Contracting with private providers for primary care services: Evidence from urban China

Controversy surrounds the role of the private sector in health service delivery, including primary care and population health services. China's recent health reforms call for non-discrimination against private providers and emphasize strengthening primary care, but formal contracting-out initiatives remain few, and the associated empirical evidence is very limited. This paper presents a case study of contracting with private providers for urban primary and preventive health services in Shandong Province, China. The case study draws on three primary sources of data: administrative records; a household survey of over 1600 community residents in Weifang and City Y; and a provider survey of over 1000 staff at community health stations (CHS) in both Weifang and City Y. We supplement the quantitative data with one-on-one, in-depth interviews with key informants, including local officials in charge of public health and government finance. We find significant differences in patient mix: Residents in the communities served by private community health stations are of lower socioeconomic status (more likely to be uninsured and to report poor health), compared to residents in communities served by a government-owned CHS. Analysis of a household survey of 1013 residents shows that they are more willing to do a routine health exam at their neighborhood CHS if they are of low socioeconomic status (as measured either by education or income). Government and private community health stations in Weifang did not statistically differ in their performance on contracted dimensions, after controlling for size and other CHS characteristics. In contrast, the comparison City Y had lower performance and a large gap between public and private providers. We discuss why these patterns arose and what policymakers and residents considered to be the main issues and concerns regarding primary care services

Boiling a Unitary Fermi Liquid

We study the thermal evolution of a highly spin-imbalanced, homogeneous Fermi gas with unitarity limited interactions, from a Fermi liquid of polarons at low temperatures to a classical Boltzmann gas at high temperatures. Radio-frequency spectroscopy gives access to the energy, lifetime, and short-range correlations of Fermi polarons at low temperatures $T$. In this regime, we observe a characteristic $T^2$ dependence of the spectral width, corresponding to the quasiparticle decay rate expected for a Fermi liquid. At high $T$, the spectral width decreases again towards the scattering rate of the classical, unitary Boltzmann gas, $\propto T^{-1/2}$. In the transition region between the quantum degenerate and classical regime, the spectral width attains its maximum, on the scale of the Fermi energy, indicating the breakdown of a quasiparticle description. Density measurements in a harmonic trap directly reveal the majority dressing cloud surrounding the minority spins and yield the compressibility along with the effective mass of Fermi polarons.Comment: Accepted version at PR

Impact of central venous pressure on the mortality of patients with sepsis-related acute kidney injury: a propensity score-matched analysis based on the MIMIC IV database

Central venous pressure (CVP); Database; MortalityPressió venosa central (PVC); Base de dades; MortalitatPresión venosa central (PVC); Base de datos; MortalidadBackground: Sepsis has long been a life-threatening organ dysfunction. Sepsis associated acute kidney injury (SA-AKI) is an important complication of sepsis, as an important hemodynamic index, the impact of central venous pressure (CVP) on sepsis patients needs to be explored. Thus this study aimed to investigate the relationship between CVP and the mortality of SA-AKI. Methods: Clinical data of adult patients with sepsis-related acute kidney injury, defined as met both the Sepsis 3.0 criteria and the Kidney Disease Improving Global Outcomes Clinical Practice Guideline (KDIGO) criteria, were obtained from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. The included cohort was divided into a high CVP and a low CVP group were determined based on the cuf-off value from receiver operating characteristic curve, with propensity score-matched analysis of the 28-day mortality for both groups and sensitivity analysis using inverse the probability-weighting model, multifactorial regression, and doubly robust estimation, patients acquired chronic coronary syndrome (CCS) and diabetes were also taken into consideration. Results: Of 1,377 patients with sepsis-related acute kidney injury, low CVP group (<13 mmHg) was 67.4% (n=928) and high CVP group (≥13 mmHg) was 32.6% (n=449). The two groups were matched 1:1 by propensity score to obtain a matched cohort (n=288). The mortality rates in the low versus high CVP group (19.4% vs. 34.7%) were statistically difference (odds ratio OR: 0.454; 95% confidence interval 0.263, 0.771). Moreover, the bistable analysis of logistic regression of the matched cohort (OR: 0.434; 95% CI: 0.244, 0.757), propensity score inverse probability weighting (IPW) (OR: 0.547; 95% CI: 0.454, 0.658), and multifactorial logistic regression (OR: 0.352; 95% CI: 0.127, 0.932) all yielded the same results. Conclusions: In patients with sepsis-related acute kidney injury, a lower CVP level (<13 mmHg) is an independent variable associated with decreased mortality. The threshold of CVP needs to be controlled in clinical work to improve the prognosis of patients with SA-AKI

Super-radiant and Sub-radiant Cavity Scattering by Atom Arrays

We realize collective enhancement and suppression of light scattered by an array of tweezer-trapped $^{87}$Rb atoms positioned precisely within a strongly coupled Fabry-P\'erot optical cavity. We illuminate the array with light directed transverse to the cavity axis and detect photons scattered by the array into the cavity. For an array with integer-optical-wavelength spacing, in the low saturation regime, each atom Rayleigh scatters light into the cavity with nearly identical scattering amplitude, leading to an observed $N^2$ scaling of cavity photon number as the atom number increases stepwise from N = 1 to N = 8. By contrast, in an array with half-integer-wavelength spacing, the scattering amplitude for neighboring atoms is equal in magnitude but alternates in sign. Scattering from such an array yields a non-monotonic, sub-radiant cavity intensity versus N. By analyzing the polarization of light emitted from the cavity, we find that Rayleigh scattering can be collectively enhanced or suppressed with respect to Raman scattering. We observe also that atom-induced shifts and broadenings of the cavity resonance are precisely tuned by varying the atom number and positions. Altogether, deterministically loaded atom tweezer arrays provide exquisite control of atomic cavity QED spanning from the single- to the many-body regime

Crystallization of Bosonic Quantum Hall States

The dominance of interactions over kinetic energy lies at the heart of strongly correlated quantum matter, from fractional quantum Hall liquids, to atoms in optical lattices and twisted bilayer graphene. Crystalline phases often compete with correlated quantum liquids, and transitions between them occur when the energy cost of forming a density wave approaches zero. A prime example occurs for electrons in high magnetic fields, where the instability of quantum Hall liquids towards a Wigner crystal is heralded by a roton-like softening of density modulations at the magnetic length. Remarkably, interacting bosons in a gauge field are also expected to form analogous liquid and crystalline states. However, combining interactions with strong synthetic magnetic fields has been a challenge for experiments on bosonic quantum gases. Here, we study the purely interaction-driven dynamics of a Landau gauge Bose-Einstein condensate in and near the lowest Landau level (LLL). We observe a spontaneous crystallization driven by condensation of magneto-rotons, excitations visible as density modulations at the magnetic length. Increasing the cloud density smoothly connects this behaviour to a quantum version of the Kelvin-Helmholtz hydrodynamic instability, driven by the sheared internal flow profile of the rapidly rotating condensate. At long times the condensate self-organizes into a persistent array of droplets, separated by vortex streets, which are stabilized by a balance of interactions and effective magnetic forces

Geometric squeezing into the lowest Landau level

The equivalence between neutral particles under rotation and charged particles in a magnetic field relates phenomena as diverse as spinning atomic nuclei, weather patterns, and the quantum Hall effect. In their quantum descriptions, translations along different directions do not commute, implying a Heisenberg uncertainty relation between spatial coordinates. Here, we exploit the ability to squeeze non-commuting variables to dynamically create a Bose-Einstein condensate occupying a single Landau gauge wavefunction in the lowest Landau level. We directly resolve the extent of the zero-point cyclotron orbits, and demonstrate geometric squeezing of the orbits' guiding centers by more than ${7}~$dB below the standard quantum limit. The condensate attains an angular momentum of more than ${1000}\,{\hbar}$ per particle, and an interatomic distance comparable to the size of the cyclotron orbits. This offers a new route towards strongly correlated fluids and bosonic quantum Hall states.Comment: 6 pages, 4 figures and Supplementary Materials of 8 pages, 4 figure

Critical role of FGF21 in diabetic kidney disease: from energy metabolism to innate immunity

Diabetic kidney disease (DKD) stands as the predominant cause of chronic kidney disease (CKD) on a global scale, with its incidence witnessing a consistent annual rise, thereby imposing a substantial burden on public health. The pathogenesis of DKD is primarily rooted in metabolic disorders and inflammation. Recent years have seen a surge in studies highlighting the regulatory impact of energy metabolism on innate immunity, forging a significant area of research interest. Within this context, fibroblast growth factor 21 (FGF21), recognized as an energy metabolism regulator, assumes a pivotal role. Beyond its role in maintaining glucose and lipid metabolism homeostasis, FGF21 exerts regulatory influence on innate immunity, concurrently inhibiting inflammation and fibrosis. Serving as a nexus between energy metabolism and innate immunity, FGF21 has evolved into a therapeutic target for diabetes, nonalcoholic steatohepatitis, and cardiovascular diseases. While the relationship between FGF21 and DKD has garnered increased attention in recent studies, a comprehensive exploration of this association has yet to be systematically addressed. This paper seeks to fill this gap by summarizing the mechanisms through which FGF21 operates in DKD, encompassing facets of energy metabolism and innate immunity. Additionally, we aim to assess the diagnostic and prognostic value of FGF21 in DKD and explore its potential role as a treatment modality for the condition