Research on the application of Blended Teaching in Secondary Vocational Electronic Technology Course Teaching

with the development of the times, China’s educational technology is also progressing at a high speed. Especially in today’s information technology era, online teaching has become an educational trend, and promotes the development of China’s education in the direction of modernization. Hybrid teaching is a new education mode bred under the background of this era. Its core is to carry out teaching in the way of effective combination of online and offline, and use the advantages of information technology to improve the quality of teaching, so as to promote the development of education modernization in China. Therefore, this paper studies the application of Blended Teaching in the teaching of secondary vocational electronic technology course. Its purpose is to fi nd the eff ective application strategy of Blended Teaching in vocational education, so as to improve the talent training system of Vocational Colleges and cultivate more excellent professional talents for our country

Is outpatient care benefit distribution of government healthcare subsidies equitable in rural ethnic minority areas of China? : results from cross-sectional studies in 2010 and 2013

Objectives Government healthcare subsidies for healthcare facilities play a significant role in providing more extensive healthcare access to patients, especially poor ones. However, equitable distribution of these subsidies continues to pose a challenge in rural ethnic minority areas of China. This study aimed to evaluate the benefits distribution of outpatient services across different socioeconomic populations in China's rural ethnic minority areas. Setting Inner Mongolia Autonomous Region, Xinjiang Autonomous Region and Qinghai Province. Design Two rounds of cross-sectional study. Participants One thousand and seventy patients in 2010 and 907 patients in 2013, who sought outpatient services prior to completing the household surveys, were interviewed. Methods Benefits incidence analysis was performed to measure the benefits distribution of government healthcare subsidies across socioeconomic groups. The concentration index (CI) for outpatient care at different healthcare facility levels in rural ethnic minority areas was calculated. Two rounds of household surveys using multistage stratified samples were conducted. Findings The overall CI for outpatient care was -0.0146 (P>0.05) in 2010 and -0.0992 (P0.05) and '0.0034 (P>0.05) at levels of village clinics (VCs), township health centres (THCs) and county hospitals (CHs), respectively. In 2013, the CI was -0.1353 (P0.05) and -0.1633 (P<0.01) at the levels of VCs, THCs and CHs, respectively. Conclusion Implementation of the gatekeeper mechanism helped improve the benefits distribution of government healthcare subsidies in rural Chinese ethnic minority areas. Equitable distribution of government healthcare subsidies for VCs was improved by increasing financial input and ensuring the performance of primary healthcare facilities. Equitable distribution of subsidies for CHs was improved by policies that rationally guided patients' care-seeking behaviour. In addition, highly qualified physicians were also a key factor in ensuring equitable benefits distribution

Definitive Simultaneous Integrated Boost Versus Conventional-Fractionated Intensity Modulated Radiotherapy for Patients With Advanced Esophageal Squamous Cell Carcinoma: A Propensity Score-Matched Analysis

BackgroundThe aim of this study was to compare the effects of simultaneous integrated boost–intensity modulated radiotherapy (SIB-IMRT) and conventional fractionated-IMRT (CF-IMRT) for patients with esophageal squamous cell carcinoma (ESCC).MethodsThe data of 1173 patients treated with either CF-IMRT or SIB-IMRT for a curative intent from 2005 to 2016 were retrospectively reviewed. Propensity score matching (PSM) was used to create a well-balanced cohort of 687 patients at 1:2 ratio (237 patients in SIB-IMRT group and 450 patients in CF-IMRT group). Overall survival (OS), progression-free survival (PFS), recurrence pattern, and toxicity profiles were evaluated and compared between the two groups after PSM.ResultsAfter a median follow-up time of 42.3 months (range, 3.0-153.2 months) for surviving patients, survival results were comparable in the two groups. After PSM, the 1-year, 2-year and 4-year OS rates in the SIB-IMRT and CF-IMRT groups were 70.0% vs. 66.4%, 41.9% vs. 41.7% and 30.2% vs. 27.6%, respectively (p = 0.87). The 1-year, 2-year and 4-year PFS rates were 48.4% vs. 49.1%, 31.2% vs. 29.4%, and 26.1% vs. 17.9%, respectively (p = 0.64). Locoregional recurrence (p = 0.32) and distant metastasis (p = 0.54) rates were also comparable between two groups. The toxicity profile was similar in the two groups. Multivariate analyses in the matched samples showed that female, concurrent chemotherapy and earlier clinical stage were independently associated with longer OS and PFS.ConclusionsSIB-IMRT appears to be equivalent to CF-IMRT in treatment efficacy and safety, and could become an alternative option for definitive radiotherapy of ESCC

Superiority of integrated cervicothoracic immobilization in the setup of lung cancer patients treated with supraclavicular station irradiation

ObjectiveTo investigate the superiority of the integrated cervicothoracic immobilization devices (ICTID) on the mobility of the supraclavicular station in lung cancer patients requiring both primary lung lesion and positive supraclavicular lymph nodes irradiation.MethodsOne hundred patients with lung cancer were prospectively enrolled in the study. The following four different fixation methods are used for CT simulation positioning: thoracoabdominal flat immobilization device fixation with arms lifting (TAFID group), head-neck-shoulder immobilization device fixation with arms on the body sides (HNSID group), ICTID fixation with arms on the body sides (ICTID arms-down group), and n ICTID fixation with arms lifting (ICTID arms-up group). Cone-beam computed tomography (CBCT) images are taken daily or weekly before treatment, to assess anatomical changes during the radiotherapy course.ResultsThe translation errors in X (left-right direction), Y (head-foot direction), and Z (abdomen-back direction) directions of the ICTID arms-up, TAFID, ICTID arms-down and HNSID groups were (0.15 ± 0.18) cm, (0.15 ± 0.16) cm, (0.16 ± 0.16) cm, and (0.15 ± 0.20) cm; (0.15 ± 0.15) cm, (0.21 ± 0.25) cm, (0.28 ± 0.23) cm, and (0.27 ± 0.21) cm; (0.13 ± 0.14) cm, (0.15 ± 0.14) cm, (0.17 ± 0.13) cm, and (0.16 ± 0.14) cm, respectively. Among them, the ICTID arms-up group had the minimal setup errors in X direction than those in ICTID arms-down (p=0.001) and HNSID groups (p=0.001), and in Y direction than those in TAFID (p&lt;0.001), and in Z direction than those in ICTID arms-down (p&lt;0.001) and TAFID groups (p=0.034). For the rotational errors of the four groups in the directions of sagittal plane, transverse plane, and coronal plane, the ICTID arms-up group had the smallest setup errors in the sagittal plane than that of TAFID groups and similar rotation setup errors with those of the other three groups.ConclusionFor patients requiring radiation of primary lung lesion and positive supraclavicular lymph nodes, an integrated frame fixation device is preferred the ICTID arms-up methods provide the smallest set up error and satisfied repeatability of body position, compared with TAFID and HNSID

Two-year impact of an educational intervention in primary care on blood glucose control and diabetes knowledge among patients with type 2 diabetes mellitus: a study in rural China

Background: Type 2 diabetes mellitus is increasing in rural China and should be managed in primary health care, but knowledge is lacking. Educational interventions have been implemented but not followed up long-term. Objective: The study aimed to assess the long-term impact of an educational intervention on patients’ diabetes knowledge and fasting blood glucose (FBG) level, and whether these outcomes differed between two rural counties. Methods: The study was nested in an educational intervention project in primary health care in Jiangsu province. Patients with type 2 diabetes mellitus from Huaiyin county and Gaochun county were randomly divided into an intervention group receiving an educational intervention and follow-up visits, and a control group with standard care. Questionnaires and medical records, including FBG level and diabetes knowledge score, were compared, at baseline in 2015 and two follow-ups, in 2016, and 2017, respectively. A paired t-test and two mixed-effects linear regression models were used. Results: The diabetes knowledge score increased in the intervention group in 2016 and in 2017, compared with 2015. The FBG level decreased in 2016 compared with 2015 in the intervention and control groups. Comparing data in 2015 and 2017, there was no significant change in FBG level in the intervention or control group, but the diabetes knowledge score increased in the intervention group both in 2016 and 2017. A significant association between FBG level and the interaction of time and group, suggesting a long-term effect, was only found in Gaochun county in 2017. Conclusion: The educational intervention improved the diabetes knowledge score in the intervention group, while no significant improvement was found in the control group in both year 2016 and 2017. Meanwhile, the intervention had a positive impact on FBG level in the intervention group in 2017. Patients in Gaochun county had better improvement in both diabetes knowledge and controlling FBG level, compared with Huaiyin county

Shifting the Care of Type 2 Diabetes Mellitus from Hospital to Primary Health Care Institutions through an Educational Intervention for Health Care Professionals: An Example from Rural China

This study assessed the impact of an educational intervention on the knowledge, attitudes, and practice regarding Type 2 Diabetes Mellitus (T2DM) of Primary Health Care (PHC) professionals, as well as on the types of T2DM care services which they were able to provide. The intervention was carried out in collaboration with county hospitals. The study was conducted from 2015 to 2016 among 241 health care professionals in 18 township health centers and 55 village clinics in three counties in Jiangsu Province, randomly divided into an intervention group and a control group. Participants in the intervention group received professional skills training sessions and team communication and were involved in regular meetings. The control group followed the routine work plan. At one-year follow up, the diabetes knowledge score, practice score, and attitudes score were significantly higher in the intervention group than in the control group. A significantly higher proportion of health care professionals in the intervention group was able to provide services compared with the control group, for all types of services, except T2DM emergency treatment. The intervention among health care professionals in PHC had a positive impact on their professional diabetes skills, knowledge, attitudes, practices, and types of services they were able to provide, at one-year follow-up

Vertical integrated service model: an educational intervention for chronic disease management and its effects in rural China – a study protocol

Abstract Background Chronic diseases are becoming a huge threat to the Chinese health system. Although the New Round of Medical Reform aims to improve this, the chronic disease management in rural China is still worrying as it relies highly on hospital care instead of primary care. The vertical integrated care model has proven to be effective for chronic disease patients in many high-income countries, while few studies have been conducted in China. In this project, vertical integrated care will be applied to optimize the care of patients with type 2 diabetes mellitus (T2DM) and primary hypertension in rural China, and to shift the care from hospital to primary care. Methods An educational intervention was conducted in three pilot counties in Jiangsu province, a high-income province in southeast China. The intervention was based on the model of vertical integrated care between the three-levels of healthcare institutions. In the pilot counties, 22 townships were included (11 in the intervention and control groups, respectively). Service teams assembled by the local health bureaus implemented the intervention which provides services for both patients and healthcare professionals. Questionnaire interviews (n = 4259) and medical records were used to collect patient data (physiological measures, health-related quality of life, satisfaction with care). Data from healthcare professionals (n = 282) was gathered through questionnaires and in-depth interviews (knowledge about chronic diseases, general procedure of diagnosing and registering, chronic disease management situation, perceptions of chronic disease treatment and prevention). Baseline data were collected before the start of the intervention in Nov 2015, follow-up data in Oct-Nov 2016, and final data completed in Jul-Aug 2017. Discussion The intervention has been conducted smoothly and gotten support from patients, healthcare institutions and local health authorities. The research team anticipates that the vertical integrated model will improve patients’ health, satisfaction with care, and their understanding of their chronic disease. We also anticipate that healthcare professionals can acquire more information about chronic diseases and improve their strategy for providing good quality care for patients. Trial registration ISRCTN13319989 Registration date: 4th April, 2017

Determinants of the use of different types of health care provider in urban China: A tracer illness study of URTI

With the reform of urban health delivery systems in China, concern has been growing about the effect of these changes on health care demand and utilization at basic-level health institutions, especially Community Health Services Centers (CHC). Using data from the fourth China National Health Services Survey (NHSS) that was conducted in 2008, the authors conducted a tracer illness study of urban people with acute upper respiratory tract infections (URTI) to examine the factors that affect their use of different outpatient health care providers. The study addresses the observed demand for both public and private providers and is believed to be the first to attempt this for urban China. The findings indicate that overall private clinics are important sources of medical care for low consumption households, that insured patients are less likely to use private clinics and more likely to use CHC and that children are more likely to see a high-level provider. A number of other factors, including city size and severity of illness were found to play a role in determining provider utilization. We discuss the policy implications of the results in terms of meeting the health care needs of the urban population in China.Health care provider Health care seeking behaviour Health care demand Urban health China

Effect of Ultrasonic-Assisted Modification Treatment on the Microstructure and Properties of A356 Alloy

Ultrasonic treatment was applied to an A356 aluminum melt with different modifiers, and the effects of ultrasonic treatment on the structure and properties of the A356 alloy were studied. The results showed that α-Al was effectively refined with different ultrasonic modification treatments. In particular, ultrasonic treatment showed the most obvious refinement with macroscopic grains of unmodified alloy and optimized the refinement of secondary dendrite arm spacings in the Sr/Ce synergistic alloys. The eutectic Si of the unmodified A356 alloy had no obvious change after the ultrasonic treatment, but the branch diameter of the eutectic Si reduced in the Sr and Sr/Ce modification alloys after the ultrasonic treatment. The ultrasonic treatment significantly improved the ultimate tensile strength and elongation of the as-cast A356 alloy with the unmodified material, which was due to refinement of the α-Al grains by the ultrasonic treatment. After the T6 heat treatment, the ultimate tensile strength values of the alloys showed no obvious change due to the ultrasonic treatment, but the plasticity of the alloy was significantly improved. Mg2Si precipitation was the dominant strengthening mechanism during the T6 heat treatment, while the plasticity was determined by the size and distribution of the eutectic Si. Acoustic cavitation caused by the ultrasound-activated impurities and the induced heterogeneous nucleation and supercooled nucleation in the groove melt was the main cause of the α-Al refinement, the eutectic Si modification and the improvement in the mechanical properties

Dynamic Evolution Game of Travelers’ Air-to-HSR Choice under the Scenario of HSR Speed-Up

With the technological advancement, China’s high-speed rail (HSR) has achieved a higher running speed than ever before, which at the same time leads to the intensive competition between air and high-speed rail with trips within 500–1000 km, as well as to the significant changes of travelers’ air-to-HSR choice. In order to explore the dynamic adaptation of travelers’ choice of high-speed rail (HSR) and air in the case of HSR speed-up, a logit dynamics model of travelers’ choice based on evolutionary game was constructed to describe the evolution of travelers’ choice. With HSR-air travel time and the ticket price of origin-destination (OD) points of Beijing-Shanghai as the benchmark, the study set up two scenarios of HSR speed-up and compared and analyzed their payoffs in value. On the basis of mathematical simulation, the travelers’ “air-to-HSR choice” and the change of competition range under the background of HSR speed-up were both discussed. The result indicated that the HSR speed-up would attract more travelers, and its share rate would rise to 58.31% and 72.73%, respectively, with HSR running speed increasing to 400 and 600 km/h; the marginal utility of HSR speed-up is more obvious, and in the meantime, the increase of HSR running speed extends the intense HSR-air competition range to longer-distance travels. In the case of HSR speed-up, travelers’ choice changes as well. The HSR operators themselves should formulate reasonable ticket prices and improve their management. At the same time, the air operators should adjust their operation plan in time