Reengineering the management process of hospital consumable medical supplies to reduce cost and improve quality: an empirical study in China

JEL: M00As the society continues developing and people’s living standards rise in China, the top priority of its new medical reform has become pushing forward public hospital reform and optimizes the medical service system. At the same time, the medical reform’s guiding principles for operating the country’s hospital system have changed into maintaining non-profit medical institutions as the main body of the healthcare system, for-profit medical institutions as supplements; public medical institutions playing the leading role, and encouraging the concurrent development of non-public medical institutions. This change in guiding principles has led to intensified competition among hospitals. To survive in the competition, hospitals are emphasizing on reducing cost and improving service quality. Therefore, reducing cost and providing high quality medical services has become an important goal for hospital management. With continued advancement of medical technologies, the type and the quantity of medical supplies have been continuously increasing. The number of wasted medical supplies has also been increasing rapidly. Medical supplies include three major categories, namely, pharmaceuticals, consumable medical supplies, and medical logistical materials (Fu, 2009). This thesis aims to study the management of consumable medical supplies. This thesis examines how hospitals can achieve inventory reduction of hospital consumable supplies, improve management quality, and lower cost by reengineering and optimizing the management process of the whole lifecycle of consumable medical supplies, including production, circulation, hospital, units and utilization, and by utilizing information management systems. The first half of the thesis describes the theoretical bases of reengineering and optimization as well as information systems utilized to achieve improved hospital consumable supply management. The second half uses three groups of data, namely, interviews, a case study and questionnaire surveys, to provide analysis results of successful use of reengineering and optimization as well as information system to improve hospital consumable supply management process in China. The first group of data includes interviews of several managers from three companies providing hospital consumable medical supplies which offer qualitative analyses regarding the problems in hospital consumable medical supply management process, solutions to resolve those problems, and challenges in solution implementing. The second group of data includes a case study of a large hospital in Shanghai, from the supplier’s perspective, of their consumable medical supply management process resulted from the restructured information systems platform. The third group of data includes questionnaire survey responses from leaders of multiple hospitals regarding comparisons of its consumable medical supply management process and results between before and after the implementation of the information systems platform.À medida que a sociedade Chinesa se desenvolve e as condições de vida melhoram, a prioridade da reforma médica tem vindo a concentrar-se na reestruturação dos hospitais públicos e na otimização do sistema médico nacional. Ao mesmo tempo, os princípios orientadores do funcionamento do sistema hospitalar nacional mantêm as instituições médicas não orientadas para o lucro como o corpo principal da sistema de saúde, e as instituições orientadas para o lucro como suplementares; em suma, enquanto as instituições médicas públicas desempenham o papel principal no sistema de saúde, o desenvolvimento de instituições privadas é incentivado. Esta mudança de princípios desencadeou uma concorrência entre hospitais. Para sobreviverem no ambiente cada vez mais concorrencial, os hospitais concentraram-se na redução de custos e na melhoria da qualidade dos seus serviços. Deste modo a redução dos custos e a melhoria dos serviços médicos prestados transformaram-se em objetivos principais, para os gestores hospitalares. Com a evolução contínua das tecnologias médicas, o tipo e a quantidade de fornecimentos hospitalares tem vindo a aumentar. A quantidade de desperdícios resultantes dos fornecimentos hospitalares tem também aumentado de uma forma muito rápida. Os fornecimentos hospitalares consumíveis incluem três categorias: farmacêutica, consumíveis médicos e materiais de logística (Fu, 2009). Esta tese tem como objetivo principal investigar a gestão dos fornecimentos médicos consumíveis. Esta tese investiga como os hospitais podem diminuir o inventário dos fornecimentos hospitalares consumíveis, melhorar a qualidade da gestão e baixar o custo através da reengenharia e otimização da gestão de todo o processo de vida dos consumíveis médicos, incluindo a produção, a circulação e utilização, apoiando-se sistemas de informação para a gestão. A primeira parte desta tese descreve as bases teóricas da reengenharia e otimização, assim como dos sistemas de informação utilizados para conseguir a melhoria da gestão dos fornecimentos. A segunda parte utiliza três tipos de dados, nomeadamente, dados recolhidos através de entrevistas, dados provenientes de um caso, e dados recolhidos através de um questionário. Estes dados permitem-nos descrever casos de sucesso na melhoria da gestão dos fornecimentos hospitalares na China. Os dados provenientes das entrevistas a gestores de três empresas fornecedoras de consumíveis médicos permitem-nos, uma visão qualitativa dos problemas e soluções para os resolver. Os dados provenientes do estudo de caso de um grande hospital de Shanghai, na perspetiva dos fornecedores fornecem-nos uma ideia da importância da existência de plataforma de sistemas de informação. O terceiro grupo de dados é proveniente dos questionários administrados a gestores de hospitais onde se questiona sobre a situação da gestão dos consumíveis médicos hospitalares antes e depois da existência de plataformas de informação

Study of spatio-temporal modeling in video quality assessment

Video quality assessment (VQA) has received remarkable attention recently. Most of the popular VQA models employ recurrent neural networks (RNNs) to capture the temporal quality variation of videos. However, each long-term video sequence is commonly labeled with a single quality score, with which RNNs might not be able to learn long-term quality variation well. A natural question then arises: What’s the real role of RNNs in learning the visual quality of videos? Does it learn spatio-temporal representation as expected or just aggregating spatial features redundantly? In this study, we conduct a comprehensive study by training a family of VQA models with carefully designed frame sampling strategies and spatio-temporal fusion methods. Our extensive experiments on four publicly available in-the-wild video quality datasets lead to two main findings. First, the plausible spatio-temporal modeling module ( i.e ., RNNs) does not facilitate quality-aware spatio-temporal feature learning. Second, sparsely sampled video frames are capable of obtaining the competitive performance against using all video frames as the input. In other words, spatial features play a vital role in capturing video quality variation for VQA. To our best knowledge, this is the first work to explore the issue of spatio-temporal modeling in VQA

Proteomic profiling of eIF3a conditional knockout mice

Eukaryotic translation initiation factor 3 subunit A (eIF3a) is the largest subunit of the eukaryotic translation initiation factor 3 (eIF3). eIF3a plays an integral role in protein biosynthesis, hence impacting the onset, development, and treatment of tumors. The proteins regulated by eIF3a are still being explored in vivo. In this study, a Cre-loxP system was used to generate eIF3a conditional knockout mice. Tandem mass tag (TMT) labeling with LC-MS/MS analysis was used to identify differentially expressed proteins (DEPs) in fat, lungs, skin, and spleen tissue of the eIF3a knockout mice and controls. Bioinformatics analysis was then used to explore the functions and molecular signaling pathways of these protein landscapes. It was observed that eIF3a is essential for life sustenance. Abnormal tissue pathology was found in the lungs, fat, skin, spleen, and thymus. In total, 588, 210, 324, and 944 DEPs were quantified in the lungs, fat, skin, and spleen, respectively, of the eIF3a knockout mice as compared to the control. The quantified differentially expressed proteins were tissue-specific, except for eight proteins shared by the four tissues. A broad range of functions for eIF3a, including cellular signaling pathway, immune response, metabolism, defense response, phagocytes, and DNA replication, has been revealed using bioinformatics analysis. Herein, several pathways related to oxidative stress in the Kyoto Encyclopedia of Genes and Genomes (KEGG) database, including nitrogen metabolism, peroxisome, cytochrome P450 drug metabolism, pyruvate metabolism, PPAR signaling pathway, phospholipase D signaling pathway, B-cell receptor signaling pathway, ferroptosis, and focal adhesion, have been identified. Collectively, this study shows that eIF3a is an essential gene for sustaining life, and its downstream proteins are involved in diverse novel functions beyond mRNA translational regulation

Complex 3D microfluidic architectures formed by mechanically guided compressive buckling.

Microfluidic technologies have wide-ranging applications in chemical analysis systems, drug delivery platforms, and artificial vascular networks. This latter area is particularly relevant to 3D cell cultures, engineered tissues, and artificial organs, where volumetric capabilities in fluid distribution are essential. Existing schemes for fabricating 3D microfluidic structures are constrained in realizing desired layout designs, producing physiologically relevant microvascular structures, and/or integrating active electronic/optoelectronic/microelectromechanical components for sensing and actuation. This paper presents a guided assembly approach that bypasses these limitations to yield complex 3D microvascular structures from 2D precursors that exploit the full sophistication of 2D fabrication methods. The capabilities extend to feature sizes <5 μm, in extended arrays and with various embedded sensors and actuators, across wide ranges of overall dimensions, in a parallel, high-throughput process. Examples include 3D microvascular networks with sophisticated layouts, deterministically designed and constructed to expand the geometries and operating features of artificial vascular networks

A Study on the Radiosensitivity of Radiation-Induced Lung Injury at the Acute Phase Based on Single-Cell Transcriptomics

Background and AimsRadiation-induced lung injury (RILI) is the most common complication associated with chest tumors, such as lung and breast cancers, after radiotherapy; however, the pathogenic mechanisms are unclear. Single-cell RNA sequencing has laid the foundation for studying RILI at the cellular microenvironmental level. This study focused on changes during the acute pneumonitis stage of RILI at the cellular microenvironmental level and investigated the interactions between different cell types.MethodsAn acute RILI model in mice and a single-cell transcriptional library were established. Intercellular communication networks were constructed to study the heterogeneity and intercellular interactions among different cell types.ResultsA single-cell transcriptome map was established in a mouse model of acute lung injury. In total, 18,500 single-cell transcripts were generated, and 10 major cell types were identified. The heterogeneity and radiosensitivity of each cell type or subtype in the lung tissues during the acute stage were revealed. It was found that immune cells had higher radiosensitivity than stromal cells. Immune cells were highly heterogeneous in terms of radiosensitivity, while some immune cells had the characteristics of radiation resistance. Two groups of radiation-induced Cd8+Mki67+ T cells and Cd4+Cxcr6+ helper T cells were identified. The presence of these cells was verified using immunofluorescence. The ligand-receptor interactions were analyzed by constructing intercellular communication networks. These explained the origins of the cells and revealed that they had been recruited from endothelial cells to the inflammatory site.ConclusionsThis study revealed the heterogeneity of in vivo radiosensitivity of different cell types in the lung at the initial stage post irradiatio

Bioinspired Ultrathin Piecewise Controllable Soft Robots

In nature, animals or plants often use soft organs to move and hunt. Research works on bioinspired materials and devices have attracted more and more interest as which show the potential for future intelligent robots. As key components of soft robots, biomimetic soft actuators are adapted to greater requirements for convenient, accurate, and programmable controlling robots. Here, a class of materials and processing routes of ultrathin actuators are reported for bioinspired piecewise controllable soft robots, where the actuators associate with thermal-responsible soft silicone thin film with thickness as thin as 45 µm and electrically driven by well mechanical designed metallic thin film electrodes. Multiple electrodes in the robots in charge of individual segments control allow the soft robots exhibiting similar functionalities of animals or plants (for example, imitating the tongue of a reptile, such as chameleon to hunt moving preys, and mimicking vines to tightly wind around objects). These bionic results in the soft robots demonstrate their advantages in precise and flexible operation, which provides a good reference for the future research of intelligent soft actuators and robots.acceptedVersionPeer reviewe

Polytropic Influence of TRIB3 rs2295490 Genetic Polymorphism on Response to Antihypertensive Agents in Patients With Essential Hypertension

Tribbles homolog 3 (TRIB3) mediating signaling pathways are closely related to blood pressure regulation. Our previous findings suggested a greater benefit on vascular outcomes in patients carrying TRIB3 (251, A &gt; G, rs2295490) G allele with good glucose and blood pressure control. And TRIB3 (rs2295490) AG/GG genotypes were found to reduce primary vascular events in type 2 diabetic patients who received intensive glucose treatment as compared to those receiving standard glucose treatment. However, the effect of TRIB3 genetic variation on antihypertensives was not clear in essential hypertension patients. A total of 368 patients treated with conventional dosage of antihypertensives (6 groups, grouped by atenolol/bisoprolol, celiprolol, doxazosin, azelnidipine/nitrendipine, imidapril, and candesartan/irbesartan) were enrolled in our study. Genetic variations were successfully identified by sanger sequencing. A linear mixed model analysis was performed to evaluate blood pressures among TRIB3 (251, A &gt; G) genotypes and adjusted for baseline age, gender, body mass index, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol and other biochemical factors appropriately. Our data suggested that TRIB3 (251, A &gt; G) AA genotype carriers showed better antihypertensive effect than the AG/GG genotype carriers [P = 0.014 for DBP and P = 0.042 for mean arterial pressure (MAP)], with a maximal reduction of DBP by 4.2 mmHg and MAP by 3.56 mmHg after azelnidipine or nitrendipine treatment at the 4th week. Similar tendency of DBP-change and MAP-change was found for imidapril (ACEI) treatment, in which marginally significances were achieved (P = 0.073 and 0.075, respectively). Against that, we found that TRIB3 (251, A &gt; G) AG/GG genotype carriers benefited from antihypertensive therapy of ARBs with a larger DBP-change during the period of observation (P = 0.036). Additionally, stratified analysis revealed an obvious difference of the maximal blood pressure change (13 mmHg for the MAP between male and female patients with AA genotype who took ARBs). Although no significant difference in antihypertensive effect between TRIB3 (251, A &gt; G) genotypes in patients treated with α, β-ADRs was observed, we found significant difference in age-, sex-dependent manner related to α, β-ADRs. In conclusion, our data supported that TRIB3 (251, A &gt; G) genetic polymorphism may serve as a useful biomarker in the treatment of hypertension

Compliant and stretchable thermoelectric coils for energy harvesting in miniature flexible devices

With accelerating trends in miniaturization of semiconductor devices, techniques for energy harvesting become increasingly important, especially in wearable technologies and sensors for the internet of things. Although thermoelectric systems have many attractive attributes in this context, maintaining large temperature differences across the device terminals and achieving low–thermal impedance interfaces to the surrounding environment become increasingly difficult to achieve as the characteristic dimensions decrease. Here, we propose and demonstrate an architectural solution to this problem, where thin-film active materials integrate into compliant, open three-dimensional (3D) forms. This approach not only enables efficient thermal impedance matching but also multiplies the heat flow through the harvester, thereby increasing the efficiencies for power conversion. Interconnected arrays of 3D thermoelectric coils built using microscale ribbons of monocrystalline silicon as the active material demonstrate these concepts. Quantitative measurements and simulations establish the basic operating principles and the key design features. The results suggest a scalable strategy for deploying hard thermoelectric thin-film materials in harvesters that can integrate effectively with soft materials systems, including those of the human body