On Communicative Competence in Curriculum Design: A Comparison of the College English Curriculum Requirements and the English Curriculum Standards

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The Knowledge, Attitude, Practices, and Satisfaction of Non-Invasive Prenatal Testing among Chinese Pregnant Women under Different Payment Schemes: A Comparative Study

Non-invasive prenatal testing (NIPT) for aneuploidy screening has been widely applied across China, and costs can affect Chinese pregnant women's choices. This study aims to assess the knowledge, attitude, practices (KAP) and satisfaction regarding NIPT among pregnant women in China, and to further explore the relationship between payment schemes and women's acceptability of and satisfaction with NIPT. A questionnaire survey was performed in Shenzhen and Zhengzhou, China, which separately applied "insurance coverage" and "out-of-pocket" payment scheme for NIPT. The major differences between the two cities were compared using chi-square test, Wilcoxon rank sum test, and propensity score matched analysis. Logistic regression models were applied to explore predictors for women's acceptability and satisfaction. Compared with Zhengzhou participants, a higher proportion of Shenzhen women had heard of NIPT (87.30% vs. 64.03%), were willing to receive NIPT (91.80% vs. 80.43%) and had taken NIPT (83.12% vs. 54.54%), while their satisfaction level was lower. Having NIPT-related knowledge was associated with higher acceptability, and receiving genetic counseling helped to improve satisfaction. Besides, women with higher annual household incomes were more likely to take and be satisfied with NIPT. In conclusion, more attention should be paid to health education, subsidies for NIPT, and genetic counseling

Brake or Step On the Gas? Empirical Analyses of Credit Effects on Individual Consumption

Understanding the effects of credit on consumption is crucial for guiding users’ consumption behavior, designing financial marketing strategies, and identifying credit\u27s value in stimulating the economy. Whereas several studies have endeavored on this issue, most simply utilize observations of a single credit channel and/or focus on an overall effect without considering the potentially heterogeneous short-term and long-term consumption changes. This study, leveraging a quasi-experimental design with high-resolution transaction data, examines how people respond to credit in both short- and long-term periods. Results show that credit users’ consumption amount significantly expand by 51.74% after getting access to credit in the short term. However, they ultimately cut their consumption by 4.02% to cope with financial constraints in the long term. We also reveal and quantify the spillover effects of credit on consumption with savings channels. We draw on regulatory focus theory to rationalize the changes on consumers’ consumption behavior after credit activation

Multi-criteria group decision-making method for green supplier selection based on distributed interval variables

Addressing the multi-criteria group decision making problem with interval attribute values and attribute weights, this paper proposes a decision method based on attribute distribution information. The selection of green suppliers is taken as an example for decision analysis. First, in the case of group decision-making, the quantitative values of the evaluation attributes of green suppliers are imputed by decision-makers, and the relevant distributions are constructed for each attribute. Next, combined with the ranges of attribute values, the random interval values are used to describe the information represented by each attribute to overcome the loss caused by the aggregation of individual expert information into group information. We then propose the distributed interval weighted arithmetic average (DIWAA) operator and corresponding operation rules, which realizes the fusion of qualitative data and quantitative judgment. Thus, the proposed approach allows ensuring reasonable results of the multi-criteria analysis. We also construct a ranking method for alternatives based on distributed interval comprehensive scores. Finally, we verify the feasibility and effectiveness of the proposed method for the task of green supplier selection through numerical experiments

Association between the systemic immune-inflammatory index and the immune response after hepatitis B vaccination: a cross-sectional analysis of NHANES data

AimOur research aimed to investigate the relationship between the systemic immune-inflammatory index (SII) and the immunological response to hepatitis B vaccination.MethodsWe collected data from the National Health and Nutrition Examination Survey database from 2007 to 2018. To examine the association between the SII and immunological response, we conducted weighted multiple regression analysis and subgroup analysis. Furthermore, we utilized restricted cubic splines (RCSs) to analyze the linear relationship between the two variables.ResultsIn our study, we included a total of 6,123 patients, of whom 2,770 tested positive for hepatitis B antibodies. Multivariate logistic regression analysis indicated that, after controlling for all measured factors, a high level of the SII was inversely associated with the presence of antibodies following three doses of the hepatitis B vaccine (OR = 0.8661, 95% CI = 0.7577–0.9899, p = 0.035). Subgroup analysis and interaction testing revealed that sex, age, body mass index, diabetes, and other factors did not significantly influence this negative association (P for interaction >0.05). Additionally, the RCS model revealed no non-linear relationship between the SII and the immune response to the hepatitis B vaccine (p > 0.05). Notably, antibody expression significantly decreased as the SII increased beyond the threshold of 448.3.ConclusionThis cross-sectional study revealed a strong association between low antibody production following hepatitis B vaccination and the SII. However, this cross-sectional study could not establish a causal relationship between the two variables. Therefore, further experimental verification is necessary to confirm the correlation observed in our study

A health economic analysis of an integrated diabetes care program in China: based on real-world evidence

IntroductionAn integrated care program was set up in China to improve the collaboration between primary healthcare centers and hospitals on diabetes management. This study aims to evaluate the economic value of this program with real-world data and to examine whether it can be promoted in primary healthcare settings in China.MethodsThis integrated diabetes care program was implemented in Yuhuan City, China, to coordinate primary care and specialty care, treatment and prevention services, as well as the responsibilities of doctors and nurses. Cost-effectiveness analysis was used to compare the short-term economic value of this program (intervention group) versus usual diabetes management (control group). The cost data were collected from a societal perspective, while the effectiveness indicators pointed to the improvement of control rates of fasting blood glucose (FBG), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels after the 1 year intervention. In addition, cost-utility analysis was applied to evaluate the long-term value of the two groups. Patients’ long-term diabetes management costs and quality-adjusted life years (QALYs) were simulated by the United Kingdom Prospective Diabetes Study Outcomes Model 2.ResultsThe results showed that for 1% FBG, SPB, and DBP control rate improvement, the costs for the intervention group were 290.53, 124.39, and 249.15 Chinese Yuan (CNY), respectively, while the corresponding costs for the control group were 655.19, 610.43, and 1460.25 CNY. Thus, the intervention group’s cost-effectiveness ratios were lower than those of the control group. In addition, compared to the control group, the intervention group’s incremental costs per QALY improvement were 102.67 thousand CNY, which means that the intervention was cost-effective according to the World Health Organization’s standards.DiscussionIn conclusion, this study suggested that this integrated diabetes care program created short-term and long-term economic values through patient self-management support, primary care strengthening, and care coordination. As this program followed the principles of integrated care reform, it can be promoted in China. Also, its elements can provide valuable experience for other researchers to build customized integrated care models

MM-TTS: Multi-modal Prompt based Style Transfer for Expressive Text-to-Speech Synthesis

The style transfer task in Text-to-Speech refers to the process of transferring style information into text content to generate corresponding speech with a specific style. However, most existing style transfer approaches are either based on fixed emotional labels or reference speech clips, which cannot achieve flexible style transfer. Recently, some methods have adopted text descriptions to guide style transfer. In this paper, we propose a more flexible multi-modal and style controllable TTS framework named MM-TTS. It can utilize any modality as the prompt in unified multi-modal prompt space, including reference speech, emotional facial images, and text descriptions, to control the style of the generated speech in a system. The challenges of modeling such a multi-modal style controllable TTS mainly lie in two aspects:1)aligning the multi-modal information into a unified style space to enable the input of arbitrary modality as the style prompt in a single system, and 2)efficiently transferring the unified style representation into the given text content, thereby empowering the ability to generate prompt style-related voice. To address these problems, we propose an aligned multi-modal prompt encoder that embeds different modalities into a unified style space, supporting style transfer for different modalities. Additionally, we present a new adaptive style transfer method named Style Adaptive Convolutions to achieve a better style representation. Furthermore, we design a Rectified Flow based Refiner to solve the problem of over-smoothing Mel-spectrogram and generate audio of higher fidelity. Since there is no public dataset for multi-modal TTS, we construct a dataset named MEAD-TTS, which is related to the field of expressive talking head. Our experiments on the MEAD-TTS dataset and out-of-domain datasets demonstrate that MM-TTS can achieve satisfactory results based on multi-modal prompts.Comment: Accepted at AAAI202

Relationship between diabetic knowledge, attitudes and practices among patients with diabetes in China: a structural equation model

ObjectivesWhether the routine delivery of diabetes-related knowledge can change patients' attitudes and hence influence their self-management activities remains unknown in primary healthcare settings in China. Thus, this study aims to explore the complex transformation process between knowledge, attitude and practice (KAP) among patients with diabetes in a city in China.DesignA cross-sectional study.SettingYuhuan City, Zhejiang Province, China.ParticipantsA total of 803 patients with diabetes were invited to attend a questionnaire survey and 782 patients with type 2 diabetes completed the survey. The average age of participants was 58.47 years old, 48.21% of whom only attended primary school or below.Primary and secondary outcome measuresA questionnaire based on existing scales and expert consultation was applied to assess patients' socio-demographic information (SI), disease progression risk and diabetes-related KAP. A structural equation model was built to analyse the relationships between patients' characteristics and KAP.ResultsNo significant association was found between patients' knowledge and attitude (β=0.01, p=0.43). Better knowledge and attitude were both found to be associated with better diet and physical activities (β=0.58, p<0.001; β=0.46, p=0.01). However, patients with a more positive attitude toward diabetic care showed worse foot care practice (β=-0.13, p=0.02), while better knowledge was associated with better foot care practice (β=0.29, p<0.001). In addition, patients with higher SI (β=0.88, p<0.001) and/or disease progression risk (β=0.42, p<0.001) tended to present higher levels of disease knowledge.ConclusionsWhile successful KAP transformation has been achieved in practice for diet and physical activities, there is a need to improve foot care practice. Health education should also prioritise the prevention, detection and care of diabetic foot. Also, appropriate methods should be adopted to deliver health education to vulnerable patients, such as the elderly, those living in rural areas, those with minimal education, the unemployed and low-income patients

Efficiency trends of essential public health services and possible influencing factors since the new round health reform in China: a case study from Hainan Province

ObjectiveThis article aimed to evaluate the efficiency trends and influencing factors of essential public health services in Hainan Province after the healthcare reform launched in 2009 in China.MethodsThe efficiency of essential public health services (EPHS) at primary health institutions was assessed using data envelopment analysis (DEA), and the efficiency change was analyzed by employing the Malmquist productivity index (MPI). We used Tobit regression to identify the influence of environmental factors on the efficiency of public health services. The bootstrap method was adopted to reduce the impact of random errors on the result.ResultsThe bootstrapping bias-corrected efficiency revealed that the average values of technical efficiency, pure technical efficiency, and scale efficiency were 0.7582, 0.8439, and 0.8997, respectively, which meant that the EPHS in Hainan Province were not at the most effective state. The average bias-corrected MPI was 1.0407 between 2010 and 2011 and 1.7404 between 2011 and 2012. MPIs were less than 1.0000 during other periods investigated, ranging from 0.8948 to 0.9714, indicating that the efficiency of EPHS has been decreasing since 2013. The Tobit regression showed that the regression coefficients of per capita GDP, population density, the proportion of older people aged over 65, and the proportion of ethnic minority population were 0.0286, −0.0003, −0.0316, and − 0.0041 respectively, which were statistically significant (p < 0.05).ConclusionThere was a short-term improvement in the efficiency of EPHS in Hainan after the launch of the new round of health reform. However, this trend has not been sustained after 2013. In particular, equalized financial investment in essential public health could not fulfill the needs of poor counties. This has resulted in the inability to improve scale efficiency in some counties, which in turn has affected the improvement of overall EPHS efficiency. Therefore, to promote EPHS efficiency sustainably, it is suggested that under this model of provincial control of counties, the equity of resource allocation should be effectively improved while further advancing the technology of service delivery