Effects of medical consortium policy on health services: an interrupted time-series analysis in Sanming, China

ObjectivesChina has implemented reforms to enhance the operational efficiency of three-level medical services through medical consortiums (MCs). This study evaluated the impact of MCs reform on health services in Sanming, China.MethodsAn interrupted time-series analysis (ITSA) was conducted to assess the impact of MCs on changes in health service levels and trends across the overall situation of MCs and different institutional types within MCs, including county hospitals and grassroots medical institutions. The evaluation focused on various indicators such as outpatient and emergency visits, inpatients, average length of stay, occupancy rate of hospital beds, and hospital bed turnover times. Monthly data were collected from April 2015 to June 2019 through reports on the Sanming Municipal Health Commission website and the Sanming public hospital management monitoring platform.ResultsAfter the intervention of MCs reform, a significant increase was observed in the total number of inpatients (β3 = 174.28, p < 0.05). However, no statistically significant change was observed in the total number of outpatient and emergency visits (β3 = 155.82, p = 0.91). Additionally, the implementation of MCs reform led to an amplification in service volumes provided by county hospitals, with significant increases in the number of outpatient and emergency visits (β3 = 1376.54, p < 0.05) and an upward trend in the number of inpatients (β3 = 98.87, p < 0.01). However, no significant changes were observed under the MCs policy for grassroots medical institutions regarding the number of outpatient and emergency visits (β3 = −1220.72, p = 0.22) and number of inpatients (β3 = 75.42, p = 0.09).ConclusionThe Sanming MCs reform has achieved some progress in augmenting service volumes. Nevertheless, it has not led to an increase in service volumes at the grassroots medical institutions. There persists an insufficiency in the efficiency of services and a need for further improvement in primary healthcare. To address these concerns, it is imperative for county hospitals to offer targeted assistance that can enhance motivation among grassroots medical institutions. Besides the MCs should explore initiatives, including improved management of medical equipment, allocation of funding, and personnel resources

From Local to Global: Spectral-Inspired Graph Neural Networks

Graph Neural Networks (GNNs) are powerful deep learning methods for Non-Euclidean data. Popular GNNs are message-passing algorithms (MPNNs) that aggregate and combine signals in a local graph neighborhood. However, shallow MPNNs tend to miss long-range signals and perform poorly on some heterophilous graphs, while deep MPNNs can suffer from issues like over-smoothing or over-squashing. To mitigate such issues, existing works typically borrow normalization techniques from training neural networks on Euclidean data or modify the graph structures. Yet these approaches are not well-understood theoretically and could increase the overall computational complexity. In this work, we draw inspirations from spectral graph embedding and propose $\texttt{PowerEmbed}$ -- a simple layer-wise normalization technique to boost MPNNs. We show $\texttt{PowerEmbed}$ can provably express the top-$k$ leading eigenvectors of the graph operator, which prevents over-smoothing and is agnostic to the graph topology; meanwhile, it produces a list of representations ranging from local features to global signals, which avoids over-squashing. We apply $\texttt{PowerEmbed}$ in a wide range of simulated and real graphs and demonstrate its competitive performance, particularly for heterophilous graphs.Comment: Accepted for publication at the NeurIPS 2022 GLFrontiers Worksho

Quality of Life of Adults with Chronic Spinal Cord Injury in Mainland China: A Cross-Sectional Study

Objective: To evaluate the quality of life of patients with chronic spinal cord injury in mainland China. Design: Cross-sectional study. Subjects: A total of 247 adults ≥ 1 year post-SCI in mainland China. Methods: The World Health Organization (WHO) Quality of Life Scale Brief Version (WHOQOL-BREF) and the add-on modules on disability-related QoL (WHOQOL-DIS) were used to assess quality of life. Anxiety/depression was measured using the Zung Self-Rating Anxiety/Depression Scale. Quality of life was compared with that of reference populations from China, Korea, the international field trial (23 countries). Multivariate linear regression was conducted to determine the factors that might be associated with quality of life. Results: The means of the 4 domains of the WHOQOLBREF varied from 11.5 to 13.0. The mean of the 12- item WHOQOL-DIS module was 38.7. The quality of life of the participants as measured by the WHOQOLBREF was 1.1--4.7 points lower than that of the global reference population, while quality of life as measured by the WHOQOL-DIS module was 1.2 points lower than that of the Korean data. Anxiety and depression were negative factors associated with quality of life (p \u3c 0.05). Better community integration was a positive factor for physical quality of life and quality of life as measured by the WHOQOL-DIS module (p \u3c0.01). Conclusion: The quality of life of adults with chronic spinal cord injury in mainland China was lower compared with reference populations. Duration of spinal cord injury, sex, community integration, anxiety, and depression were related to quality of life

Effects of a Rehabilitation Program for Individuals with Chronic Spinal Cord Injury in Shanghai, China

Background: Specialized Institution-Based Rehabilitation (SIBR) is the cornerstone of care and treatment for individuals with spinal cord injury, but most people with chronic spinal cord injury (CSCI) living in China have no SIBR experience after acute care hospital discharge. In 2009, an SIBR facility was set up in Shanghai (China) to fill this important gap in care. The purpose of the study was to evaluate the effectiveness of an integrated rehabilitation training program among individuals with CSCI living in Shanghai. Methods: A within-subject pre-posttest design was used to evaluate the SIBR. The sample included 455 individuals ≥1 year post-SCI, who were older than 18 years of age and were enrolled in a rehabilitation center in Shanghai, China, between 2013 and 2019. The data included individuals’ sociodemographic and injury characteristics, and twenty-three indicators were used as outcome measurements to evaluate basic life skills and their applications in family and social life. Multivariate linear regression was conducted to determine which factors might have influenced the effectiveness of the SIBR. Results: All basic life skills and their applications in family and social life were improved, but with variations across socio-demographics. Female individuals with CSCI had better outcomes in basic life skills than did males. In terms of basic life skills and their applications in family and social life, individuals with a low level (thoracic or lumbosacral) of injury achieved more significant functional gains than those with a higher level (cervical). The baseline score was also a relevant factor in functional outcome. Conclusions: Even for individuals with a long SCI history, SIBR training can improve basic life skills and the applications of those skills in family and social life settings

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

Effective adsorption of Hg(II) ions by new ethylene imine polymer/β-cyclodextrin crosslinked functionalized magnetic composite

A new effective magnetic composite material was prepared successfully for adsorption Hg(II) ions by introducing β-cyclodextrin/ethylene imine polymer to the mesoporous silica. The morphology and structure of EIP-β-CD magnetic adsorbents were characterized by FT-IR, XR, DTG, XPS and SEM technologies. The effect of many factors were discussed detailedly such as adsorption time, initial concentration, pH, different composition of adsorbent and adsorption temperature. It was found that EIP-β-CD showed excellent adsorption capacity, high selectivity, good reutilization and fast adsorption rate. The maximum adsorption capacity was 248.72 mg/g and the best removal rate was 99.49 % under the optimized experimental conditions. The kinetic and thermodynamic study showed typical characteristic of chemical adsorption, exothermic and spontaneous. The best mass proportion of β-cyclodextrin, ethylene imine polymer and glutaraldehyde was 1.0:0.4:0.2, and proper β-cyclodextrin can develop the adsorption capacity for Hg(II) ions in this adsorbent. The possible adsorption mechanism was investigated in detail. After the fifth cycle experiment, this new adsorbent still showed excellent adsorption capacity which indicated that it has great potential for Hg(II) ions cleanup in water solution

A Multibody Model of Tilt-Rotor Aircraft Based on Kane’s Method

A tilt-rotor aircraft can switch between two flight configurations (the helicopter configuration and the fixed-wing plane configuration) by tilting its rotors. In the process of rotor tilting, the nacelles which drive the rotors tilt together with the rotors. Because the mass of the nacelles cannot be ignored compared to the mass of the whole aircraft, the tilting of the nacelles is a coupling motion of the body and the nacelles. In order to better character the aircraft dynamics during the nacelle tilting, a multibody model is established in this paper. In this multibody model, Kane’s method is used to build a dynamic model of a tilt-rotor aircraft. The generalized rates are used to describe the movement of the body and the nacelles (with rotors). The generalized active forces and generalized inertial forces of both the body and the nacelles (with rotors) are obtained, respectively, and the first-order differential equations of the generalized rates are obtained. The longitudinal trim of the XV-15 aircraft is calculated according to the single-body model and our multibody model, in this paper, and the results verify the correctness of the multibody model. In the process of nacelle inclination angle command tracking, the multibody model can provide more information about the disturbance torque of the nacelle than the single-body model, and model inversion control based on the proposed multibody model can obtain a better tracking result than a PID control method only using nacelle angle feedback information