Efficiency and equity of bed utilization in China's health institutions: based on the rank-sum ratio method.

OBJECTIVE: The study aimed to analyze the efficiency and equity of bed utilization in Please check if the section headings are assigned to appropriate levels.China's healthcare institutions and to compare and analyze the overall health resource utilization efficiency in recent years and some specific utilization conditions in 2021, to provide empirical experience for the allocation of health care resources in epidemic China. METHODS: To compare and analyze the overall health resource utilization efficiency of the whole country with that of the East, middle, and West in 2021, and to analyze the bed utilization efficiency of different types of healthcare institutions in China and the bed utilization efficiency of various types of specialist hospitals in the country in 2021 by using the rank-sum ratio method. RESULTS: In 2021, the bed utilization rate of China's health institutions was 69.82%, and the number of bed turnover times was 27.65 times; the bed utilization rate of hospitals was 74.6%, and the number of bed turnover times was 26.08 times. The number of hospital bed turnovers was highest in the western region, lowest in the central region, and close to the national average in the eastern region. The average length of stay for discharged patients was the highest in the central region, the lowest in the eastern region, and the same as the national average in the western region. The analysis of rank-sum ratio method shows that among different types of health institutions' bed utilization efficiency (r = 0.935, P = 0.000), general hospitals and traditional Chinese medicine hospitals have the best bed utilization rate, and the bed utilization rate of community health service centers (stations) needs to be improved; while among various types of specialized hospitals' bed utilization efficiency (r = 0.959, P = 0.000), oncology hospitals, thoracic hospitals, and hematology hospitals, children's hospitals have high bed utilization efficiency; leprosy hospitals, cosmetic hospitals, and stomatology hospitals have low bed utilization efficiency. Health technicians per 1,000 population are highest in the western region, lowest in the central region, and lower in the eastern region than in the western region but slightly higher than the national average. The number of beds in health institutions per 1,000 population is the highest in the central region, the lowest in the eastern region, and slightly lower in the northwest than in the central region but higher than the national average. CONCLUSION: China's investment in health funding in the field of health care has been on the rise in recent years. However, there still exists the situation of uneven investment in health expenses and inconsistent medical efficiency among regions. And change such a status quo can be further improved in terms of government, capital, human resources, technology, information system, and so on.

CropQuant-Air: an AI-powered system to enable phenotypic analysis of yield- and performance-related traits using wheat canopy imagery collected by low-cost drones.

As one of the most consumed stable foods around the world, wheat plays a crucial role in ensuring global food security. The ability to quantify key yield components under complex field conditions can help breeders and researchers assess wheat's yield performance effectively. Nevertheless, it is still challenging to conduct large-scale phenotyping to analyse canopy-level wheat spikes and relevant performance traits, in the field and in an automated manner. Here, we present CropQuant-Air, an AI-powered software system that combines state-of-the-art deep learning (DL) models and image processing algorithms to enable the detection of wheat spikes and phenotypic analysis using wheat canopy images acquired by low-cost drones. The system includes the YOLACT-Plot model for plot segmentation, an optimised YOLOv7 model for quantifying the spike number per m2 (SNpM2) trait, and performance-related trait analysis using spectral and texture features at the canopy level. Besides using our labelled dataset for model training, we also employed the Global Wheat Head Detection dataset to incorporate varietal features into the DL models, facilitating us to perform reliable yield-based analysis from hundreds of varieties selected from main wheat production regions in China. Finally, we employed the SNpM2 and performance traits to develop a yield classification model using the Extreme Gradient Boosting (XGBoost) ensemble and obtained significant positive correlations between the computational analysis results and manual scoring, indicating the reliability of CropQuant-Air. To ensure that our work could reach wider researchers, we created a graphical user interface for CropQuant-Air, so that non-expert users could readily use our work. We believe that our work represents valuable advances in yield-based field phenotyping and phenotypic analysis, providing useful and reliable toolkits to enable breeders, researchers, growers, and farmers to assess crop-yield performance in a cost-effective approach.

Policy Disparities Between Singapore and Israel in Response to the First Omicron Wave.

Purpose: The purpose of this study is to evaluate public health measures during the first Omicron wave in Singapore and Israel to inform other countries confronted by COVID-19 outbreaks. Methods: A comparative analysis was conducted using epidemiological data from Singapore and Israel between November 25th, 2021 and May 2nd, 2022 and policy information to examine the effects of public health measures in the two countries during the COVID-19 pandemic. Results: Public health measures implemented by Singapore and Israel in response to the first Omicron wave were primarily intended to mitigate the effects of the COVID-19 pandemic. In Singapore, the pandemic led to more than 910,000 confirmed cases, a mortality rate of approximately 0.047%, a hospitalization rate of approximately 10.95%, and a severe illness rate of approximately 0.48%, without a second peak. In Israel, the pandemic not only resulted in over 2.74 million confirmed cases, a mortality rate of 0.095%, a hospitalization rate of about 7.39%, and a severe illness rate of approximately 2.30% but also returned after the significant relaxation of prevention regulations from March 1st, 2022. Conclusion: Early and strict border control measures and surveillance measures are more effective in preventing and controlling the rapid spread of new strains of COVID-19 in the early stage. Furthermore, to prevent and control this highly infectious disease, COVID-19 vaccinations and booster shots must be promoted as soon as possible, medical service capacity must be enhanced, the hierarchical medical system must be improved, and non-pharmacological interventions must be implemented.

Assessment of long-term large deformation in deep roadways due to roof fracturing impact loading.

The rock mass around deep roadways has obvious creep characteristics in high-stress environments. Meanwhile, the cyclic impact load induced by roof fracturing also causes dynamic damage to the surrounding rock, leading to long-term large deformation. This paper examined the rock mass deformation mechanism around deep roadways based on the theory of rock creep perturbation effect considering perturbation sensitive zone. This study proposed a long-term stability control guideline for deep roadways under dynamic load. An innovative support system was developed for deep roadways, with concrete-filled steel tubular support being recommended as the main supporting body. A case study was conducted to validate the proposed supporting system. Monitoring over one year in the case study mine showed that the overall convergence deformation of the roadway was 35 mm, indicating that the roadway's long-term large deformation induced by creep perturbation was effectively controlled by using the proposed bearing circle support system.

Usual source of care and access to care in the US: 2005 vs. 2015.

INTRODUCTION: The study examined the association of usual source of care (USC) and healthcare access using a series of access indicators including both positive and negative measures for the US population in 2005 and 2015 while controlling for individual sociodemographic and socioeconomic characteristics. Results of the study would help advance the knowledge of the relationship between USC and access to care and assist decisionmakers in targeted interventions to enhance USC as a strategy to enhance access. METHODS: The household component of the US Medical Expenditure Panel Survey (MEPS-HC) in 2005 and 2015 were used for the study. To estimate the relative risk of having USC on access to care, odds ratios (ORs) and their 95% confidence intervals (CIs) were used with unconditional logistic regression and adjusted for socioeconomic and demographic characteristics. RESULTS: Those with USC were significantly more likely to have better access to care compared to those without USC. The USC-access connection remains significant and strong even after controlling for socioeconomic and demographic characteristics. Regarding subpopulations likely to lack USC, two notable findings are that racial/ethnic minorities (Black, Asian, and Hispanic) are more likely than White to lack USC and that those uninsured are more likely to lack USC. CONCLUSION: The study contributes to the literature on USC and access to care and has significant policy and practical implications. For example, having a USC is critical to accessing the health system and is particularly important as a tool to addressing racial disparities in access.

The efficiency of health resource allocation and its influencing factors: evidence from the super efficiency slack based model-Tobit model.

BACKGROUND: This study aims to analyze the health resource allocation efficiency in Sichuan Province from 2010 to 2018 and provide other countries with China's experience. METHODS: We used the super efficiency slack based model (SBM) model and Malmquist index to analyze the super efficiency and inter-period efficiency of health resource allocation in 19 cities in Sichuan Province from 2010 to 2018 and propose the input-output optimization scheme of health resource allocation in 2018. Finally, the Tobit model was used to estimate the influencing factors of health resource allocation efficiency. RESULTS: The total allocation of health resources in Sichuan Province was increasing in addition to the total number of visits from 2010 to 2018. The super efficiency SBM results identified that the sample's average score was between 0.651 and 3.244, with an average of 1.041, of which 15 cities had not reached data envelopment analysis effectiveness. According to the Malmquist index, the average total factor productivity index of Sichuan Province was 0.930, which showed an imbalance in resource input, and its fluctuation was mainly related to the technological progress index and scale efficiency. The efficiency score was affected by the average annual income of residents, population density and education level. CONCLUSIONS: The amount of health resource allocation in Sichuan Province had shown an overall upward trend since 2010. However, resource allocation efficiency was not high, and there were problems such as significant regional differences, insufficient technological innovation capabilities and unscientific allocation of resource scale. To optimize the resource allocation structure, we suggest that the relevant departments pay attention to the impact of natural disasters, the average annual income of residents, population density and education level on efficiency to allocate health resources scientifically.

Health insurance coverage and access to care in China.

OBJECTIVE: The study examined the relationship between health insurance coverage and access to needed healthcare including preventive, primary, and tertiary care among Chinese adult population. DATA AND METHODS: Data for this study came from the 2018 China Health and Retirement Longitudinal Study (CHARLS), a population-based probability sample survey. Key measures included insurance coverage (high-, moderate-, low- and no-insurance), access to care (physical examination, physician visit, office visit, inpatient care, and satisfaction with care), and personal sociodemographics. Multiple-factor generalized linear mixed model was applied to estimate the odds ratio (OR) and the 95% confidence interval (CI) of HI coverage for the four indicators of access to care, after controlling for individual characteristics and aggregation among different villages. RESULTS: The majority of Chinese adults had some health insurance with only 3.15% uninsured. However, most had low-coverage insurance (64.82%), followed by moderate-coverage insurance (16.70%), and high-coverage insurance (15.33%). Health insurance was significantly and positively associated with access to needed healthcare (preventive, primary, and tertiary). There was also a significant gradient association between extent of insurance coverage and access to care. CONCLUSION: Not only health insurance mattered in enhancing access to care but that there was a significant gradient association between extent of insurance coverage and access to care with higher coverage relating to better access.

Hubei's Core Response Policies in the Early Stage of COVID-19.

BACKGROUND: This study is aimed at confirming the effectiveness of nonpharmaceutical interventions during the COVID-19 outbreak in Hubei, China. METHODS: The data are all from the epidemic information released by the National Health Commission of the People's Republic of China and the Health Commission of Hubei Province. We used the multivariable linear regression by the SPSS 19.0 software: the cumulative number of confirmed cases, the cumulative number of cured cases, and the number of daily severe cases were taken as dependent variables, and the six policies, including the Joint Prevention and Control Mechanism of the State Council, lockdown Wuhan city, the first-level response to public health emergencies, the expansion of medical insurance coverage to suspected patients, mobile cabin hospitals, and counterpart assistance in Hubei province, were gradually entered into multiple linear regression models as independent variables. RESULTS: The factors influencing the cumulative number of diagnosed cases ranged from large to small: mobile cabin hospitals and the expansion of medical insurance coverage to suspected patients. The factors influencing the cumulative number of cured cases ranged from large to small: counterpart support medical teams in Hubei province and mobile cabin hospitals. The factors influencing the number of daily severe cases ranged from large to small: mobile cabin hospitals and the expansion of medical insurance coverage to suspected patients. CONCLUSION: The mobile cabin hospital is a major reason for the successfully defeating COVID-19 in China. As COVID-19 pandemic spreads globally, the mobile cabin hospital is a successful experience in formulating policies to defeat COVID-19 for other countries in the outbreak phase.

Policy Disparities in Response to COVID-19 between China and South Korea.

OBJECTIVES: This study analyzed the effects of COVID-19 non-pharmaceutical measures between China and South Korea to share experiences with other countries in the struggle against SARS-CoV-2. METHODS: We used the generalized linear model to examine the associations between non-pharmaceutical measures adopted by China and South Korea and the number of confirmed cases. Policy disparities were also discussed between these two countries. RESULTS: The results show that the following factors influence the number of confirmed cases in China: lockdown of Wuhan city (LWC); establishment of a Leading Group by the Central Government; raising the public health emergency response to the highest level in all localities; classifying management of "four categories of personnel"; makeshift hospitals in operation (MHIO); pairing assistance (PA); launching massive community screening (LMCS). In South Korea, these following factors were the key influencing factors of the cumulative confirmed cases: raising the public alert level to orange (three out of four levels); raising the public alert to the highest level; launching drive-through screening centers (LDSC); screening all members of Shincheonji religious group; launching Community Treatment Center (LCTC); distributing public face masks nationwide and quarantining all travelers from overseas countries for 14 days. CONCLUSION: Based on the analysis of the generalized linear model, we found that a series of non-pharmaceutical measures were associated with contain of the COVID-19 outbreak in China and South Korea. The following measures were crucial for both of them to fight against the COVID-19 epidemic: a strong national response system, expanding diagnostic tests, establishing makeshift hospitals, and quarantine or lockdown affected areas.

Policy disparities in response to the first wave of COVID-19 between China and Germany.

OBJECTIVE: Our research summarized policy disparities in response to the first wave of COVID-19 between China and Germany. We look forward to providing policy experience for other countries still in severe epidemics. METHODS: We analyzed data provided by National Health Commission of the People's Republic of China and Johns Hopkins University Coronavirus Resource Center for the period 10 January 2020 to 25 May 252,020. We used generalized linear model to evaluate the associations between the main control policies and the number of confirmed cases and the policy disparities in response to the first wave of COVID-19 between China and Germany. RESULTS: The generalized linear models show that the following factors influence the cumulative number of confirmed cases in China: the Joint Prevention and Control Mechanism; locking down the worst-hit areas; the highest level response to public health emergencies; the expansion of medical insurance coverage to suspected patients; makeshift hospitals; residential closed management; counterpart assistance. The following factors influence the cumulative number of confirmed cases in Germany: the Novel Coronavirus Crisis Command; large gathering cancelled; real-time COVID-19 risk assessment; the medical emergency plan; schools closure; restrictions on the import of overseas epidemics; the no-contact protocol. CONCLUSIONS: There are two differences between China and Germany in non-pharmaceutical interventions: China adopted the blocking strategy, and Germany adopted the first mitigation and then blocking strategy; China's goal is to eliminate the virus, and Germany's goal is to protect high-risk groups to reduce losses. At the same time, the policies implemented by the two countries have similarities: strict blockade is a key measure to control the source of infection, and improving medical response capabilities is an important way to reduce mortality.

Policy disparities in fighting COVID-19 among Japan, Italy, Singapore and China.

OBJECTIVE: In order to provide experiences for international epidemic control, this study systematically summarized the Coronavirus disease 2019 (COVID-19) prevention and control policies in Japan, Italy, China and Singapore, and also analyzed the possible inequalities that exist in these response approaches to improve global infectious disease control. METHODS: We summarized the epidemic prevention and control policies in Japan, Italy, China, and Singapore, and analyzed the policy effects of these four countries by using the data published by Johns Hopkins Coronavirus Resource Center. RESULTS: As of May 27, 2020, the growing trend of new cases in Japan, Italy, China and Singapore has stabilized. However, the cumulative number of confirmed cases (231139) and case-fatality rate (14.3%) in Italy far exceeded those in the other three countries, and the effect of epidemic control was inferior. Singapore began to experience a domestic resurgence after April 5, with a cumulative number of confirmed cases reaching 32,876, but the case-fatality rate remained extremely low (0.1%). The growth of cumulative confirmed cases in China (84547) was almost stagnant, and the case-fatality rate was low (5.5%). The growth of cumulative confirmed cases in Japan (16661) increased slowly, and the case-fatality rate (4.8%) was slightly lower than that in China. CONCLUSION: This study divided the epidemic prevention and control policies of the four countries into two categories: the blocking measures adopted by China and Singapore, and the mitigation measures adopted by Japan and Italy. According to the Epidemic control results of these four countries, we can conclude that the blocking measures were generally effective. As the core strategy of blocking measures, admitting mild patients into hospital and cases tracing helped curb the spread of the outbreak in Singapore and China. Countries should choose appropriate response strategies on the premise of considering their own situation, increase investment in health resources to ensure global health equity, and eventually control the spread of infectious diseases in the world effectively.

Effects of total parathyroidectomy treatment on parathyroid hormone levels, recurrent laryngeal nerve function, and the rate of infection complications of secondary hyperparathyroidism patients under image information health monitoring by magnetic resonance imaging.

In order to explore the application of computer information health monitoring technology in the evaluation of the treatment effect after total parathyroidectomy (T-PTX) for patients with Secondary Hyperparathyroidism (SHPT), preoperative magnetic resonance imaging (MRI) computer health monitoring technology was used to locate and diagnose the parathyroid glands. Autotransplantation were performed. The changes of total intact parathyroid hormone (iPTH) before and after surgery, serum Calcium (Ca), serum phosphorus (P), and alkaline phosphatase (ALP) were observed and recorded. The postoperative complications were observed. The postoperative recurrent laryngeal nerve injury was analyzed. The results showed that serum Ca, serum P, and iPTH of the patients were significantly decreased within 6 months after parathyroid gland resection compared with that before surgery (P < 0.05); however, there was no significant change in ALP level within one week after surgery (P > 0.05); after surgical treatment, the clinical symptoms of patients with bone pain, itchy skin, and restless leg syndrome were significantly decreased, and 2 cases of recurrent laryngeal nerve injury, and 1 case of new arrhythmia, with a complication rate of 7.14 %, which showed that MRI based on computer information technology had a good value in preoperative localization and diagnosis of the parathyroid gland in SHPT patients and lower the rate of postoperative infection and complications and the impairment of recurrent laryngeal nerve function.

Does governance quality moderate the finance-renewable energy-growth nexus? Evidence from five major regions in the world.

This paper investigates the moderating role of governance quality on the finance-renewable energy-growth nexus in five major regions in the world, including 123 countries from 1990 to 2017. In a disaggregated approach, we used several financial variables denoting financial depth, financial efficiency, financial inclusion, and financial stability, which represent the different components of financial development. In an aggregated approach, we constructed composite indexes of governance quality and financial development following the principal component analysis (PCA). Next, we applied the two-stage least squares, difference-GMM, and system-GMM methods, as well as the Granger non-causality test in (Dumitrescu and Hurlin Econ Model 29(4):1450-1460, 2012). First, the results show that financial development and improved governance quality are complementary drivers of economic growth in all regions, except in America and Europe and Central Asia in most cases. Similarly, renewable energy consumption and enhanced governance quality are interrelated factors in strengthening economic growth in the Asia Pacific, MENA, and SSA regions, as opposed to the Americas and Europe and Central Asia. Second, there is bidirectional causality between financial development and economic growth in all areas, while the two-way causality between renewable energy consumption and growth is only confirmed in America and SSA regions, respectively. This study reveals the threshold effect of governance quality on the renewable energy-finance-growth nexus across regions. Therefore, policymakers should improve the level of governance quality and the efficiency of financial systems and renewable energy consumption to promote sustainable development in the different regions, especially in the Asia Pacific, MENA, and SSA zones.

The impact of the government health funding on prescribing behaviors in community health institutions in China.

Government health funding (GHF) is a cosmopolitan problem. It is especially conspicuous in China, where drug sales become a main source of medical institutions' incomes due to limited GHF. This is well known as China's "drug maintain medical institutions (DMMIs)" system which results directly in very high use of antibiotics, injections, and corticosteroids. However, few statistical data existed in China on the association between the GHF and the prevalence of inappropriate drug prescribing, despite widespread acknowledgment of its existence.A multistage sampling strategy was employed to select 442,100 prescriptions written between 2007 and 2011 by urban community health (CH) institutions and check the GHF in 36 key cities (districts) across China. This study examined the association between the GHF and the prevalence of inappropriate drug prescribing, which differs somewhat from previous studies.The data suggested that from 2007 to 2011, with the increase of GHF, prescribing behaviors (PB) gradually improved on the whole although doctors still prescribed a few more drugs than the recommendations from World Health Organization (WHO). This study found that there is significant negative association between GHF and main indicators of PB (correlation coefficients more than 0.5).The findings implied that government should further perfect the compensation mechanism to medical institutions for gradually weakening the compensation function of drug sales in medical institutions.

The within-host population dynamics of Mycobacterium tuberculosis vary with treatment efficacy.

BACKGROUND: Combination therapy is one of the most effective tools for limiting the emergence of drug resistance in pathogens. Despite the widespread adoption of combination therapy across diseases, drug resistance rates continue to rise, leading to failing treatment regimens. The mechanisms underlying treatment failure are well studied, but the processes governing successful combination therapy are poorly understood. We address this question by studying the population dynamics of Mycobacterium tuberculosis within tuberculosis patients undergoing treatment with different combinations of antibiotics. RESULTS: By combining very deep whole genome sequencing (~1000-fold genome-wide coverage) with sequential sputum sampling, we were able to detect transient genetic diversity driven by the apparently continuous turnover of minor alleles, which could serve as the source of drug-resistant bacteria. However, we report that treatment efficacy has a clear impact on the population dynamics: sufficient drug pressure bears a clear signature of purifying selection leading to apparent genetic stability. In contrast, M. tuberculosis populations subject to less drug pressure show markedly different dynamics, including cases of acquisition of additional drug resistance. CONCLUSIONS: Our findings show that for a pathogen like M. tuberculosis, which is well adapted to the human host, purifying selection constrains the evolutionary trajectory to resistance in effectively treated individuals. Nonetheless, we also report a continuous turnover of minor variants, which could give rise to the emergence of drug resistance in cases of drug pressure weakening. Monitoring bacterial population dynamics could therefore provide an informative metric for assessing the efficacy of novel drug combinations.

Risk Factors Associated with Mortality and Increased Drug Costs in Nonvariceal Upper Gastrointestinal Bleeding.

BACKGROUND/AIMS: To determine risk factors associated with mortality and increased drug costs in patients with nonvariceal upper gastrointestinal bleeding. METHODOLOGY: We retrospectively analyzed data from patients hospitalized with nonvariceal upper gastrointestinal bleeding between January 2001-December 2011. Demographic and clinical characteristics and drug costs were documented. Univariate analysis determined possible risk factors for mortality. Statistically significant variables were analyzed using a logistic regression model. Multiple linear regression analyzed factors influencing drug costs. p < 0.05 was considered statistically significant. RESULTS: The study included data from 627 patients. Risk factors associated with increased mortality were age > 60, systolic blood pressure<100 mmHg, lack of endoscopic examination, comorbidities, blood transfusion, and rebleeding. Drug costs were higher in patients with rebleeding, blood transfusion, and prolonged hospital stay. CONCLUSION: In this patient cohort, re-bleeding rate is 11.20% and mortality is 5.74%. The mortality risk in patients with comorbidities was higher than in patients without comorbidities, and was higher in patients requiring blood transfusion than in patients not requiring transfusion. Rebleeding was associ-ated with mortality. Rebleeding, blood transfusion, and prolonged hospital stay were associated with increased drug costs, whereas bleeding from lesions in the esophagus and duodenum was associated with lower drug costs.

An integrated model of infection risk in a health-care environment.

Certain respiratory tract infections can be transmitted by hand-to-mucous-membrane contact, inhalation, and/or direct respiratory droplet spray. In a room occupied by a patient with such a transmissible infection, pathogens present on textile and nontextile surfaces, and pathogens present in the air, provide sources of exposure for an attending health-care worker (HCW); in addition, close contact with the patient when the latter coughs allows for droplet spray exposure. We present an integrated model of pertinent source-environment-receptor pathways, and represent physical elements in these pathways as "states" in a discrete-time Markov chain model. We estimate the rates of transfer at various steps in the pathways, and their relationship to the probability that a pathogen in one state has moved to another state by the end of a specified time interval. Given initial pathogen loads on textile and nontextile surfaces and in room air, we use the model to estimate the expected pathogen dose to a HCW's mucous membranes and respiratory tract. In turn, using a nonthreshold infectious dose model, we relate the expected dose to infection risk. The system is illustrated with a hypothetical but plausible scenario involving a viral pathogen emitted via coughing. We also use the model to show that a biocidal finish on textile surfaces has the potential to substantially reduce infection risk via the hand-to-mucous-membrane exposure pathway.