Stratified Approach Research Articles

A Novel Framework for Stratified-Coupled BLS Tree Trunk Detection and DBH Estimation in Forests (BSTDF) Using Deep Learning and Optimization Adaptive Algorithm

Diameter at breast height (DBH) is a critical metric for quantifying forest resources, and obtaining accurate, efficient measurements of DBH is crucial for effective forest management and inventory. A backpack LiDAR system (BLS) can provide high-resolution representations of forest trunk structures, making it a promising tool for DBH measurement. However, in practical applications, deep learning-based tree trunk detection and DBH estimation using BLS still faces numerous challenges, such as complex forest BLS data, low proportions of target point clouds leading to imbalanced class segmentation accuracy in deep learning models, and low fitting accuracy and robustness of trunk point cloud DBH methods. To address these issues, this study proposed a novel framework for BLS stratified-coupled tree trunk detection and DBH estimation in forests (BSTDF). This framework employed a stratified coupling approach to create a tree trunk detection deep learning dataset, introduced a weighted cross-entropy focal-loss function module (WCF) and a cosine annealing cyclic learning strategy (CACL) to enhance the WCF-CACL-RandLA-Net model for extracting trunk point clouds, and applied a (least squares adaptive random sample consensus) LSA-RANSAC cylindrical fitting method for DBH estimation. The findings reveal that the dataset based on the stratified-coupled approach effectively reduces the amount of data for deep learning tree trunk detection. To compare the accuracy of BSTDF, synchronous control experiments were conducted using the RandLA-Net model and the RANSAC algorithm. To benchmark the accuracy of BSTDF, we conducted synchronized control experiments utilizing a variety of mainstream tree trunk detection models and DBH fitting methodologies. Especially when juxtaposed with the RandLA-Net model, the WCF-CACL-RandLA-Net model employed by BSTDF demonstrated a 6% increase in trunk segmentation accuracy and a 3% improvement in the F1 score with the same training sample volume. This effectively mitigated class imbalance issues encountered during the segmentation process. Simultaneously, when compared to RANSAC, the LSA-RANCAC method adopted by BSTDF reduced the RMSE by 1.08 cm and boosted R2 by 14%, effectively tackling the inadequacies of RANSAC’s filling. The optimal acquisition distance for BLS data is 20 m, at which BSTDF’s overall tree trunk detection rate (ER) reaches 90.03%, with DBH estimation precision indicating an RMSE of 4.41 cm and R2 of 0.87. This study demonstrated the effectiveness of BSTDF in forest DBH estimation, offering a more efficient solution for forest resource monitoring and quantification, and possessing immense potential to replace field forest measurements.

Water consumption rationalization using demarketing strategies in the Gaza Strip, Palestine

Water access is a critical public policy problem that many people face worldwide. As demand for fresh water rises and supply declines, a growing number of regions and localities, including cities, will be compelled to respond to water shortages. Therefore, this paper aims to examine the rationalization of water consumption utilizing demarketing strategies in the Gaza Strip (GS), Palestine. The population under study comprises the residents of the GS, amounting to approximately 2.1 million (2021) individuals. A survey among 372 respondents living and working in the five GS governorates, using a stratified random sample approach to mirror the population distribution, finds a significant relationship between consumer attitudes toward reducing water consumption and 5 key marketing variables (product, price, place, promotion, and people). Furthermore, four moderators reinforced these relationships, i.e., the perceived role of laws and legislations, perceived moral obligation, perceived water right, and institutional sentiment toward the water authority's management of water resources. Additionally, age, education level, marital status, and monthly income influence the effect of the demarketing mix on consumer attitudes toward reducing water consumption. This study informs managerial action and policy-making about the key variables to modulate in order to improve consumers' attitudes toward water rationalization and thus intrinsically motivate consumers to curb water consumption.

Relationship between Restorative Practices and School Climate at Secondary Level District Lahore

The purpose of the study was to explore and compare the relationships between RPs and SC. The population consists of all public (male/female) and private (male/female) secondary school systems with 10 or more branches in the Lahore district. Multistage sampling techniques were used. The researcher used the cluster sampling approach to split the entire population into five groups (Tehsils). By using the stratified sampling approach, the researcher was able to identify two groups of strata: public/private, as well as male/female. From the private sector, a sample consisting of five male and five female schools from each tehsil in Lahore was selected. 520 teachers as a sample were selected. A questionnaire was used as a data collection tool. The researcher used both descriptive and inferential statistics. The findings revealed a strong positive relationship between restorative practices and school climate, there is no significant difference between RPs and SC of public and private schools and there is a significant difference between RPs and SC of male and female. For future research, it recommended that Schools should invest in training and resources to effectively implement RPs, which can promote a more inclusive, supportive, and positive SC.

Impact of Administrative Practices and Effective of Employee Performance: An Empirical Study among Public University Employees in Pakistan

Past studies have been conducted to examine the effects of administrative practices on Employees’ job Performance in developed countries but only rare researches were directed in developing countries like Pakistan. Pakistan is still lacking behind to conduct the research in the administrative practices. This study mainly focuses on the education sector. The study is descriptive in its nature. In this study population was comprised of all employees from public Universities in Punjab, Pakistan. 180 respondents were selected through stratified random sampling approach from 6 public universities. The Data was collected through questionnaire contained 5-point Likert scale arrangement. Administrative practices were an independent variable whereas job satisfaction of the employees was a dependent variable. The two questionnaires (administrative practices and job performance) were developed for this study. The main dimensions included in administrative practices were compensation, training & development, career planning and recruitment selection. On the other hand, the main dimensions in job performance questionnaire were quality of work, productivity, knowledge of job and interpersonal relations. There were total 32 questions. The result of the study showed that there was strong and positive effect of administrative practices on job performance of the employees at university level.

Pre-Processing Training Data Improves Accuracy and Generalisability of Convolutional Neural Network Based Landscape Semantic Segmentation

Data pre-processing for developing a generalised land use and land cover (LULC) deep learning model using earth observation data is important for the classification of a different date and/or sensor. However, it is unclear how to approach deep learning segmentation problems in earth observation data. In this paper, we trialled different methods of data preparation for Convolutional Neural Network (CNN) training and semantic segmentation of LULC features within aerial photography over the Wet Tropics and Atherton Tablelands, Queensland, Australia. This was conducted by trialling and ranking various training patch selection sampling strategies, patch and batch sizes, data augmentations and scaling and inference strategies. Our results showed: a stratified random sampling approach for producing training patches counteracted class imbalances; a smaller number of larger patches (small batch size) improves model accuracy; data augmentations and scaling are imperative in creating a generalised model able to accurately classify LULC features in imagery from a different date and sensor; and producing the output classification by averaging multiple grids of patches and three rotated versions of each patch produced a more accurate and aesthetic result. Combining the findings from the trials, we fully trained five models on the 2018 training image and applied the model to the 2015 test image. The output LULC classifications achieved an average kappa of 0.84, user accuracy of 0.81, and producer accuracy of 0.87. Future research using CNNs and earth observation data should implement the findings of this project to increase LULC model accuracy and transferability.

Short intravenous amphotericin B followed by oral posaconazole using a simple, stratified treatment approach for diabetes or COVID-19-associated rhino-orbito-cerebral mucormycosis: a prospective cohort study

ObjectivesTo evaluate the efficacy and safety of short-course intravenous amphotericin B followed by sustained release posaconazole tablets for diabetes or COVID-19-associated rhino-orbito-cerebral mucormycosis. MethodsThis prospective, pragmatic study included adults with diabetes or COVID-19-associated rhino-orbito-cerebral mucormycosis. Patients received short (7–14 days) or long (15–28 days) intravenous antifungal therapy (short intravenous antifungal treatment [SHIFT] or long intravenous antifungal treatment [LIFT], respectively) depending on the presence or absence of brain involvement. All patients received step-down posaconazole tablets, debridement, and glycemic control. The primary outcome was the treatment success at week 14, which was determined by assessing survival and the absence of disease progression through clinical evaluation and nasal endoscopy. Log-binomial regression analysis (risk ratio and 95% CI) was performed to assess factors associated with the primary outcome. ResultsIntravenous therapy was administered to 251 participants: SHIFT, 205 (median duration, 13 days); LIFT, 46 (median duration, 22 days). Treatment success at 3 months was 88% (217/248; 95% CI, 83–91%): SHIFT group, 93% (189/203; 89–96%); LIFT group, 62% (28/45; 47–76%). All-cause mortality was 12% (30/251): SHIFT group, 6% (13/205); LIFT group, 37% (17/46). Age (aRR [95% CI]: 1.02 [1.00–1.05]; p 0.027), diabetic ketoacidosis at presentation (2.32 [1.20–4.46]; p 0·012), glycated haemoglobin A1c (1.19 [1.03–1.39]; p 0.019), stroke (3.93 [1.94–7.95]; p 0·0001), and brain involvement (5.67 [3.05–10.54]; p < 0.0001) were independently associated with unsuccessful outcomes. Discussion: Short intravenous amphotericin B with step-down posaconazole tablets should be further studied as primary treatment option for diabetes or COVID-19-associated mucormycosis in randomized controlled trials.

HUBUNGAN PENGGUNAAN SMARTPHONE DENGAN POLA TIDUR PADA ANAK KELAS IV DAN V DI SDN KRAMATJEGU 1 TAMAN SIDOARJO

Smartphone usage in children if not controlled can have an impact on health, one of which is lack of sleep needs anathoer factor that can affect sleep is fatigue after physical activity such as traditional play. This study will identify of smartphone usage, traditional play activities, sleep patterns in children, analyze the relationship of using smartphone with sleep patterns and analyze the relationship traditional play activities and sleep patterns.The study used design observasional design with cross-sectional approach. The independent variable was the use of smartphone , traditional play activity and the dependent variable was sleep patterns. The sample were 54 children on smartphone use and 54 children on traditional play activities, used probability sampling technique with the Stratified random sampling approach. The instrument on this study used questionnaire SAS , traditional play activities and PSQI, analyzed were by Spearman rho test. The results showed the level of smartphone usage is at most moderate (50.0%) and traditional play activities is at most highest (40.7%) with sleep patterns on smartphone use moderate (51.9%) and with sleep patterns on traditional play activities good (44.4%). Spearman rho test showed there is no relationship between using smartphone with sleep patterns r= 0.572 (r≤a = 0.05) and there is no relationship between traditional play activities with sleep patternsr= 0.481 (r≤a = 0.05). Implications of the results showed the use of no smartphone usage don’t have relationship with sleep patterns in children and there is traditional play activities don’t have relationship with sleep patterns in children. This research is useful for parents in monitoring play activities carried out by children

Uptake and determinants of childhood vaccination status among children aged 0–12 months in three West African countries

BackgroundVaccination has long been recognized as one of the most effective ways to reduce child mortality. It has played a significant role, particularly for children, and is considered a major achievement and relevant in preventing childhood diseases worldwide. This study looks at the uptake and determinants of childhood vaccination status among children under the age of one year, for Gambia, Sierra Leon, and Liberia.MethodData from 2019 to 20 Demographic and Health Survey (DHS) data from Gambia, Sierra Leone, and Liberia were pooled for the analysis used in this study. Data were obtained from a total weighted sample of 5,368 children aged 0–12 months through a stratified two-stage cluster sampling approach. A multivariable logistic regression model was used to assess the predictors of childhood vaccination uptake at 95% confidence interval (CIs) with computed adjusted odds ratios (aORs).ResultsThe weighted sample pooled prevalence of full vaccination among children under 12 months of age was 15.1% for males and 15.0% for females. After controlling for confounders in the regression model, factors that were found to be associated with vaccination status include children whose mothers attended postnatal care (PNC) visits had higher odds of being fully vaccinated (aOR = 1.23, 95% CI = 1.03–1.46), while children whose fathers had primary education (aOR = 0.67, 95% CI = 0.48–0.96), children whose households never watched TV (aOR = 0.68, 95% CI = 0.56–0.82) and children whose mothers attended 1–3 antenatal care (ANC) visits (aOR = 0.59, 95% CI = 0.45–0.79) had lower odds of being fully vaccinated.ConclusionChildhood vaccination uptake was low among children under 12 months of age in these countries. Hence, there is a need to promote the uptake of vaccination across these three West African countries especially among rural dwellers.

Effect of Foot Reflexology on Laboratory Tests after Kidney Transplantation Surgery: A Secondary Analysis of a Parallel Randomized Controlled Trial Study

Foot reflexology has improved numerous physical and psychological symptoms in patients. The researchers in this study aimed to investigate the effect of foot reflexology on laboratory parameters, intake/output/weight and medication regimen after kidney transplant surgery. The research was a secondary analysis of a parallel randomized controlled trial. The research included patients who were admitted to the transplantation ward. The stratified randomization approach divided 53 eligible patients into two groups: foot reflexology and control. The intervention group was given 30 minutes of foot reflexology daily for three days while the control group received no reflexology. The intervention began on the second day following surgery. The demographic information questionnaire and information about laboratory tests and intake, output and weight were extracted from patients' records before, immediately and one week after the intervention. Before the kidney transplantation surgery and during the intervention, the laboratory tests of the two groups of foot reflexology and control laboratory tests were similar. During the intervention, no significant differences in intake, output, and weight values were found between the two groups of foot reflexology and control (P &gt; 0.05). The present study showed that foot reflexology had no particular effects on laboratory tests, intake/output, weight and diet of patients after kidney transplantation. Further studies are needed to achieve more accurate results in this area.

Stratified primary care for adults with musculoskeletal pain: the STarT MSK research programme including RCTs

Stratified primary care for adults with musculoskeletal pain: the STarT MSK research programme including RCTs

Palestinian Political Prisoners: Hunger Strikes and the Battle for Dignity

Thousands of Palestinians have been imprisoned in Israeli jails since 1948, reflecting an objective of Israel's occupation of Palestine to break the spirit of Palestinians in their struggle for liberation. A form of protest often undertaken by Palestinians in response to their political imprisonment is hunger strike. Indeed, when considered in relation to governance as an enactment of power upon people in prison, hunger strikes are an attempt of powerless prisoners to exercise some level of power over their circumstances. Concepts around hunger strike as form of protest are complex and multidimensional, and may reflect the interests of an individual or group, and/or speak more to the broader rights of people. Of interest to this study is the relationship between hunger strike and human dignity as manifest as a form of protest by Palestinians incarcerated in Israeli jails. Specifically, this study aimed to investigate the extent to which the concept of human dignity is a fundamental principle guiding Palestinian political prisoners' initial decision to hunger strike and then to continue to hunger strike. To facilitate the investigation, a stratified sampling approach was used to support the collection of quantitative data via a survey of 29 expolitical prisoners who had participated in hunger strikes during their imprisonment in Israeli jails. The collected data were related to three core dimensions of the protest construct: motivations for undertaking the protest (hunger strike); personal feelings when undertaking protest; and the experienced responses to/outcomes of the protest. Analysis of the participants' responses and the reporting of the main findings was informed by reference to key theoretical frameworks developed by Habermas, Kant, Sartre, and Durkheim. This study found that Palestinian political prisoners often considered human dignity to be more important than food. They therefore believed that hunger strike was a way to express that they would not surrender their dignity nor stray from their resistance. This article contributes to the important debate on the extent to which the hunger strike is an effective way to protest against the loss of human dignity experienced as a Palestinian political prisoner.

Effects of Social Media Advertising on Consumer Buying Decision Making Process: A Case of Leading Online Shopping Sites in Kenya

The goal of this research was to assess the influence of social media advertising on the buying decision-making process of consumers, using the case of leading online shopping sites in Kenya. the theory of reasoned action was used to frame this investigation. The study was conducted using a descriptive research approach, and the participants were management staff from five online shopping sites situated in Nairobi, Kenya. The population of study included members of staff in the management of top five (5) selected Online Shopping Sites in Kenya: Jumia, Kilimall, Jiji Kenya, Masoko and Copia. After randomly selecting 200 respondents from the target population, the stratified sampling approach was used to pick an unbiased sample of 133 respondents from the target population of 200 respondents. Primary data was gathered via the use of questionnaires. The research issued a total of 133 questionnaires and a total of 90 were filled and returned giving a response rate of 68%. The data will be analyzed with the help of the Statistical Package for Social Sciences (SPSS) software. For ease of understanding, data was coded according to various variables and descriptive statistics such as frequencies, means, and standard deviations. Analysis of regression and correlation were carried out in order to analyze and establish the link between the variables under investigation. The findings on the effect of use of social media advertising on consumer buying decision revealed that respondents agreed that the social media pages is interactive and it influences consumers shopping experience, Facebook and Twitter pages offer content aligned with the brand and gives consumers reasons to keep engaging with the company, making emotional connections through positive consumer experiences, exceptional service and engaging conversations has significantly influenced social media marketing. Respondents also agreed that changing the conversation and engaging fully with existing consumers increases the level of social media marketing. The study recommended that Online shopping sites should develop an online platform that will be engaging fully with existing consumers, providing sufficient information and personal, interesting, timely and responsive.

أثر حوكمة المصارف على جودة المعلومات المحاسبية (دراسة ميدانية على عينة من المصارف السودانية العاملة بولاية القضارف)

هدفت الدراسة إلى قياس أثر حوكمة المصارف بآلياتها الداخلية والخارجية على جودة المعلومات المحاسبية من وجهة نظر منتجي ومستخدمي المعلومات المحاسبية بعيّنة من المصارف العاملة بولاية القضارف. تكوّن مجتمع الدراسة من (52) مصرفيًا، تم اختيار عيّنة الدراسة ممن هم على رأس العمل باستخدام أسلوب العيّنة الطبقية العشوائية. استخدمت الدراسة المنهج المسحي الوصفي التحليلي، وحُللت البيانات باستخدام التحليل الإحصائي الـــ SPSS وتحليل الانحدار البسيط والمتعدد. أظهرت النتائج وجود أثر لتطبيق حوكمة المصارف على جودة المعلومات المحاسبية، وأن مستوى تطبيق حوكمة المصارف، وجودة المعلومات المحاسبية جاء بدرجة مرتفعة. كما أنّ هنالك علاقة متوسطة لتطبيق آليات الحوكمة على جودة المعلومات المحاسبية، وأن تطبيق آليات الحوكمة الخارجية يفوق تطبيق آليات الحوكمة الداخلية بالمصارف المبحوثة، مع عدم وجود فروقات في مستويات تطبيق آليات الحوكمة الداخلية والخارجية، ومستوى جودة المعلومات المحاسبية يمكن إرجاعها لطبيعة المصرف (حكومي، خاص، مشترك) أو لمسمى البنك. بينما أظهرت نتائج الدراسة وجود فروق في مستويات تطبيق الحوكمة يمكن إرجاعها لانتظام دورية انعقاد مجلس إدارة المصرف لصالح الانعقاد المنتظم. وفي ضوء النتائج، توصي الدراسة بتفعيل آليات حوكمة المصارف بوصفها أحد المجالات لتعزيز جودة المعلومات المحاسبية، والتركيز على الآليات الخارجية للحوكمة كونها أكثر تأثيراً في جودة المعلومات المحاسبية مع تعزيز الجانب المرتبط بالملكية الإدارية للتنفيذيين بالقطاع المصرفي بوصفه أحد مجالات تعزيز التطبيق لآليات الحوكمة الداخلية.

The mediating role of sleep quality on the relationship between internet gaming disorder and perceived stress and suicidal behaviour among Indian medical students

BackgroundIn the recent digital era, individuals with internet gaming disorder (IGD) have reported a much higher prevalence of poor sleep quality, perceived stress and suicidal behaviour. However, the underlying mechanisms...

Differences and similarities in personality functioning across different types of eating disorders.

The classification of anorexia nervosa (AN) into subtypes is relevant due to their different symptomatology. However, subtypes (restricting type: AN-R; purging type: AN-P) differ also in terms of their personality functioning. Knowledge about these differences would allow for better treatment stratification. A pilot study indicated differences in structural abilities that can be assessed by the operationalized psychodynamic diagnosis (OPD) system. The aim of this study was therefore to systematically explore differences in personality functioning and personality between the two AN subtypes and bulimia nervosa (BN) using three personality (functioning) constructs. A total of N = 110 inpatients with AN-R (n = 28), AN-P (n = 40), or BN (n = 42) were recruited in three clinics for psychosomatic medicine. Assignment to the three groups was performed using a comprehensive questionnaire validated for diagnostic purposes (Munich-ED-Quest). Personality functioning was examined using OPD Structure Questionnaire (OPD-SQ), personality by using the Personality Inventory for DSM-5-Brief Form and Big Five Inventory-10. (M)ANOVAs were used to examine differences across eating disorder groups. In addition, correlation and regression analyses were conducted. We observed differences on several sub- and main scales of the OPD-SQ. Whereas patients with BN showed the lowest levels, AN-R patients displayed the highest levels of personality functioning. On some sub- and main scales, such as "affect tolerance," the subtypes of AN differed from BN, whereas on the scale "affect differentiation," AN-R, differed from the other two groups. The total eating disorder pathology score of the Munich-ED-Quest best predicted overall personality structure [stand. β = 0.650; t(104) = 6.666; p < 0.001] and self-regulation [stand. β = 0.449; t(104) = 3.628; p < 0.001]. Our findings confirm most of the results of the pilot study. These findings can facilitate the development of stratified treatment approaches for eating disorders.

Assessing violence risk in first-episode psychosis: external validation, updating and net benefit of a prediction tool (OxMIV)

BackgroundViolence perpetration is a key outcome to prevent for an important subgroup of individuals presenting to mental health services, including early intervention in psychosis (EIP) services. Needs and risks are...

Agricultural mechanization in Ethiopia: hiring service transactions, mechanization clusters and land consolidation

PurposeAgriculture in Ethiopia relies heavily on traditional farm power sources and is designated by the lowest farm machinery access, in contrast to other Sub-Sahara African (SSA) countries. The purpose of this research is to analyze the heterogeneity of mechanization service transactions and factors determining farmers' cooperation in mechanization clusters and willingness to accept land consolidation.Design/methodology/approachThe authors conducted a cross-sectional survey of producer households in major crop production areas in the Oromia, SNNPR, Amhara and Tigray regions. The sampling design involved three stages: districts were selected using a stratified sampling approach accompanied by simple random samples of kebele units and producer households in the second and final stages, respectively.FindingsThis study’s results show that mechanization service costs, service relationships, clustering and land consolidation exhibit significant heterogeneity across the study areas. Cluster farming was found to be advantageous against diseconomies, rationalized by upgrading the mechanization scale. The probit model parameterization of the probability distributions reveals that household, land, crop, mechanization service, remoteness and location-related factors determine participation in mechanization clusters and willingness to accept land consolidation.Research limitations/implicationsFostering cooperation by focusing on constraints and demand of users is suggested to reduce transaction costs and expand hired mechanization services to unaddressed areas. The findings are relevant to most SSA countries where mechanization development is hampered by land fragmentation.Originality/valueLimited information is available on agricultural mechanization development for smallholder farmers, particularly in Ethiopia, and this study adds empirical evidence about the synergy between cluster farming and mechanization, horizontal coordination and alternative supply models.

Measurement invariance of the Domain‐Specific Risk‐Taking (DOSPERT) scale

AbstractGroup‐level risk attitudes are often studied across psychology domains (e.g., binge drinking among college students, and driving risk by gender). In measuring these differences by self‐report, such work relies on the assumption that those measures of risk attitude function equivalently across demographic groups—that is, that the measure employed has the property of measurement invariance. Here, we examine the measurement invariance properties of a widely used risk measure, the Domain‐Specific Risk‐Taking (DOSPERT) scale across different demographic groups. A secondary goal was to determine whether a hierarchical or bifactor model better fits the data. Data were collected from Prolific using a stratified sampling approach to ensure sufficient and unconfounded sampling of sex, socioeconomic status (SES), and race (N = 412). Sample groups consisted of approximately 50 participants each, based on the intersection of three dichotomized demographic groups (high vs. low SES, White vs. non‐White, and female vs. male). Subjects completed the 30‐item form of the DOSPERT assessing likelihood, perceived benefit, and riskiness of the same 30 behaviors. The bifactor models showed a superior fit to the hierarchical models and were used in subsequent analyses. These analyses demonstrated that no models fit generally acceptable criteria for configural fit, and many models additionally fail cutoffs for metric and scalar invariance. This study adds to findings that the DOSPERT does not perform equivalently across demographic groups. We suggest development of a scale of risk that is invariant across commonly assessed demographic factors.

Who consumes curative care expenditure of medical institutions in Beijing: a case study based on System of Health Accounts 2011

BackgroundChina’s health system is challenged by complex health problems experienced by different population groups and caused by multiple diseases. This study examined the distribution of curative care expenditure (CCE) of medical institutions in Beijing using beneficiary characteristics such as residency, gender, age, and disease. Suggestions are presented for the development of health policies.MethodsA total of 81 medical institutions with approximately 80 million patients in Beijing, China, were selected via a multistage stratified cluster random sampling approach. Based on this sample, the System of Health Accounts 2011 was used to estimate the CCE of medical institutions.ResultsThe CCE of medical institutions in Beijing was ¥246.93 billion in 2019. The consumption of patients from other provinces was ¥60.04 billion, accounting for 24.13% of the total CCE. The CCE of female consumption (52.01%/¥128.42 billion) exceeded that of male consumption (47.99%/¥118.51 billion). Almost half of the CCE (45.62%/¥112.64 billion) was consumed by patients aged 60 or above. Adolescent patients up to an age of 14 (including those aged 14) mainly chose secondary or tertiary hospitals for treatment. Chronic non-communicable diseases accounted for the largest share of CCE consumption, with circulatory diseases accounting for the highest proportion.ConclusionsThis study identified significant differences in CCE consumption in Beijing according to region, gender, age, and disease. Currently, the utilization of resources in medical institutions is not reasonable, and the hierarchical medical system is not sufficiently effective. Therefore, the government needs to optimize the allocation of resources according to the needs of different groups and rationalize the institutional process and functions.

Stratified split sampling of electronic health records

Although superficially similar to data from clinical research, data extracted from electronic health records may require fundamentally different approaches for model building and analysis. Because electronic health record data is designed for clinical, rather than scientific use, researchers must first provide clear definitions of outcome and predictor variables. Yet an iterative process of defining outcomes and predictors, assessing association, and then repeating the process may increase Type I error rates, and thus decrease the chance of replicability, defined by the National Academy of Sciences as the chance of “obtaining consistent results across studies aimed at answering the same scientific question, each of which has obtained its own data.”[1] In addition, failure to account for subgroups may mask heterogeneous associations between predictor and outcome by subgroups, and decrease the generalizability of the findings. To increase chances of replicability and generalizability, we recommend using a stratified split sample approach for studies using electronic health records. A split sample approach divides the data randomly into an exploratory set for iterative variable definition, iterative analyses of association, and consideration of subgroups. The confirmatory set is used only to replicate results found in the first set. The addition of the word ‘stratified’ indicates that rare subgroups are oversampled randomly by including them in the exploratory sample at higher rates than appear in the population. The stratified sampling provides a sufficient sample size for assessing heterogeneity of association by testing for effect modification by group membership. An electronic health record study of the associations between socio-demographic factors and uptake of hepatic cancer screening, and potential heterogeneity of association in subgroups defined by gender, self-identified race and ethnicity, census-tract level poverty and insurance type illustrates the recommended approach.