Description of the medical services provided to children in Shanghai: a cross-sectional study of the characteristics and disparities of hospitals of different levels and types.

Background: The development of the pediatric care system is uneven in China. Limited research has been conducted on pediatric care in Shanghai, which is a well-developed region in China, in which the National Children's Medical Centers are located. Methods: In November 2021, under the commission of the Shanghai Center for Medical Quality Control, a city-wide questionnaire designed to examine the provision of medical services to children in Shanghai in 2020 was conducted at 86 hospitals providing pediatric care. The overall characteristics and disparities between the general hospitals and children's hospitals and suggestions for future developments were explored. Results: In 2020, there were 86 hospitals providing pediatric care, covering all 16 municipal districts of Shanghai, with an average distribution of 1.4 hospitals per 100 km2. The hospitals were mainly public (94.2%) and general (96.5%) hospitals. With a response rate of 90.7%, the questionnaire results revealed that there were 2,683 in-service pediatricians in Shanghai, with an average of 1.1 pediatrician per 1,000 children aged 0-14 years in Shanghai. The pediatricians were mainly women (71.8%), aged 40 years or younger (60.6%), who held a bachelor's degree or higher (99.5%). The total number of pediatric outpatient and emergency visits was approximately 8 million, with an average of 2,973 visits per pediatrician in 2020. There were >370,000 visits to fever clinics. The number of pediatric inpatient visits exceeded 160,000, with an average hospital stay length of 5.8 days. The uneven development between the children's hospitals and general hospitals represents a major challenge facing Shanghai's pediatric care system, and the close links between the 2 types of hospitals need to be further strengthened. Conclusions: Shanghai provides an overall superior medical service to children in China. The close link between the children's hospitals and general hospitals should be further strengthened to optimize the distribution of high-quality resources and greatly improve the overall provision of pediatric medical services.

Direct costs of community-acquired pneumonia for hospitalized children in Shanghai, China from 2018 to 2020: a cross-sectional analysis.

Background: Community-acquired pneumonia (CAP) is an acute respiratory infection with a high clinical and economic burden. Clarifying the burden is important for health policy making. However, there is inadequate data on the economic burden of childhood CAP in China. In this study, the direct disease burden of CAP in children was analyzed using city-level data. Methods: A cross-sectional study of the direct costs of CAP for hospitalized children aged 28 days to 18 years old in Shanghai from January 2018 to December 2020 was performed. Information, including the hospitalization costs from the first page of the children's hospitalized medical records, was obtained. The direct costs included medical services, diagnostics, medications, and medical supplies. The continuous variables with non-normal distributions are expressed as the median (interquartile range). Comparisons between groups were performed using the Kruskal-Wallis H test. The enumeration data are expressed as the number (percentage), and comparisons between groups were performed using the χ2 test. Results: A total of 59 hospitals and 63,614 hospitalized CAP patients were included in this study. Significantly fewer patients were discharged in 2020 than 2018 and 2019 (6,662, 27,943, and 29,009, respectively, P<0.001). Among the patients, 27,741 patients (43.6%) were covered by social medical insurance, 13,509 (21.2%) by commercial health insurance, and 22,364 (35.2%) were self-paying. The annual total direct costs for 2018, 2019, and 2020 were 118.553, 140.865, and 40.064 million Chinese Yuan (CNY), respectively. The average direct costs per hospital stay due to pediatric CAP in Shanghai was 4,707.83 CNY in 2018, a sum that accounted for 7.3% and 16.7% of the per capita disposable income in Shanghai and China in 2018, respectively. The total costs of the group aged <1 year were significantly higher than those of the other age groups (6,271.1 vs. 3,244.3~4,610.7 CNY, P<0.001). The total costs of severe cases were significantly higher than those of non-severe cases (5,200.6 vs. 3,170.4 CNY, P<0.001). The median duration of hospital stay was 6.0 days (5.0, 8.0). Conclusions: CAP hospitalization continues to represent a high clinical and economic burden in Shanghai, China. Specialized hospitals, severe cases, and the length of hospital stay were positively correlated with inpatient costs.

Expert Consensus on Clinical Practice of Burn Units in Shanghai During the COVID-19 Epidemic.

In response to coronavirus disease 2019 (COVID-19), the Shanghai Burn Clinical Quality Control Center organized experts to formulate and implement a set of rapid, simple, and effective prevention and control measures, and there have not been any cases of health care professionals or inpatients in burn units suspected or confirmed with COVID-19. This article elaborates on the specific measures in burn units in response to the epidemic, including the implementation of standardized procedures, remote consultations, strengthened follow-up, exchange of experience, and popular science, among others. We share experience from Shanghai to benefit related disciplines in other countries and regions.

Shape-Driven EIT Reconstruction Using Fourier Representations.

Shape-driven approaches have been proposed as an effective strategy for the electrical impedance tomography (EIT) reconstruction problem in recent years. In order to augment the shape-driven approaches, we propose a new method that transforms the shape to be reconstructed as basic primitives directly modeled by using Fourier representations. To allow automatic topological changes between the basic primitives and surrounding objects simultaneously, Boolean operations are employed. The Boolean operations with direct representation of primitives can be utilized for dimensionality and ill-posedness reduction, enabling feasible shape and topology optimization with shape-driven approaches. As a proof of principle, we leverage the proposed method for two dimensional shape reconstruction in EIT with various conductivity distributions. We demonstrate that our method is able to improve EIT reconstructions by enabling accurate shape and topology optimization.

Shape-Driven Difference Electrical Impedance Tomography.

This work proposes a novel shape-driven reconstruction approach for difference electrical impedance tomography (EIT). In the proposed approach, the reconstruction problem is formulated as a shape reconstruction problem and solved via an explicit and geometrical methodology, where the geometry of the embedded inclusions is represented by a shape and topology description function (STDF). To incorporate more geometry and prior information directly into the reconstruction and to provide better flexibility in the solution process, the concept of a moving morphable component (MMC) is applied here implying that MMC is treated as the basic building block of the embedded inclusions. Simulations, phantom studies, and in vivo pig data are used to test the proposed approach for the most popular biomedical application of EIT - lung imaging - and the performance is compared with the conventional linear approach. In addition, the modality's robustness is studied in cases where (i) modeling errors are caused by inhomogeneity in the background conductivity, and (ii) uncertainties in the contact impedances and reference state are present. The results of this work indicate that the proposed approach is tolerant to modeling errors and is fairly robust to typical EIT uncertainties, producing greatly improved image quality compared to the conventional linear approach.

Shape Reconstruction Using Boolean Operations in Electrical Impedance Tomography.

In this work, we propose a new shape reconstruction framework rooted in the concept of Boolean operations for electrical impedance tomography (EIT). Within the framework, the evolution of inclusion shapes and topologies are simultaneously estimated through an explicit boundary description. For this, we use B-spline curves as basic shape primitives for shape reconstruction and topology optimization. The effectiveness of the proposed approach is demonstrated using simulated and experimentally-obtained data (testing EIT lung imaging). In the study, improved preservation of sharp features is observed when employing the proposed approach relative to the recently developed moving morphable components-based approach. In addition, robustness studies of the proposed approach considering background inhomogeneity and differing numbers of B-spline curve control points are performed. It is found that the proposed approach is tolerant to modeling errors caused by background inhomogeneity and is also quite robust to the selection of control points.

B-Spline Level Set Method for Shape Reconstruction in Electrical Impedance Tomography.

A B-spline level set (BLS) based method is proposed for shape reconstruction in electrical impedance tomography (EIT). We assume that the conductivity distribution to be reconstructed is piecewise constant, transforming the image reconstruction problem into a shape reconstruction problem. The shape/interface of inclusions is implicitly represented by a level set function (LSF), which is modeled as a continuous parametric function expressed using B-spline functions. Starting from modeling the conductivity distribution with the B-spline based LSF, we show that the shape modeling allows us to compute the solution by restricting the minimization problem to the space spanned by the B-splines. As a consequence, the solution to the minimization problem is obtained in terms of the B-spline coefficients. We illustrate the behavior of this method using simulated as well as water tank data. In addition, robustness studies considering varying initial guesses, differing numbers of control points, and modeling errors caused by inhomogeneity are performed. Both simulation and experimental results show that the BLS-based approach offers clear improvements in preserving the sharp features of the inclusions in comparison to the recently published parametric level set method.

B-Spline-Based Sharp Feature Preserving Shape Reconstruction Approach for Electrical Impedance Tomography.

This paper presents a B-spline-based shape reconstruction approach for electrical impedance tomography (EIT). In the proposed approach, the conductivity distribution to be reconstructed is assumed to be piecewise constant. The geometry of the inclusions is parameterized using B-spline curves, and the EIT forward solver is modified as a set of control points representing the inclusions' boundary to the data on the domain boundary. The low-order representation decreases the computational demand and reduces the ill-posedness of the EIT reconstruction problem. The performance of the proposed B-spline-based approach is tested with simulations that demonstrate the most popular biomedical application of EIT: lung imaging. The approach is experimentally validated using water tank data. In addition, robustness studies of the proposed approach considering varying initial guesses, inaccurately known contact impedances, differing numbers of control points, and degree of B-spline are performed. The simulation and experimental results show that the B-spline-based approach offers improvements in image quality in comparison to the traditional Fourier series-based reconstruction approach, as measured by quantitative metrics such as relative size coverage ratio and relative contrast. Inasmuch, the proposed approach is demonstrated to offer clear improvement in the ability to preserve the sharp properties of the inclusions to be imaged.

[Pulmonary functions in children with segmental Mycoplasma pneumoniae pneumonia].

OBJECTIVE: To investigate the changes of pulmonary functions in children with segmental Mycoplasma pneumoniae pneumonia (SMPP). METHODS: A total of 55 children with SMPP were recruited into this study. Pulmonary functions were measured at both acute and recovery phases, including FVC, FEV1, FEV1/FVC, PEF, FEF25%, FEF50%, FEF75% and FEF25%-75%. RESULTS: FVC, FEV1, FEV1 /FVC, PEF, FEF25%, FEF50%, FEF75%, and FEF25%-75% were reduced in all of the 55 cases at the acute phase. FEF25%, FEF50%, FEF75% and FEF25%-75% decreased more significantly. The indexes above mentioned were improved significantly at the recovery phase compared with the acute phase (P<0.05). During the acute phase FVC and FEV1 decreased more significantly in the group with multiple area lesions than in the group with single area lesions (P<0.05). CONCLUSIONS: Both large and small airway functions are damaged in different degrees in children with SMPP during the acute phase. More cases show restrictive ventilatory disorders and the injury of small airway function is more severe. The pulmonary function is markedly improved at the recovery phase, suggesting that the pulmonary function impairments are reversible. The pulmonary function impairments are more severe in children with multiple area lesions.