Identification of Human Body Fluid Stains and Non-Biological Stains by Three-Dimensional Fluorescence Spectroscopy.

OBJECTIVES: To establish a rapid and nondestructive identification method for human body fluid stains and non-biological stains using three-dimensional fluorescence spectroscopy. METHODS: The collected three-dimensional fluorescence spectrum data of human saliva, 3% blood, coffee and Fanta® stains were processed with dimensionality reduction. After wavelet transform, spectral denoising and feature extraction, the classification formula was established. The Fisher discriminant was used for spectrum matching and recognition to establish the analysis method to distinguish stain types. RESULTS: According to the results of data training and comparison, all the recognition accuracies of Fanta®, coffee, saliva and blood were more than 91.39%. Among them, saliva reached 100% recognition accuracy. CONCLUSIONS: Three-dimensional fluorescence spectroscopy is a potential method for rapid and nondestructive identification of biological and non-biological stains.

Effect of inappropriate admissions on hospitalization performance in county hospitals: a cross-sectional study in rural China.

BACKGROUND: Inappropriate admissions cause excessive utilization of health services compared with outpatient services. However, it is still unclear whether inappropriate admissions cause excessive use of health services compared with appropriate admissions. This study aims to clarify the differences in the hospitalization performances between appropriately admitted inpatients and inappropriately admitted inpatients. METHODS: A total of 2575 medical records were obtained after cluster sampling in three counties. Admission appropriateness was assessed by appropriateness evaluation protocol (AEP). The propensity score matching (PSM) was computed to match patients in treatment and control group with similar characteristics, and to examine the differences in the utilization of hospitalization services between the two groups. The samples were matched in two major steps in this study. In the first step, total samples were matched to examine the differences in the utilization of hospital services between the two groups using 15 individual covariates. In the second step, PSM was computed to analyze the differences between the two groups in different disease systems using 14 individual covariates. RESULTS: For the whole sample, the inappropriate group has lower expenditure of hospitalization (EOH) (difference = - 0.12, p = 0.003) and shorter length of stay (LOS) (difference = - 0.73, p = 0.016) than the appropriate group. For number of clinical inspection (NCI), it has no statistically significant difference (difference = - 0.39, p = 0.082) between the two groups. Among different disease systems, no significant differences were observed between the two groups among EOH, LOS and NCI, except that the EOH was lower in the inappropriate group than that in the appropriate group for surgical disease (difference = - 0.169, p = 0.043). CONCLUSION: Inappropriate admissions have generated excessive health service utilization compared with appropriate admissions, especially for internal diseases. The departments in charge of medical services and hospital managers should pay high attention to the health service utilization of the inappropriately admitted inpatients. Relevant medical policies should be designed or optimized to increase the appropriateness in health care service delivery and precision in clinical pathway management.

Determinants of inappropriate admissions of children to county hospitals: a cross-sectional study from rural China.

BACKGROUND: The incidence of inappropriate admissions in China has become the shackle of its' service supply system. This research aims to assess the level of children's inappropriate admissions to county hospitals in rural China and identify the characteristics and determinants of children's inappropriate admissions. METHODS: A retrospective review was conducted on data of children aged 0-14 years. A total of 771 children medical records in four county hospitals was collected by stratified random sampling in Midwestern China and was evaluated through the Rural Appropriateness Evaluation Protocol. A questionnaire survey was conducted among doctors whose names were shown in medical records. Chi-square test was used to analyse the characteristics of inappropriate admissions, and a binary logistic regression model was used to examine the determinants of inappropriate admissions. RESULTS: Inappropriate admissions indicate that patients who could have been treated as outpatients received services as inpatients. The average rate for inappropriate admissions of children in county hospitals was 61.35%. The highest rate of inappropriate admissions was found among children aged 1-5 years (68.42%). Inappropriate admissions mostly occurred in children with respiratory diseases (72.45%), circulatory diseases (72.22%) and certain infectious diseases and parasitic diseases (70.37%). Binary logistic regression analysis showed that county, normal health status, treating department, disease, the length of hospital stay and the doctor's self-evaluation on the understanding about the degree of the patient's feelings were determinants for children's inappropriate admissions. CONCLUSIONS: County hospitals have a high rate of inappropriate admissions of children. The relationship of children's inappropriate admissions to age distribution and the insurance compensation is affected by disease and hospitalisation expenses, respectively. The determinants of children's inappropriate admissions are directly related to the weak level of primary care services in the health service system, the initial requirements requested by children's admission decision makers and the interests among medical institutions and doctors.

Changes in inpatients' distribution and benefits under institution level-based quota payment for specific diseases in rural China: An interrupted time-series analysis.

The distribution of patients is increasingly disordered in China, which leads to the waste of medical resources, increase in inpatients' economic burden, and decrease in benefits from health insurance. Institution level-based quota payment for specific diseases represents a typical payment-system reform mode in rural China that rationalizes the distribution of rural inpatients. The aim of this study is to evaluate the effectiveness of this mode by estimating rural inpatients' distribution among hospitals at different levels, per capita cost of hospitalization, and actual compensation ratio and then to provide suggestions to advance this mode. Interrupted time-series analysis was applied to evaluate the effect of the reform mode in the study, and Weiyuan County, Gansu Province, was selected as our sample. Institution level-based quota payment for specific diseases in Weiyuan County has rationalized the distribution of rural inpatients and improved their benefit levels. Further research should be conducted to evaluate the appropriateness of medical services, the health outcomes of rural inpatients, and the sustainability and replicability of the policy.

Effectiveness evaluation of quota payment for specific diseases under global budget: a typical provider payment system reform in rural China.

BACKGROUND: Quota payment for specific diseases under global budget is one of the most typical modes of provider payment system reform in rural China. This study aimed to assess this reform mode from aspects of the total fee, structure of the fee and enrollees' benefits. METHODS: A total of 127,491 inpatient records from 2014 to 2016 were extracted from the New Rural Cooperative Medical Scheme (NRCMS) database in Weiyuan County, Gansu Province. Total fee, actual compensation ratio, out-of-pocket ratio, constituent ratio of the treatment fee, constituent ratio of the inspection and laboratory fee, and length of stay were selected as dependent variables. Both generalized additive models (GAMs) and multiple linear regression models were used to measure the change in dependent variables along with year. RESULTS: Prior to the adjustment of the compensation type, out-of-pocket ratio and length of stay decreased, while total fee, actual compensation ratio, constituent ratio of the treatment fee, and constituent ratio of the inspection and laboratory fee increased. After the compensation type was adjusted, the mean of the total fee increased rapidly in 2015 and remained stable in 2016. The mean length of stay increased in 2015 but decreased in 2016. A comparison of inpatients suffering from diseases covered by quota payments and those suffering from general diseases revealed that total fee, out-of-pocket ratio, and length of stay decreased and actual compensation ratio increased for the former, whereas the opposite was true for the latter. Constituent ratio of the treatment fee and constituent ratio of the inspection and laboratory fee increased for both samples, except for the constituent ratio of the inspection and laboratory fee of quota payment diseases in 2016, which did not change. CONCLUSIONS: Quota payment for specific diseases under global budget had obviously positive effects on cost control in Weiyuan, Gansu. Considering the limited coverage of quota payment for diseases, the long-term effect of this reform mode and its replicability awaits further evaluation.

Automation of anaesthesia: a review on multivariable control.

Anaesthesia is a multivariable problem where a combination of drugs are used to induce desired hypnotic, analgesia and immobility states. The automation of anaesthesia may improve the safety and cost-effectiveness of anaesthesia. However, the realization of a safe and reliable multivariable closed-loop control of anaesthesia is yet to be achieved due to a manifold of challenges. In this paper, several significant challenges in automation of anaesthesia are discussed, namely model uncertainty, controlled variables, closed-loop application and dependability. The increasingly reliable measurement device, robust and adaptive controller, and better fault tolerance strategy are paving the way for automation of anaesthesia.

Spontaneously Micropatterned Silk/Gelatin Scaffolds with Topographical, Biological, and Electrical Stimuli for Neuronal Regulation.

Effective integration of stimulation and direction in bionic scaffolds by materials and microstructure design has been the focus in the advancement of nerve regeneration. Hydrogels are the most promising biomimicked materials used in developing nerve grafts, but the highly hydrated networks limit the fabrication of hydrogel materials into complex biomedical devices. Herein, facile lithography-free and spontaneously micropatterned techniques were used to fabricate a smart protein hydrogel-based scaffold, which carried topographical, electrical, and chemical induction for neural regulation. The synthesized tissue-mimicked silk-gelatin (SG)/polylactic acid bilayer system can self-form three-dimensional ordered corrugation micropatterns with well-defined dimensions (wavelength, λ) based on the stress-induced topography. Through magnetically and topographically guided deposition of the synthesized nerve growth factor-incorporated Fe3O4-graphene nanoparticles (GFPNs), a biologically and electrically conductive cell passage with one-dimensional directionality was constructed to allow for a controllable constrained geometric effect on neuronal adhesion, differentiation, and neurite orientation. Particularly, the SG with corrugation patterns of λ ≈ 30 µm resulted in the optimal cell adhesion and differentiation in response to the pattern guidance. Furthermore, the additional electrical stimulation applied on GFPN-deposited SG resulted in a 1.5-fold increase in the neurite elongation by day 7, finally leading to the neuronal connection by day 21. Such a hydrogel device with synergistic effects of physical and chemical enhancement on neuronal activity provides an expectable opportunity in the development of next-generation nerve conduits.

[Application of Mentype Argus X-8 kit in forensic paternity testing].

OBJECTIVE: To evaluate the application value of Mentype Argus X-8 kit in Chinese population, and to gather the genetic data of the eight X-STR loci. METHODS: The X-STR of 177 blood samples of unrelated East China Han population and 104 duo paternity testing cases was typed using Mentype Argus X-8 kit. The allele frequency and genetic data of the eight loci were investigated. RESULTS: The PIC of the eight X-STR loci was between 0.4454 and 0.9187. Among them, DXS10135 and DXS10101 had the highest PIC and exclusion rate in paternity cases. The other seven loci showed no difference in sex-related allele frequency except DXS7132. In addition, there were several new alleles detected including DXS10074 (allele 15.3), DXS10101 (allele 36) and DXS10134 (allele 37.3). CONCLUSION: Eight X-STR loci included in Mentype Argus X-8 kit are high polymorphic and valuable.

[Comparing and evaluating six methods of extracting human genomic DNA from whole blood].

OBJECTIVE: Comparing the differences in purity and yield among six methods of extracting human genomic DNA from whole blood, which included Classic Phenol-chloroform extraction, modified combined technique composed of improved Phenol-chloroform extraction and Chelex-100 extraction, Chelex-100 extraction, IQ, Qiagen and SP. METHODS: Ten samples of intravenous whole blood (5 mL/sample) were collected and human genomic DNA was extracted with these six methods. The purity and concentration of the DNA products were detected by ultraviolet spectrophotometry and fluorescent quantitation technique, the yield was calculated and tested with statistical software. RESULTS: The Chelex-100 extraction was inferior in DNA purity to other methods while the other five methods showed no statistical difference. Modified combined technique was the poorest and IQ was the best in yield among the six methods of extraction. Statistical result showed that the extraction with high quality kits was better than that with classic Phenol-chloroform extraction, Chelex-100 extraction and modified combined technique composed of improved Phenol-chloroform. There was statistical difference between them. CONCLUSION: Comparing to Phenol-chloroform extraction and Chelex-100 extraction, high quality kits are more useful in DNA extraction from forensic materials.

Design of an adaptive stator for bundled piezo-walk motors.

Bundled piezoelectric motors combine several actuators to achieve high output power. However, mutual interference between the actuators leads to reduction in working efficiency. This work presents an adaptive stator that can reduce the mutual interference in bundled piezowalk motors. The stator consists of leaf springs for improving motor contact condition and proof masses that serve as an inertial body for maintaining high output force. Parameters of the proof masses and leaf springs are analyzed, and the working zone of the stator is discussed. A prototype of a linear motor with the designed adaptive stator is fabricated and tested. The maximum speed of a six-leg motor is 103 mm/s, and the stall force is approximately 1.2 N, driven with sinusoidal waveforms of 25Vpp at 30 kHz. Mutual interference between actuators is reduced remarkably with the adaptive stator. A comparison of six- and four-leg motors proves that motor performance has a linear relationship with the number of actuators, thereby indicating the potential of increasing output capability with additional actuators.

Effect of integrated urban and rural residents medical insurance on the utilisation of medical services by residents in China: a propensity score matching with difference-in-differences regression approach.

OBJECTIVES: In this study, we aim to evaluate the effect of urban and rural resident medical insurance scheme (URRMI) on the utilisation of medical services by urban and rural residents in the four pilot provinces. SETTING AND PARTICIPANTS: The sample used in this study is 13 305 individuals, including 2620 in the treatment group and 10 685 in the control group, from the 2011 and 2015 surveys of China Health and Retirement Longitudinal Study. OUTCOME MEASURES: Propensity score matching and difference-in-differences regression approach (PSM-DID) is used in the study. First, we match the baseline data by using kernel matching. Then, the average treatment effect of the four outcome variables are analysed by using the DID model. Finally, the robustness of the PSM-DID estimation is tested by simple model and radius matching. RESULTS: Kernel matching have improved the overall balance after matching. The URRMI policy has significantly reduced the need-but-not outpatient care and significantly increased outpatient care cost and inpatient care cost for rural residents, with DID value of -0.271, 0.090 and 0.256, respectively. After robustness test, the DID competing results of four outcome variables are consistent. CONCLUSIONS: URRMI has a limited effect on the utilisation of medical and health services by all residents, but the effect on rural residents is obvious. The government should establish a unified or income-matching payment standard to prevent, control the use of medical insurance funds and increase its efforts to implement URRMI integration in more regions to improve overall fundraising levels.

[Isolation of an effective benzo [a] pyrene degrading strain and its degradation characteristics].

A strain which could utilize BaP as a sole carbon and energy source and efficiently degrade benzo[a] pyrene (BaP) was isolated from the contaminated sediments of Guiyu, Guangdong province, China. The strain was identified as Brevibacillus brevis based on physiological and biochemical experiments together with 16S rRNA sequence analysis. The experimental results showed that the biodegradation rate of BaP by B. brevis in 7 days was 51.35%. The study also demonstrated that pH, temperature, bacterial dosage, initial concentration of BaP and processing time were important factors for BaP degradation. B. brevis could tolerate wide pH and temperature ranges, from 2 to 12 degrees C and 25 to 40 degrees C, respectively. The optimum condition for BaP degradation was pH 7 and 25 degrees C. With the increase of B. brevis inoculation amount, the degradation efficacy displayed an initial increasing trend and then came to a plateau. And the increase of BaP concentration led to the enhancement of BaP degradation. Addition of salicylic, succinate and phthalate showed no obvious positive effect on BaP biodegradation. After degradation of BaP, the surface of B. brevis was wrinkled, and became depressed and deformed over time.

[Characteristics and functional protein analysis of an effective decabromodiphenyl ether-degrading strain].

An effective decabromodiphenyl ether (BDE-209) degrading strain was isolated and identified as Enterococcus casseliflavus based on the 16S rRNA gene sequence analysis. The optimal conditions for strain growth were pH 7 and culture time of 48 h, respectively. E. casseliflavus has a good ability to degrade BDE-209. The biodegradation rate of 1 mg.L-1 BDE-209 by 1 g.L-1 E. casseliflavus reached the highest of 56. 7% after 4 days degradation with 5 mg.L-1 glucose as the additional carbon source. During the degradation process of BDE-209, SDS-PAGE demonstrated that some new extracellular proteins were induced under 2 mg.L-1 and 5 mg.L-1 BDE-209. As for the intracellular proteins, the quantity of protein expression varied, and some proteins even disappeared compared with the blank control. Two-dimensional electrophoresis steps for protein analysis detected 31 different protein points, demonstrating that during the degradation process, the conformation of some proteins which were related with degradation was changed, and resulted in the variation of type and content of the proteins.