Post-operative morbidity after neoadjuvant chemotherapy and resection for gallbladder cancer: A national surgical quality improvement program analysis

BACKGROUND Gallbladder cancer is the most common malignancy of the biliary tract.Neo-adjuvant chemotherapy(NACT)has improved overall survival by enabling R0 resection.Currently,there is no consensus of guidelines for neoadjuvant therapy in gallbladder cancer.As investigations continue to analyze the regimen and benefit of NACT for ongoing care of gallbladder cancer patients,we examined American College of Surgeons National Surgical Quality Improvement Program(NSQIP)database to determine if there was higher morbidity among the neo-adjuvant group within the 30-day post-operative period.We hypothesized patients who underwent NACT were more likely to have higher post-operative morbidity.AIM To investigate the 30-day post-operative morbidity outcomes between patients who received NACT and underwent surgery and patients who only had surgery.METHODS A retrospective analysis of the targeted hepatectomy NSQIP data between 2015 and 2019 was performed to determine if NACT in gallbladder cancer increased the risk for post-operative morbidity(bile leak,infection rate,rate of converting to open surgery,etc.)compared to the group who only had surgery.To calculate the odds ratio for the primary and secondary outcomes,a crude logistic regression was performed.RESULTS Of the 452 patients,52 patients received NACT prior to surgery.There were no statistically significant differences in the odds of morbidity between the two groups,including bile leak[odds ratio(OR),0.69;95%confidence interval(95%CI):0.16-2.10;P=0.55],superficial wound infection(OR,0.58;95%CI:0.03-3.02;P=0.61),and organ space wound infection(OR,0.63;95%CI:0.18-1.63;P=0.61).CONCLUSION There was no significant difference in the risk of 30-day post-operative morbidity between the NACT and surgery group and the surgery only group.

Hospice and Palliative Care Services in South Korea Supported by the National Health Insurance (NHI) Program

Previous main body of research on end-life-care in South Korea has focused on developing services quality in hospital settings or service payment system in National Health Insurance Program. The delivery system of hospice and palliative care services has evolved in diverse ways but there is little research on reviewing the past history of development and whole picture of them so far. So, the aim of this study is to review the old hospice and palliative care system and also to introduce the current one supported by the National Health Insurance Program in South Korea. The palliative care or hospice services in South Korea have been available in diverse settings and provided by different organizations (i.e. catholic hospitals or charity organizations). Finally, it was set up in 2004 that the hospice team or official Palliative Care Units (PCUs) was established in hospitals, in order to meet the end-of-life care for the patients with terminal cancer under the Cancer Control Act. The current hospice and palliative care services such as pain management, bereavement services, and counselling can be reimbursed by National Health Insurance program since 2008. Nevertheless hospice and palliative care services are available to dying patients, yet the utilization rate of hospice and palliative care services or the length of stay in the palliative care unit (PCU) is still relatively short compared to other country systems. South Korea is undergoing several efforts to expand the services in PCU along with the development of quality indicators for PCU. Hospice and palliative care services are still new in the health care system and unfamiliar to the public so it requires raising awareness for medical professionals and the public as well as further research.

Results of National Colorectal Cancer Screening Program in Croatia(2007-2011)

AIM:To study the epidemiologic indicators of uptake and characteristic colonoscopic findings in the Croatian National Colorectal Cancer Screening Program.METHODS:Colorectal cancer(CRC) was the second leading cause of cancer mortality in men(n = 1063,49.77/100 000),as well as women(n = 803,34.89/100 000) in Croatia in 2009.The Croatian National CRC Screening Program was established by the Ministry of Health and Social Welfare,and its implementation started in September,2007.The coordinators were recruited in each county institute of public health with an obligation to provide fecal occult blood testing(FOBT) to the participants,followed by colonoscopy in all positive cases.The FOBT was performed by hypersensitive guaiac-based Hemognost card test(Biognost,Zagreb).The test and short questionnaire were delivered to the home addresses of all citizens aged 50-74 years consecutively during a 3-year period.Each participant was required to complete the questionnaire and send it together with the stool specimen on three test cards back to the institute for further analysis.About 4% FOBT positive cases are expected in normal risk populations.A descriptive analysis was performed.RESULTS:A total of 1 056 694 individuals(born between 1933-1945 and 1952-1957) were invited to screening by the end of September 2011.In total,210 239(19.9%) persons returned the envelope with a completed questionnaire,and 181 102 of them returned it with a correctly placed stool specimen on FOBT cards.Until now,12 477(6.9%),FOBT-positive patients have been found,which is at the upper limit of the expected values in European Guidelines for Quality Assurance in CRC Screening and Diagnosis [European Union(EU) Guidelines].Colonoscopy was performed in 8541 cases(uptake 66%).Screening has identified CRC in 472 patients(5.5% of colonoscopied,3.8% of FOBT-positive,and 0.26% of all screened individuals).This is also in the expected range according to EU Guidelines.Polyps were found and removed in 3329(39% of colonoscopied) patients.The largest number of polyps were found in the left half of the colon:64%(19%,37% and 8% in the rectum,sigma,and descendens,respectively).The other 36% were detected in the proximal part(17% in the transverse colon and 19% in ceco-ascending colon).Small polyps in the rectum(5-10 mm in diameter),sigmoid and descending colon were histologically found to be tubular adenomas in 60% of cases,with a low degree of dysplasia,and 40% were classified as hyperplastic.Polyps of this size in the transverse or ceco-ascending colon in almost 20% had a histologically villous component,but still had a low degree of dysplasia.Polyps sized 10-20 mm in diameter were in 43% cases tubulovillous,and among them,32% had areas with a high degree of dysplasia,especially those polyps in the cecoascending or transverse part.The characteristics of the Croatian CRC Screening National Program in the first 3 years were as follows:relatively low percentage of returned FOBT,higher number of FOBT-positive persons but still in the range for population-based programs,and higher number of pathologic findings(polyps and cancers).CONCLUSION:These results suggest a need for intervention strategies that include organizational changes and educational activities to improve awareness of CRC screening usefulness and increase participation rates.

Impact of Africa Regional Food Security Program on Nigerian Farmers： The Case of National Special Program for Food Security

This paper examined the impact of National Special Program for Food Security （NSPFS） on the beneficiaries through a qualitative measurement of the food security status of the beneficiaries. A food insecurity index was estimated to measure the well-being of the beneficiaries as affected by the impact of the program. Beneficiaries were classified into four categories： food secure （41%）, food insecure without hunger （46%）, food insecure with moderate hunger （11%）, and food insecure with severe hunger （2%）. Perceptions of beneficiaries were measured. In conclusion, the program has had a positive impact and enhanced food security among the Nigerian beneficiaries. It is not without its short comings which include delayed and untimely disbursement of funds and lack of output markets, irrigation facilities, production inputs and adequate training on technology know-how. The default rate and number of debtors remain high among beneficiaries. Efforts should be made to correct the short comings to improve the effectiveness of the program and justify the huge financial resources that have been committed.

National Swine Genetic Improvement: An overview of essential program components and organizational structure needed for success

The swine industry in China is a thriving and evolving industry that has shown phenomenal growth over the past 10 years. To insure long term success and viability in a worldwide competitive industry such as pork, there is need for a National Swine Genetic Improvement Program. This program needs to draw on expertise and technology from across the world for its development, but it should be based on the structure of the pig industry in China and be led by Chinese scientists, administrators and producers. National Genetic Improvement requires more than just technology. A successful program of national genetic improvement will require cooperation from the industry and the government. The support for the university system is essential for the success of the pig industry. The university system has a vital role on education (of students, faculty, producers and consumers) as well as research and technology transfer. The government could also have a role in supporting the central test stations and AI stations across the country. An accurate and comprehensive pedigree maintenance system is essential to genetic improvement. And it will be vitally important to be active in the importation of new genetics to sample other populations.

Developments in quantitative genetics methodology as applied to national genetic improvement programs for swine

Genetic selection in pigs through BLUP was very successful. However, strong selection mainly on growth and number of born alive decreased fitness and reduced environmental changes that animals can tolerate especially under suboptimal environments. Additional challenges are genetic differences between purebreds (selected animals) and crossbreds (commercial animals), and possibly different environments for these groups of animals. A successful genetic selection at this time requires comprehensive data for all levels of the pyramid, multitrait models for a variety of traits including categorical and survival, and software that can implement complicated models while supporting large data sets. Many projects in pig genetic evaluation are carried out at the University of Georgia. Those studies are supported by software family called BGF90.

National Basic Research Program of China (973 Program) Indo-Pacific Oceanic Channel Project Special Issue

1 INTRODUCTION The tropical Indo-Pacific Oceans span over twothirds of the global tropical oceans.A major warm pool with the highest large-scale sea surface temperature of the global oceans is located in the western Pacific and eastern Indian Oceans.The climate systems over the tropical Pacific and Indian Oceans are subject to strong ocean-atmosphere coupling at multiple scales from intraseasonal to interannual,and to centennial.The

Situation of China's solar water heater industry,related national standards,testing and the Golden Sun certification program

China is the largest solar water heater producer and market in the world.Despite the fast growth and an installed capacity that accounts for the majority of the global gross,China's per capita solar hot water capacity is still very low,implying a huge margin of market potential;and the recognition of the industry in the global market is handicapped by the scattered scale of production and inconsistent product quality.To ensure continued growth of China's solar water heating(SWH) industry,Chinese Government has established a series of national SWH standards,three national testing centers,and a certification program to lay the foundation for the development of the Golden Sun product labeling system.China General Certification Center(CGC) developed the Golden Sun product certification and labeling system on a pass/fail basis evaluating with established criteria.The system was designed to help manufacturers acclimate to explicit consistent requirements and to identify and fix the deficiencies in the design and execution of the program itself.Timely revision and integration of the national standards are recommended to accommodate the test procedures and requirements to new technologies and the evolving SWH market.Strict implementation of the Golden Sun certification and labeling system are suggested to avail improving the quality control and forging internationally reputable brands of Chinese solar water heating products.

Marine Research Accomplishments by CAS under National 863 Program

This article gives a systematic and comprehensive summary of the marine research results ac complished by the Chinese Academy of Sciences (CAS) with the support of the National High-tech Research and Development Program during the period of the Ninth Five-year Plan (1996 - 2000). It includes achievements in the exploitation of marine resources, protection of the marine environment, reduction of marine disasters and the safeguarding of national marine sovereignty.

CASC Signed First Commercial Launch Service Deal for a National Program

CASC and China Academy of Sciences (CAS) signed a contract on the development of launch vehicles for the satellite project Strategic Pioneer Program on space science on October 31 in Beijing.According to the contract, CGWIC is the general contractor to arrange the launch service and SAST is responsible for developing three LM-2D launch vehicles. It was the first time that LM launch vehicle would be used for a national program in a commercial mode. This new attempt was expected to

Gender Equality:Now a Basic State Strategy——On the Salient Features of the National Program on the Development of Chinese Women(2011-2020)

The National Program on the Development of Chinese Women （2011-2020）, herein- after referred to as the ＂NewProgram,＂ was published in August 2011. This is an important document designed to ensure implementation of the basic state strategy of gender equal- ity and the all-round development of Chinese women. The New Program is a part of China＇s policy program for the protection of human rights. It sets 57 major targets to be attained over the decade. The targets cover seven fields, namely, health, education, economy,

From Mutual Creation to Mutual Benefit:China’s National Teacher Training Program between Higher Teacher Education and K-12 Teachers

Sustainable Development Goal(SDG 4)lays solid theoretical foundation for the development of higher teacher education in improving the quality of teaching faculty nationwide.Sustainable teacher training paves a way for teacher professional development in the long run.China’s“National Teacher Training Program”serves a connection between higher teacher education and K-12 teachers in multiple perspectives when exploring K-12 teachers’improvement of the essence by upgrading the initiative of the program with the assistance of educational technology and modern educational philosophy from mutual creation to mutual benefit.Direction orientation strategic design based on demand for teaching faculty,curriculum setting in modules,and characteristics creation have been carried out to upgrade the training of teacher colleges and National Teacher Training Program in the future for achieving a win-win situation between higher teacher education and K-12 education.

Foreign Scientists Join National Research Program for the First Time

Aproposal to carry out research into the chemistry of molecular agglomerate, jointly made by Tong Zhenhe with CAS Institute of Physical and Chemical Technologies, Jiang Xikui with Shanghai Institute of Organic Chemistry, Shen Jiaocong of Jilin University, and two German and

Is Nationwide Special Campaign on Antibiotic Stewardship Program Effective on Ameliorating Irrational Antibiotic Use in China? Study on the Antibiotic Use of Specialized Hospitals in China in 2011–2012

Summary： With dwindling number of new antibiotics and inappropriate use of antibiotics, the emergence and spread of antibiotics resistance occurs commonly in healthcare institutions worldwide. In China, antibiotics are commonly overprescribed and misused. This study is to assess the effect of the nationwide special campaign on antibiotic stewardship program （ASP） at specialized hospitals in China by investigating prescription information from 2011 to 2012. Data on the hospital consumption and prescription of systemic antibiotics were obtained from four specialized hospitals, including maternity, children＇s, stomatological and cancer hospitals. Systematic random sampling was used to select outpatient prescriptions and inpatient cases. A total of 105 specialized hospitals in 2011 and 121 specialized hospitals in 2012 were analysed. The defined daily doses （DDDs） per 100 inpatient days, the percentage of antibiotic use in outpatient prescriptions, and the percentage of antibiotic use in inpatient eases were used as measurements of antibiotic use. The overall antibiotic use density in the selected hospitals decreased between 2011 and 2012 from 39.37 to 26.54 DDD/100 inpatient days （P〈0.001）. The percentage of antibiotic use in outpatient prescriptions （range： 24.12%-18.71%, P=0.109） and inpatient cases （64.85%-60.10%, P=-0.006） also decreased within the two years. Significant changes were observed among regions and different hospitals within the two years. And antibiotic consumption was correlated with the type and size of specialized hospital in 2012, but not with the regions. This analysis of antibiotic consumption of specialized hospitals allows relevant comparisons for benchmarking and shows that national ASP has improved antibiotic rational use in China. The data will assist policymakers in formulating effective strategies to decrease antibiotic overuse and identify areas that require further work.

Two Singapore public healthcare AI applications for national screening programs and other examples

This article explains how two AI systems have been incorporated into the everyday operations of two Singapore public healthcare nation‐wide screening programs.The first example is embedded within the setting of a national level population health screening program for diabetes related eye diseases,targeting the rapidly increasing number of adults in the country with diabetes.In the second example,the AI assisted screening is done shortly after a person is admitted to one of the public hospitals to identify which inpatients—especially which elderly patients with complex conditions—have a high risk of being readmitted as an inpatient multiple times in the months following discharge.Ways in which healthcare needs and the clinical operations context influenced the approach to designing or deploying the AI systems are highlighted,illustrating the multiplicity of factors that shape the requirements for successful large‐scale deployments of AI systems that are deeply embedded within clinical workflows.In the first example,the choice was made to use the system in a semi‐automated(vs.fully automated)mode as this was assessed to be more cost‐effective,though still offering substantial productivity improvement.In the second example,machine learning algorithm design and model execution trade-offs were made that prioritized key aspects of patient engagement and inclusion over higher levels of predictive accuracy.The article concludes with several lessons learned related to deploying AI systems within healthcare settings,and also lists several other AI efforts already in deployment and in the pipeline for Singapore's public healthcare system.

Advancing the National Immunization Program in an era of achieving universal vaccine coverage in China and beyond

Background Immunization is a cornerstone of public health.Despite great success,China’s National Immunization Program(NIP)faces challenges,such as the integration of several World Health Organization-recommended vaccines and other systemic issues.The Innovation Laboratory for Vaccine Delivery Research(VaxLab),supported by the Bill&Melinda Gates Foundation and established in 2021 at Duke Kunshan University,focuses on enhancing China’s NIP through research and policy advocacy.This editorial aims to summarize the key findings of the manuscripts published in the collection contributed by VaxLab team and set the future research agenda.Key findings The collection contains eleven manuscripts discussing China’s immunization landscape and strategies to improve coverage,particularly for non-NIP vaccines like human papillomavirus vaccine(HPV),pneumococcal conjugate vaccine(PCV),Haemophilus influenzae type b vaccine(Hib),and rotavirus vaccines.Key findings include:(i)The COVID-19 vaccination campaign demonstrated China’s capacity for rapid,large-scale immunization efforts,suggesting potential for broader vaccine coverage improvements;(ii)Efforts in combating cervical cancer through the HPV vaccine indicate progress but also highlight challenges like vaccine supply and equitable access;(iii)The lag in adopting higher-valent paediatric combination vaccines in China needs attention to address regulatory and health system hurdles;(iv)Disparities in access to non-NIP vaccines underscore the need for government initiatives to improve vaccine coverage,especially for remote areas and marginalized populations;(v)Original studies emphasize the influence of caregivers’knowledge,health workers’financial incentives,and concerns about vaccine efficacy on immunization rates;(vi)Case studies from the Weifang City of China and Indonesia to introduce PCV offer insights on successful vaccine introduction strategies and the impact of innovative financing and government support.Conclusion The articles emphasize the need for government leadership,strategic policymaking,and public awareness to enhance vaccine coverage and equity.The VaxLab will continue strengthening China’s NIP by focusing on vaccine financing,emphasizing diversity,equity,and inclusion,and improving maternal vaccination coverage.Research will extend to Southeast Asian and Western Pacific regions,especially in middle-income countries facing challenges in vaccine financing and delivery.The collective efforts outlined in this collection show a commitment to evolving and adapting immunization strategies to meet global health goals and to provide equitable access to vaccines for all.

Effectiveness of gastric cancer screening programs in South Korea:Organized vs opportunistic models

AIM:To investigate the outcome and effectiveness of two screening programs,National Cancer Screening Program(NCSP)and opportunistic screening(OS),for the detection of gastric cancer. METHODS:A total of 45 654 subjects underwent upper endoscopy as part of the NCSP or OS at the Chung-Ang University Healthcare System in Korea between January 2007 and December 2010.The study population was comprised of subjects over the age of 40 years.More specifically,subjects who took part in the NCSP were Medicaid recipients and beneficiaries of the National Health Insurance Corporation.Still photo-graphs from the endoscopies diagnosed as gastric cancer were reviewed by two experienced endoscopists. RESULTS:The mean age of the screened subjects was 55 years for men and 54 years for women.A total of 126 cases(0.28%)of gastric cancer were detected from both screening programs;100 cases(0.3%)from NCSP and in 26 cases(0.2%)from OS.The proportion of early gastric cancer(EGC)detected in NCSP was higher than that in OS(74.0%vs 53.8%,P=0.046). Among the 34 416 screenees in NCSP,6585(19.1%) underwent upper endoscopy every other year as scheduled.Among the 11 238 screenees in OS,3050(27.1%) underwent upper endoscopy at least once every two years during the study period.The detection rate of gastric cancer was found to be significantly higher during irregular follow-up than during regular follow-up in both screening programs(0.3%vs 0.2%,P=0.036).A higher incidence of EGC than advanced gastric cancer was observed during regular follow-up compared with irregular follow-up. CONCLUSION:Compliance to the screening program is more important than the type of screening system used.

Mash1 efficiently reprograms rat astrocytes into neurons

To date, it remains poorly understood whether astrocytes can be easily reprogrammed into neurons. Mashl and Brn2 have been previously shown to cooperate to reprogram fibroblasts into neurons. In this study, we examined astrocytes from 2-month-old Sprague-Dawley rats, and found that Brn2 was expressed, but Mashl was not detectable. Thus, we hypothesized that Mashl alone could be used to reprogram astrocytes into neurons. We transfected a recombinant MSCV-MASH1 plasmid into astrocytes for 72 hours, and saw that all cells expressed Mashl. One week later, we observed the changes in morphology of astrocytes, which showed typical neuro- nal characteristics. Moreover, β-tubulin expression levels were significantly higher in astrocytes expressing Mashl than in control cells. These results indicate that Mashl alone can reprogram astrocytes into neurons.

Feasibility of Using Two versus Three Rapid Tests for HIV Diagnosis in India: Analysis of Public Health Program Data

Under India’s National AIDS Control Program (NACP), WHO recommended strategy of using three rapid tests is adopted for diagnosis of HIV in an asymptomatic individual. Since the NACP has a stringent kit evaluation procedure and due to the availability of newer third generation Rapid Diagnostic Tests (RDTs) it may be possible to adapt two test strategy for HIV diagnosis instead of the recommended three test strategy. The authors reviewed programmatic data on HIV testing to explore whether use of two rapid tests for HIV diagnosis as against three tests could be a feasible approach without compromising the quality and readability of testing. Data on the HIV diagnosis performed on serum specimens collected for the period of one year (2011-12) from 82 Integrated Testing and Counselling Centers (ICTCs) or Prevention of Parent to Child Transmission Centers (PPTCTs) associated with State reference Laboratories (SRLs) was analysed. Out of 654258 results that were analysed 25168 (3.84%) specimens were positives. It was observed that both two and three test algorithms provided similar results for majority (>99%) of the HIV positive specimens. Discordance was observed in labelling of specimen with inconclusive status (N = 21), however the true status of these samples could not be obtained. The analysis indicated that the use of two test algorithm will have programmatic benefits in terms of reduced financial burden to the programme and ease of procurement, shipment and storage before and after distribution without comprising the quality of the testing. The prospective study would confirm this observation.