Information-Driven Integrated Healthcare: An Analysis of the Cooperation Strategy of County Medical Community Based on Multi-Subject Simulation.

The fragmentation and uneven quality of primary medical resources in China call for a deepening of integrated healthcare reform. China is promoting its county medical community (CMC) reform on a large scale in county-level administrative regions to promote the integration of local primary healthcare systems through information technology, which is consistent with the current trend of the digital governance era. Considering that the construction of a county medical community involves collaborative relationships between multi-level subjects, the evolutionary game theory was adopted in this study to construct a game model between the lead hospital of a CMC and primary healthcare institutions, and then the incentives of government department support were introduced to analyze the behavioral evolution of these three subjects. Taking into account the uncertainty of the real-life environment and information transformation, white Gaussian noise was introduced as a random disturbance term, and a numerical simulation was performed. In the two-subject model we focus on four parameters: information and management authority ceded by the primary healthcare institutions, integration coefficient of CMC information construction, intensity factor of information integration in the CMC, and medical resources delivered by the lead hospital. In the three-subject model we focus on three parameters: information and portion of authority ceded by the primary healthcare institutions and government departments, policy effect coefficient of CMC construction, and intensity of government departments' support for CMC construction. The simulation results show that there is a positive incentive for the concession of management power and information from the primary healthcare institutions to the lead hospital, but further determination of empowerment boundaries is needed. The lead hospital can improve the balance of medical resources in the county through the downward transfer of medical resources, but long-term resource delivery may inhibit the enthusiasm of the lead hospital. An improvement in the information integration intensity of the CMC can promote the efficient flow of information and knowledge and enhance the organizational closeness of the county medical community. At the same time, the integration of CMC information construction reduces the cost of collaboration among medical community members and streamlines and consolidates business modules, which can promote more efficient use of medical resources. The government departments' policies and funds provide obvious incentives to the lead hospital and primary healthcare institutions, but there is a need to explore appropriate financial payment ratios to balance the government's financial pressure.

Resource Support for "Mobilization-Participation" in Public Health Emergencies Based on a Complex Network Evolutionary Game.

The organized system of emergency resources with the participation of social subjects features a network, which puts forward new requirements for mobilization policies for public health emergencies. Considering the "mobilization-participation" action of the relationship between the government and social resource subjects and revealing the mechanism of governance measures represent the foundation of developing effective mobilization strategies. To analyze the behavior of subjects in an emergency resource network, this study proposes a framework for the emergency actions of government and social resource subjects, as well as clarifies the functions of relational mechanisms and interorganizational learning in decision making. The game model and its rules of evolution in the network were developed by considering the interventions of rewards and penalties. An emergency resource network was constructed on the basis of a response to the COVID-19 epidemic in a city in China, and a simulation of the "mobilization-participation" game was designed and conducted. We propose a path to promote emergency resource actions by analyzing the initial situations and the interventions' effects. This article suggests that guiding and improving the initial selection of subjects under a certain reward system would be an effective path to facilitate resource support actions during public health emergencies.

The Early Warning Mechanism of Public Health Emergencies Through Whistleblowing: A Perspective Based on Considering the Uncertainty of Risk Perception.

Purpose: During the early warning period of public health emergencies, the information released by whistleblowers on the risk posed by the given event can reduce uncertainty in the public's risk perception and help governments take timely actions to contain the large-scale dissemination of risk. The purpose of this study is to give full play to whistleblowers and draw attention to the risk events, forming a pluralistic model of the risk governance during the early warning period of public health emergencies. Methods: We construct an evolutionary game model of the early warning of public health emergencies through whistleblowing that involves the government, whistleblowers, and the public, discussing the mechanism of interaction between these subjects under the uncertainty of risk perception. Furthermore, we use numerical simulations to analyze the influence of changes in the relevant parameters on the evolutionary trajectory of the subjects' behaviors. Results: The results of the research are obtained by numerical simulation of the evolutionary game model. The results show that the public's cooperation with the government encourages the latter to take a positive guidance strategy. Increasing the reward for whistleblowers within an acceptable cost, strengthening the propaganda of the mechanism and the higher level of risk perception of the government and whistleblowers will promote whistleblowers' vocalization actively. When the government's reward for whistleblowers is lower, the whistleblowers choose negative vocalization with the improvement of the public's risk perception. If there is no mandatory guidance from the government at this point, the public is prone to passively cooperating with the government owing to a lack of risk-related information. Conclusion: Establishing an early warning mechanism through whistleblowing is important for containing risk in the early warning period of public health emergencies. Building the whistleblowing mechanism in daily work can improve the effectiveness of the mechanism and enhance the public's risk perception better when the public health emergencies arise.

Exploring time evolution characteristics of the collaborative mode in emergency information release of public health emergencies: A network analysis of response to COVID-19 from the central government of China.

Emergency information release during public health emergencies is a governance measure to slow down the spread of the epidemic and guide the public in scientific protection. Because of the uncertainty and life-cycle characteristics of public health emergencies, emergency information release represents the process of time dynamics. At present, it is an inevitable trend to establish a collaborative mechanism for emergency information release of public health emergencies to improve the release efficiency and respond to public demand. To determine time evolution characteristics of organizational collaboration in emergency information release, this study took the response to COVID-19 from the central government of China as an example and conducted research based on social network analysis. Based on information from COVID-19-related press conferences held by China's central government, the emergency information release collaborative networks (EIRCNs), and Emergency Organizations-Emergency Information Release Matters (EOs-EIRMs) 2-mode network were constructed. With the time evolution, the tightness, convergence, stability, and connectivity of EIRCNs in public health emergencies presented the process of lowering and then raising. At different stages, the core emergency organization (EO) nodes in EIRCNs continued to maintain a certain degree of activity. Their dynamic processes showed the characteristics of diversification rather than homogeneity. The time evolution of emergency information release matters (EIRMs) reflected the dynamic adjustment of the government's prevention and control measures and responded to the diversification of the public's understanding and protection needs during different stages of the COVID-19 pandemic. The study further examined the driving factors and implementation mechanism of the time evolution characteristics of the collaborative mode of emergency information release. The implementation of EIRMs at different stages had different resource requirements, which were usually achieved by introducing new EOs (Adding resource increment) or increasing the collaborative frequencies among EOs (Activating resource stock). In addition, further research prospects and feasibility interpretation were proposed.

Dynamic Evolution Analysis of the Emergency Collaboration Network for Compound Disasters: A Case Study Involving a Public Health Emergency and an Accident Disaster during COVID-19.

Compound disasters are highly complex and can involve different types of disasters. Since the beginning of the COVID-19 pandemic, compound disasters of public health emergencies, accident disasters, and natural hazards have occurred frequently all over the world; therefore, it is important to establish effective compound disaster emergency collaboration networks. Thus, this study examined the 7 March building collapse in Quanzhou City as a case study. This case was a typical compound disaster involving a public health emergency and an accident disaster during COVID-19. Based on the network analysis, the overall response and dynamic characteristics of the emergency collaboration for compound disasters were examined in this study. A compound disaster emergency collaboration network (ECN) was constructed by identifying the interactional relationships between emergency organizations. After applying time slices, the dynamic evolution of network structure, organizational-functional relations, organizational attributes, and cross-organizational relationships were discussed. The research results showed the following: (1) The density and connectivity of the compound disaster ECN first decreased before increasing. Meanwhile, the evolution of the network structure followed a path from decentralized to concentrated and from being uneven to an equilibrium. (2) The characteristics and practices of compound disasters during different periods indicated varied emergency needs for emergency organizations. We found that the formation of emergency tasks not only involved the passive adaptation to match the practice for compound disasters, but also the active choices of emergency organizations when facing compound disasters according to their collective experiences and decisions. (3) The national emergency management departments, the government emergency rescue organizations, and the local governments were the core organizations of the ECN. Public health management departments and social organizations were also required to participate in the ECN to improve the diverse and heterogeneous distribution of resources. (4) With increased demands during a compound disaster emergency, the number of cross-organizational collaborative relationships gradually increased. This study explored compound disaster emergencies from the perspective of network analysis to improve our understanding of the current and developing organizational relationships and practices during a compound disaster event. The dynamic characteristics of compound disasters require efficient adaptation and improvements of the collaborative mechanisms involved during emergencies.

How to Improve the Cooperation Mechanism of Emergency Rescue and Optimize the Cooperation Strategy in China: A Tripartite Evolutionary Game Model.

To reveal the interaction and influence mechanism between emergency rescue entities, and to explore and optimize a cooperation mechanism of emergency rescue entities, a tripartite evolutionary game model of emergency rescue cooperation based on government rescue teams, social emergency organizations, and government support institutions was constructed. The stability of each game subject's strategy choice was explored. Simulation analysis was applied to investigate the influence mechanism of key parameters on the evolution of the game subject's strategy combination. The research results show that government rescue teams, social emergency organizations, and government support institutions have consistent political demands and rescue targets in emergency rescue cooperation. The game subjects are driving forces for each other to choose positive strategies. The game evolution process of the emergency cooperation model shows a "mobilization-coordination" feature. At the same time, the emergency capital stock formed based on trust relationships, information matching, and institutional norms between game subjects can promote the evolution of the game system toward (1,1,1). In addition, for government organizations with limited emergency resources, the average allocation of emergency resources is not the optimal solution for emergency rescue efficiency. However, it is easier to achieve the overall target of emergency rescue cooperation by investing limited emergency resources in key variables that match the on-site situation. On this basis, combined with the practice of emergency rescues in emergencies, countermeasures and solutions are proposed to optimize the mechanism and improve the efficiency of emergency rescue cooperation.

Research on the Natural Hazard Emergency Cooperation Behavior between Governments and Social Organizations Based on the Hybrid Mechanism of Incentive and Linkage in China.

Social organizations have become an important component of the emergency management system by virtue of their heterogeneous resource advantages. It is of great significance to explore the interaction between the local government and social organizations and to clarify the key factors affecting the participation of social organizations in natural hazard emergency responses. With the aim of exploring the relationship between the local government and social organizations, based on evolutionary game theory, the emergency incentive game model and the emergency linkage game model of natural hazard emergency responses were constructed. The evolutionary trajectories of the emergency incentive game system and the emergency linkage game system were described by numerical simulation. Meanwhile, the influence mechanism of government decision parameters on the strategy selection of both game subjects was analyzed. The results show that both governmental incentive strategy and linkage strategy can significantly improve the enthusiasm of social organizations for participating in natural hazard emergency responses. Moreover, they could encourage social organizations to choose a positive participation strategy. Nevertheless, over-reliance on incentives reduces the probability of the local government choosing a positive emergency strategy. In addition, we found that, when both game subjects tend to choose a positive strategy, the strategy selection of the local government drives that of social organizations.

A Study on the Mechanism and Strategy of Cross-Regional Emergency Cooperation for Natural Disasters in China-Based on the Perspective of Evolutionary Game Theory.

Natural disasters have obvious cross-regional and compound characteristics. Cross-regional emergency cooperation for natural disasters deepens the diversification of coordination relations and the complexity of interaction modes among emergency response organizations, including horizontal and vertical organizational interactions. In order to clarify the cooperation mechanism of emergency organizations during cross-regional emergency cooperation for natural disasters and to explore the key factors that affect the cooperative relationships of emergency organizations, in this study, a game model is constructed based on evolutionary game theory, which is composed of local, neighboring, and central governments. Then, the stability of the emergency game strategy is analyzed. On this basis, a numerical simulation is used to simulate the dynamic evolution trajectory of the game system. The results show that there is an embedded mutual promotion mechanism that evolves towards a positive emergency strategy combination among the game subjects. The selection strategies of the game subjects show the characteristics of consistency and the following: enhanced cooperation efficiency between local and neighboring governments, emergency capital stock, and shared resources, therefore, guiding social emergency forces to actively participate in emergency operations. Strengthening the emergency dispatching strength of the central government and the effectiveness of central-local emergency dispatching, can support the performance of cross-regional emergency cooperation for natural disasters. Furthermore, the efficiency of cooperation between local and neighboring governments will be enhanced.

The Expansion Mechanism of the Cooperative Networks of Supply Support Organizations in a Public Health Emergency.

The outbreak of COVID-19 has significantly restricted the productive capacity of society and resulted in a shortage of supplies to maintain survival. Lightening the burden not only depends on government agencies, but also needs extensive social organization participation. However, few studies focus on how to promote social cooperation to support the provision of emergency supplies. This study aimed to find out the theoretical mechanism to expand the cooperative networks of supply support organizations during the epidemic. Data from the emergency response to the COVID-19 pandemic in China were used. Three cooperative networks from a progressive perspective were constructed based on the cooperative relationships among organizations. The expansion mechanism was verified by the exponential random graph model. The results show that when the institutional network expands into an interactive network, the composition of organization types has changed, but the cooperative network's efficiency does not improve much. The matching effect of the organizational type and the Matthew effect of nodes are both effective paths to promote cooperative network expansion, however, the structure effect shows that complex relationship structure is not a critical factor. Our findings highlight the importance of core organizations and the function of different types of organizations in building cooperative network as well as providing theoretical frameworks for policymakers to use in guiding and motivating social cooperation in emergency supplies.

Helper virus-free gutless adenovirus (HF-GLAd): a new platform for gene therapy.

Gene therapy is emerging as a treatment option for inherited genetic diseases. The success of this treatment approach greatly depends upon gene delivery vectors. Researchers have attempted to harness the potential of viral vectors for gene therapy applications over many decades. Among the viral vectors available, gutless adenovirus (GLAd) has been recognized as one of the most promising vectors for in vivo gene delivery. GLAd is constructed by deleting all the viral genes from an adenovirus. Owing to this structural feature, the production of GLAd requires a helper that supplies viral proteins in trans. Conventionally, the helper is an adenovirus. Although the helper adenovirus efficiently provides helper functions, it remains as an unavoidable contaminant and also generates replicationcompetent adenovirus (RCA) during the production of GLAd. These two undesirable contaminants have raised safety concerns and hindered the clinical applications of GLAd. Recently, we developed helper virus-free gutless adenovirus (HF-GLAd), a new version of GLAd, which is produced by a helper plasmid instead of a helper adenovirus. Utilization of this helper plasmid eliminated the helper adenovirus and RCA contamination in the production of GLAd. HF-GLAd, devoid of helper adenovirus and RCA contaminants, will facilitate its clinical applications. In this review, we discuss the characteristics of adenoviruses, the evolution and production of adenoviral vectors, and the unique features of HF-GLAd as a new platform for gene therapy. Furthermore, we highlight the potential applications of HF-GLAd as a gene delivery vector for the treatment of various inherited genetic diseases. [BMB Reports 2020; 53(11): 565-575].

No more helper adenovirus: production of gutless adenovirus (GLAd) free of adenovirus and replication-competent adenovirus (RCA) contaminants.

Gene therapy is emerging as an effective treatment option for various inherited genetic diseases. Gutless adenovirus (GLAd), also known as helper-dependent adenovirus (HDAd), has many notable characteristics as a gene delivery vector for this particular type of gene therapy, including broad tropism, high infectivity, a large transgene cargo capacity, and an absence of integration into the host genome. Additionally, GLAd ensures long-term transgene expression in host organisms owing to its minimal immunogenicity, since it was constructed following the deletion of all the genes from an adenovirus. However, the clinical use of GLAd for the treatment of inherited genetic diseases has been hampered by unavoidable contamination of the highly immunogenic adenovirus used as a helper for GLAd production. Here, we report the production of GLAd in the absence of a helper adenovirus, which was achieved with a helper plasmid instead. Utilizing this helper plasmid, we successfully produced large quantities of recombinant GLAd. Importantly, our helper plasmid-based system exclusively produced recombinant GLAd with no generation of helper plasmid-originating adenovirus and replication-competent adenovirus (RCA). The recombinant GLAd that was produced efficiently delivered transgenes regardless of their size and exhibited therapeutic potential for Huntington's disease (HD) and Duchenne muscular dystrophy (DMD). Our data indicate that our helper plasmid-based GLAd production system could become a new platform for GLAd-based gene therapy.

[Analysis of accelerant in fire debris by pyrolysis gas chromatography-mass spectrometry].

A strategy for the analysis of the accelerant and combustion residues in fires was developed by pyrolysis gas chromatography-mass spectrometry (PyGC-MS). Two kinds of accelerants (gasoline and diesel) and two kinds of carriers (cotton cloth and polyethylene terephthalate (PET) plastic) were selected for this research. Combustion residues of the accelerant and carrier were prepared. The characteristic temperatures of the samples were determined by thermal analysis technology. Then the analysis conditions were optimized and selected. The samples were subjected to PyGC-MS by a stepwise method consisting of flash analysis and pyrolysis analysis. The experimental results showed that the pyrolysates of the original combustion residues of the PET carrier consisted of 35 components, while the pyrolysates of the combustion residues of the PET carrier with gasoline, and ones of the combustion residues of the PET carrier with diesel oil consisted of only 25 components. The types and contents of the pyrolysates were different. The established method could distinguish the self-combustion residue of the carrier from the combustion residue of the accelerant and the same carrier. It was suitable for the analysis of the accelerant from the fire debris, and could determine the presence of the accelerant in the fire field. The method can provide a scientific basis for the judgement of the fire property and fire investigation work.

[Analysis of combustion residue of the typical plastic carrier and accelerant by flash gas chromatography-mass spectrometry].

A method of fire evidence identification applicable to combustion residue was developed by analyzing the combustion residue of a common plastic carrier and accelerant in a fire field. The method could detect the presence of the accelerant in a fire field, thereby preventing missed identification. The appropriate flash temperature was determined by thermal analysis. The combustion residue of the plastic carrier and accelerant was analyzed by flash technology under the appropriate flash temperature. The application of flash technology was evaluated in terms of a range of different experimental conditions, alongside feasibility and qualitative assessments. We found that the optimum flash evaporation temperature was 300℃ when analyzing the combustion residue corresponding to polyethylene (PE) and polyethylene terephthalate (PET) carrier. Experimental results showed that flash gas chromatography-mass spectrometry (Flash GC-MS) extracted the characteristic residual components of the accelerant and could be used to distinguish whether an accelerant was present in a fire or not. The application of flash evaporation technology to fire evidence identification provides a more complete and accurate analysis of the components of combustion residue, eliminating interference factors. Flash GC-MS enriches the modern fire evidence identification toolkit and can support current methods, leading to more accurate and reliable identification.