both the filament length and nitrogen ion density was investigated. Our study would pave the way to improve the energy conversion efficiency and directivity of remote air lasers, which would be significant for remote sensing applications.