Does coinsurance reduction influence informer-sector workers’ and farmers’ utilization of outpatient care? A quasi-experimental study in China

Background In recent years, the Chinese government has been trying to improve informal-sector workers’ and farmers’ access to healthcare and reduce their financial burdens by introducing a plan of cost-sharing reduction, but the effect on outpatient care utilization remains unknown. Furthermore, scarce evidence has been provided to help understand the impact of cost-sharing reduction on healthcare use in low- and middle-income countries. The policy change of the coinsurance reduction for outpatient care from 75 to 55% for the enrollees of the Urban and Rural Residents Basic Medical Insurance in Taizhou, China in 2015 provides us a good quasi-experimental setting to explore such an impact. Methods We do a quasi-experimental study to explore the impact of coinsurance reduction on outpatient care use among the informal-sector workers and farmers aged 45 and above by estimating a fixed-effects negative binomial model with the difference-in-differences approach and the matching method. Heterogeneous effects in primary care clinics and for the older people aged 60 and above are also examined. Our data is from the China Health and Retirement Longitudinal Study 2013 and 2015. Results We find neither statistically significant impact of coinsurance reduction on outpatient care utilization in all health facilities for informal-sector workers and farmers aged 45 and above, nor heterogeneous effects in primary care clinics and for older people aged 60 and above. Conclusions We conclude that the coinsurance reduction cannot effectively improve the informal-sector workers’ and farmers’ utilization of healthcare if the cost-sharing undertaken by patients remains high even after the reduction. Besides, improving healthcare quality in primary care clinics may play a more important role than merely introducing a cost-sharing reduction plan in enhancing the role of primary care clinics as gatekeepers. We propose that only a substantial coinsurance reduction may help influence the utilization of healthcare for informal-sector workers and farmers, and enhancing the healthcare quality in primary care clinics should be given priority in low- and middle-income countries

Depressive symptoms among older empty nesters in China: the moderating effects of social contact and contact with one’s children

Objectives: Mental health for older people has become a major social concern. Literature has shown that older people, especially when they become empty nesters—when a parent lives alone or lives with his/her spouse after the youngest child leaves home—may start to develop various mental health problems due to reduced contacts with their children. Methods: Using fixed-effects, multivariate regression with a difference-in-differences approach and propensity score matching, this paper examines the relationship between being an empty nester and mental health among older people in China, and the moderating effects of social contact and contact with one’s children in terms of mental health. Our data come from the China Health and Retirement Longitudinal Study of 2011, 2013, 2015 and 2018. Results: We found that, in the short term, the mental health of older people may not be affected after they became empty nesters. But in the longer term, if they did not have regular contact with their children, their mental health would deteriorate with time. Social contact, especially cognitive activities, was beneficial to the mental health of the older empty nesters. We also found that for older empty nesters with disabilities, frequent social contact and contact with their children were more important. Conclusion: We urge the government to promote community-based social activities for older people, especially for those with functional limitations

Characterizing exons 11 and 1 promoters of the mu opioid receptor (Oprm) gene in transgenic mice

BACKGROUND: The complexity of the mouse mu opioid receptor (Oprm) gene was demonstrated by the identification of multiple alternatively spliced variants and promoters. Our previous studies have identified a novel promoter, exon 11 (E11) promoter, in the mouse Oprm gene. The E11 promoter is located ~10 kb upstream of the exon 1 (E1) promoter. The E11 promoter controls the expression of nine splice variants in the mouse Oprm gene. Distinguished from the TATA-less E1 promoter, the E11 promoter resembles a typical TATA-containing eukaryote class II promoter. The aim of this study is to further characterize the E11 and E1 promoters in vivo using a transgenic mouse model. RESULTS: We constructed a ~20 kb transgenic construct in which a 3.7 kb E11 promoter region and an 8.9 kb E1 promoter region controlled expression of tau/LacZ and tau/GFP reporters, respectively. The construct was used to establish a transgenic mouse line. The expression of the reporter mRNAs, determined by a RT-PCR approach, in the transgenic mice during embryonic development displayed a temporal pattern similar to that of the endogenous promoters. X-gal staining for tau/LacZ reporter and GFP imaging for tau/GFP reporter showed that the transgenic E11 and E1 promoters were widely expressed in various regions of the central nervous system (CNS). The distribution of tau/GFP reporter in the CNS was similar to that of MOR-1-like immunoreactivity using an exon 4-specific antibody. However, differential expression of both promoters was observed in some CNS regions such as the hippocampus and substantia nigra, suggesting that the E11 and E1 promoters were regulated differently in these regions. CONCLUSION: We have generated a transgenic mouse line to study the E11 and E1 promoters in vivo using tau/LacZ and tau/GFP reporters. The reasonable relevance of the transgenic model was demonstrated by the temporal and spatial expression of the transgenes as compared to those of the endogenous transcripts. We believe that these transgenic mice will provide a useful model for further characterizing the E11 and E1 promoter in vivo under different physiological and pathological circumstances such as chronic opioid treatment and chronic pain models

Generative-Discriminative Complementary Learning

Majority of state-of-the-art deep learning methods are discriminative approaches, which model the conditional distribution of labels given inputs features. The success of such approaches heavily depends on high-quality labeled instances, which are not easy to obtain, especially as the number of candidate classes increases. In this paper, we study the complementary learning problem. Unlike ordinary labels, complementary labels are easy to obtain because an annotator only needs to provide a yes/no answer to a randomly chosen candidate class for each instance. We propose a generative-discriminative complementary learning method that estimates the ordinary labels by modeling both the conditional (discriminative) and instance (generative) distributions. Our method, we call Complementary Conditional GAN (CCGAN), improves the accuracy of predicting ordinary labels and can generate high-quality instances in spite of weak supervision. In addition to the extensive empirical studies, we also theoretically show that our model can retrieve the true conditional distribution from the complementarily-labeled data

Parallel navigation for 3-D autonomous vehicles

summary:In this paper, parallel navigation is proposed to track the target in three-dimensional space. Firstly, the polar kinematics models for the vehicle and the target are established. Secondly, parallel navigation is derived by using polar kinematics models. Thirdly, cell decomposition method is applied to implement obstacle avoidance. Fourthly, a brief study is given on the influence of uncertainties. Finally, simulations are conducted by MATLAB. Simulation results demonstrate the effectiveness of the parallel navigation

Coded Caching Schemes for Two-dimensional Caching-aided Ultra-Dense Networks

Coded caching technique is an efficient approach to reduce the transmission load in networks and has been studied in heterogeneous network settings in recent years. In this paper, we consider a new widespread caching system called $(K_1,K_2,U,r,M,N)$ two-dimensional (2D) caching-aided ultra-dense network (UDN) with a server containing $N$ files, $K_1K_2$ cache nodes arranged neatly on a grid with $K_1$ rows and $K_2$ columns, and $U$ cache-less users randomly distributed around cache nodes. Each cache node can cache at most $M\leq N$ files and has a certain service region by Euclidean distance. The server connects to users through an error-free shared link and the users in the service region of a cache node can freely retrieve all cached contents of this cache node. We aim to design a coded caching scheme for 2D caching-aided UDN systems to reduce the transmission load in the worst case while meeting all possible users' demands. First, we divide all possible users into four classes according to their geographical locations. Then our first order optimal scheme is proposed based on the Maddah-Ali and Niesen scheme. Furthermore, by compressing the transmitted signals of our first scheme based on Maximum Distance Separable (MDS) code, we obtain an improved order optimal scheme with a smaller transmission load.Comment: 44 page