The Effects of Diagnosis-Related Group Payment on Diagnostic Cerebral Angiograms through a Transradial and Transfemoral Approach: A Comparative Observational Study.

BACKGROUND: Cerebral angiography is an X-ray examination technique widely used in hospitals. At present, it is mainly divided into two kinds of angiography examination: transfemoral artery and transradial artery puncture. The diagnosis-related group (DRG) system is a new type of payment standard recognized internationally, but its impact on medical care and health outcomes is currently controversial. AIM: In this study, we conducted a comparative study on two invasive approaches, transradial artery and transfemoral artery puncture and observed whether DRG had an impact on the quality of the medical process. METHODS: We compared and analyzed patients undergoing cerebral angiography via the femoral artery and radial artery puncture by recording the relevant parameters and comfort scale scores (GCQ) during the operation, as well as postoperative complications. At the same time, we observed the proportion of different puncture routes and the success rate of cerebral angiography before and after the implementation of a DRG payment simulation. RESULTS: The results of the comparative analysis of patients' transradial artery and transfemoral artery puncture angiography showed that the puncture success rate (99.1% vs. 97.2%, P > 0.05), angiography success rate (97.3% vs. 95.1%, P > 0.05), and X-ray radiation time (4.82 vs. 5.15 min, P > 0.05) demonstrated no significant difference. The ambulation time (1.52 vs. 12.06 h, P < 0.05), puncture time (22.42 vs. 31.02 min, P < 0.05), and complications (3.57% vs. 9.03%, P < 0.05) of the radial artery group were significantly lower than those of the femoral artery group. In contrast, the GCQ score of the radial artery group at each stage after angiography was significantly higher than that of the femoral artery group (P < 0.05). Compared with before the DRG simulation, the proportion of cerebral angiography with transradial artery puncture increased significantly after its implementation. CONCLUSION: Compared with transfemoral cerebrovascular angiography, transradial cerebrovascular angiography has many advantages, such as less local damage, less pain, less postoperative bed-rest time, significantly lower incidence of total complications, and a lower cost. Following the implementation of the DRG payment method, the quality of the angiography medical process improved.

Multigenerational Social Mobility: A Demographic Approach.

Most social mobility studies take a two-generation perspective, in which intergenerational relationships are represented by the association between parents' and offspring's socioeconomic status. This approach, albeit widely adopted in the literature, has serious limitations when more than two generations of families are considered. In particular, it ignores the role of families' demographic behaviors in moderating mobility outcomes and the joint role of mobility and demography in shaping long-run family and population processes. This paper provides a demographic approach to the study of multigenerational social mobility, incorporating demographic mechanisms of births, deaths, and mating into statistical models of social mobility. Compared to previous mobility models for estimating the probability of offspring's mobility conditional on parent's social class, the proposed joint demography-mobility model treats the number of offspring in various social classes as the outcome of interest. This new approach shows the extent to which demographic processes may amplify or dampen the effects of family socioeconomic positions due to the direction and strength of the interaction between mobility and differentials in demographic behaviors. I illustrate various demographic methods for studying multigenerational mobility with empirical examples using the IPUMS linked historical U.S. census representative samples (1850 to 1930), the Panel Study of Income Dynamics (1968 to 2015), and simulation data that show other possible scenarios resulting from demography-mobility interactions.

Respiratory Variations in Peak Peripheral Artery Velocities and Waveforms for Rapid Assessment of Fluid Responsiveness in Traumatic Shock Patients.

BACKGROUND This study aimed to assess the correlation between the variability of the end-inspiratory and end-expiratory blood flow waveform and fluid responsiveness (FR) in traumatic shock patients who underwent mechanical ventilation by evaluating peripheral arterial blood flow parameters. MATERIAL AND METHODS A cohort of 60 patients with traumatic shock requiring mechanical ventilation-controlled breathing received ultrasound examinations to assess the velocity of carotid artery (CA), femoral artery (FA) and brachial artery (BA). A rehydration test was performed in which of 250 mL of 0.9% saline was administered within 30 min between the first and second measurement of cardiac output by echocardiography. Then, all patients were divided into 2 groups, a responsive group (FR+) and a non-responsive group (FR-). The velocity of end-inspiratory and end-expiratory peripheral arterial blood flow of all patients was ultrasonically measured, and the variability were measured between end-inspiratory and end-expiratory. RESULTS The changes in the end-inspiratory and end-expiratory carotid artery blood flow velocity waveforms of the FR+ groups were significantly different from those of the FR- group (P<0.001). A statistically significant difference in ΔVmax (CA), ΔVmax (BA), and ΔVmax (FA) between these 2 groups was found (all P<0.001). The ROC curve showed that DVmax (CA) and ΔVmax (BA) were more sensitive values to predict FR compared to ΔVmax (FA). The sensitivity of ΔVmax (CA), ΔVmax (FA), and ΔVmax (BA) was 70.0%, 86.7%, and 93.3%, respectively. CONCLUSIONS The study showed that periodic velocity waveform changes in the end-inspiratory and end-expiratory peripheral arterial blood flow can be used for quick assessment of fluid responsiveness.

Long-term decline in intergenerational mobility in the United States since the 1850s.

We make use of newly available data that include roughly 5 million linked household and population records from 1850 to 2015 to document long-term trends in intergenerational social mobility in the United States. Intergenerational mobility declined substantially over the past 150 y, but more slowly than previously thought. Intergenerational occupational rank-rank correlations increased from less than 0.17 to as high as 0.32, but most of this change occurred to Americans born before 1900. After controlling for the relatively high mobility of persons from farm origins, we find that intergenerational social mobility has been remarkably stable. In contrast with relative stability in rank-based measures of mobility, absolute mobility for the nonfarm population-the fraction of offspring whose occupational ranks are higher than those of their parents-increased for birth cohorts born prior to 1900 and has fallen for those born after 1940.

Shared Lifetimes, Multigenerational Exposure, and Educational Mobility.

In this article, we report analyses of the effects of fertility and mortality trends on the mutual exposure of grandparents and grandchildren and their consequences for multigenerational processes of social mobility in the United States from 1900 to 2010. Using historical vital statistics and stable population models, we report systematic analyses of grandparent-grandchild exposures from both prospective (grandparent) and retrospective (grandchild) perspectives. We also estimate exposure levels and trends specific to education levels of grandparents and grandchildren and decompose the overall trend into the effect of changing mortality, fertility level, and fertility timing. We show that changes in mutual exposure of grandparent and grandchild generations may have contributed to an increasing association between grandparents' and grandchildren's educational attainments.

Parental divorce is not uniformly disruptive to children's educational attainment.

Children whose parents divorce tend to have worse educational outcomes than children whose parents stay married. However, not all children respond identically to their parents divorcing. We focus on how the impact of parental divorce on children's education varies by how likely or unlikely divorce was for those parents. We find a significant negative effect of parental divorce on educational attainment, particularly college attendance and completion, among children whose parents were unlikely to divorce. Families expecting marital stability, unprepared for disruption, may experience considerable adjustment difficulties when divorce occurs, leading to negative outcomes for children. By contrast, we find no effect of parental divorce among children whose parents were likely to divorce. Children of high-risk marriages, who face many social disadvantages over childhood irrespective of parental marital status, may anticipate or otherwise accommodate to the dissolution of their parents' marriage. Our results suggest that family disruption does not uniformly disrupt children's attainment.

Short-Term and Long-Term Educational Mobility of Families: A Two-Sex Approach.

We use a multigenerational perspective to investigate how families reproduce and pass their educational advantages to succeeding generations. Unlike traditional mobility studies that have typically focused on one-sex influences from fathers to sons, we rely on a two-sex approach that accounts for interactions between males and females-the process in which males and females mate and have children with those of similar educational statuses and jointly determine the educational status attainment of their offspring. Using data from the Panel Study of Income Dynamics, we approach this issue from both a short-term and a long-term perspective. For the short term, grandparents' educational attainments have a direct association with grandchildren's education as well as an indirect association that is mediated by parents' education and demographic behaviors. For the long term, initial educational advantages of families may benefit as many as three subsequent generations, but such advantages are later offset by the lower fertility of highly educated persons. Yet, all families eventually achieve the same educational distribution of descendants because of intermarriages between families of high- and low-education origin.

Diverging Mobility Trajectories: Grandparent Effects on Educational Attainment in One- and Two-Parent Families in the United States.

In recent years, sociological research investigating grandparent effects in three-generation social mobility has proliferated, mostly focusing on the question of whether grandparents have a direct effect on their grandchildren's social attainment. This study hypothesizes that prior research has overlooked family structure as an important factor that moderates grandparents' direct effects. Capitalizing on a counterfactual causal framework and multigenerational data from the Panel Study of Income Dynamics, this study examines the direct effect of grandparents' years of education on grandchildren's years of educational attainment and heterogeneity in the effects associated with family structure. The results show that for both African Americans and whites, grandparent effects are the strongest for grandchildren who grew up in two-parent families, followed by those in single-parent families with divorced parents. The weakest effects were marked in single-parent families with unmarried parents. These findings suggest that the increasing diversity of family forms has led to diverging social mobility trajectories for families across generations.

Assessment of DNA Damage and Cell Senescence in Corneal Epithelial Cells Exposed to Airborne Particulate Matter (PM2.5) Collected in Guangzhou, China.

PURPOSE: To assess the genotoxic effect of airborne particulate matter on corneal epithelial cells and investigate the role of reactive oxygen species (ROS) formation in this process. METHODS: Immortalized human corneal epithelial cells (HCECs) and primary bovine corneal epithelial cells were exposed to airborne particulate matter collected from Guangzhou for 24 hours. The cell viability and toxicity were measured by the CCK-8 test and lactate dehydrogenase (LDH) release, respectively. The DNA breaks and DNA repair were examined by alkaline comet assay and by immunofluorescence staining of the phosphorylated histone variant H2AX (γH2AX), respectively. Reactive oxygen species production was assessed by the fluorescent probe, CM-H2DCFDA. Cell senescence was evaluated with senescence-associated ß-Galactosidase staining, and cell ultrastructure was observed with transmission electron microscopy. RESULTS: Exposure to PM2.5 at the concentration of 20 µg/mL to 200 µg/mL decreased cell viability and increased LDH release. Remarkably increased DNA double-stand breaks, increased expression of DNA repair-related protein γH2AX, elevated ROS formation, and altered cell ultrastructure were observed in HCECs after treatment with PM2.5. The genotoxic effect of PM2.5 was attenuated by the ROS inhibitor N-acetyl-l-cysteine (NAC). CONCLUSIONS: Particulate matter 2.5 could induce DNA damage and cell senescence in corneal epithelial cells, probably by promoting ROS formation. Thus, whether long-term exposure of PM2.5 might be related to potential risk of abnormality in corneal epithelium renewal and regeneration should be further investigated.

Ancestry Matters: Patrilineage Growth and Extinction.

Patrilineality, the organization of kinship, inheritance, and other key social processes based on patrilineal male descent, has been a salient feature of social organization in China and many other societies for centuries. Because continuity or growth of the patrilineage was the central focus of reproductive strategies in such societies, we introduce the number of patrilineal male descendants generations later as a stratification outcome. By reconstructing and analyzing 20,000 patrilineages in two prospective, multi-generational population databases from 18th and 19th century China, we show that patrilineages founded by high status males had higher growth rates for the next 150 years. The elevated growth rate of these patrilineages was due more to their having a lower probability of extinction at each point in time than to surviving patrilineal male descendants having larger numbers of sons on average. As a result, patrilineal male descendants of high status males account for a disproportionately large share of the male population in later generations. In China and elsewhere, patrilineal kin network characteristics influence individuals' life chances; thus effects of a male founder's characteristics on patrilineage size many generations later represent an indirect channel of status transmission that has not been considered previously.

Ethnic stratification amid China's economic transition: evidence from the Xinjiang Uyghur Autonomous Region.

This paper analyzes a sample from the 2005 mini-census of Xinjiang to examine ethnic stratification in China's labor markets, with a special focus on how ethnic earnings inequality varies by employment sector. We show that Han and Uyghur Chinese dominated different economic sectors. Excluding those in agriculture, Uyghurs were more likely to work in government or institutions than either Han locals or migrants, and also more likely to become self-employed. The Han-Uyghur earnings gap was negligible within government/public institutions, but increased with the marketization of the employment sector. It was the largest among the self-employed, followed by employees in private enterprises and then employees in public enterprises. Han migrants in economic sectors enjoyed particular earnings advantages and hukou registration status had no impact on earnings attainment except in government/public institutions. These findings have important implications for understanding social and economic sources of increasing ethnic conflicts in Xinjiang in recent years.

Sequential estimation in line transect surveys.

This article considers using sequential procedures to determine the amount of survey effort required in a line transect survey in order to achieve a certain precision level in estimating the abundance of a biological population. Sequential procedures are constructed for both parametric and nonparametric animal abundance estimators. The criterion used to derive the stopping rules is the width of confidence intervals for the animal abundance. For each estimator considered, we develop stopping rules based on the asymptotic distributions and the bootstrap. A sequential analysis on an aerial survey of the southern bluefin tuna indicates substantial saving of survey effort can be made by employment of the proposed sequential procedures. This savings of survey effort is also observed in a simulation study designed to evaluate the empirical performance of the proposed sequential procedures.