Universal Utilization Research Articles

The pilot results of 47148 cases of BJ-DRGs-based payment in China.

Diagnosis-related groups (DRGs)-based payment is an important tool for containment of inpatient expenditure rise in many countries. As a major developing country, China has introduced DRGs in the health reform. Beijing, the capital of China, developed a local DRGs version (BJ-DRGs) whose performance needs to be evaluated before universal utilization. The objective of this study was to survey the effect of BJ-DRGs-based payment on a pilot hospital. We surveyed the profit and loss situation of 47148 cases of hospital discharged patients in 107 groups of pilot BJ-DRGs-based payment from December 2011 to July 2018 in certain top tertiary hospital in Beijing. In pilot 107 groups of DRGs, there were 77 groups (71.96%) in profit and 30 groups (28.04%) in loss; average length of inpatient stay was 7.47days, average inpatient expenditure ¥17821.19, average DRGs standard unit price ¥15896.83, average self-pay expenditure ¥1 117.04, and average profit ¥1 849.65; logistic regression showed that whether the pilot hospital of BJ-DRGs-based payment was in profit or loss was correlated negatively with inpatient expenditure, length of inpatient stay, drug expenditure, expenditure of medical consumables, and pilot years,and positively with DRGs standard unit price, self-pay expenditure, and age and gender (P<.0001). BJ-DRGs-based payment is the first implemented DRGs-based prospective payment system in China. The current DRGs pilot model made the pilot hospital appear profitable as a whole and its length of inpatient stay decline.

Production of bacterial cellulose from byproduct of citrus juice processing (citrus pulp) by Gluconacetobacter hansenii

In this study, bacterial cellulose (BC) was produced by Gluconacetobacter hansenii and Gluconacetobacter xylinum using citrus pulp water (CPW) and coconut water (CW). The productivity and the characteristics of the BCs produced by different strains and media were investigated. The results showed that BC production could reach more than 8.0 g DW L−1 by both G. hansenii and G. xylinum (8.42 ± 0.54 and 8.77 ± 0.64 g L−1) using CPW medium, which was close to the industrial level (9.91 ± 0.42 g L−1) by G. xylinum in CW medium. Therefore, CPW medium had strong universal utilization ability for BC production by both G. hansenii and G. xylinum. On the other hand, BC produced by G. hansenii in CPW medium had low hardness and high water holding capacity, and the preferred orientation of microfiber crystallites in BCs obtained by G. hansenii and G. xylinum using CPW was different. This difference enabled the production of BC products with different physicochemical features based on the requirements. In addition, the economics of BC production using CPW and CW as the raw fermentation materials was analyzed and compared, and the result indicated that the former was more economical and would be a promising candidate for producing BC. Finally, producing BC using CPW to replace the traditional CW medium would expand the raw material collection regions, reduce transportation cost, and realize BC products diversity.

Deep learning for printed document source identification

Due to the rapid development of the information technology and wide use of the Internet, Information is easily to be obtained in the form of digital format. Digital content can be freely printed into documents since the convenience and accessibility of the printers. On the other hand, printed documents can be illegally manipulated by some criminal issues such as: forged documents, counterfeit currency, copyright infringement, and so on. Therefore, how to develop an efficient and appropriate safety testing tool to identify the source of printed documents is an important task in the meantime. Currently, the forensic system using the statistical methods and support vector machine technology has been able to identify the source printer for the text and the image documents. Such an approach belongs to the category of shallow machine learning with human interaction during the stages of feature extraction, feature selection and data pre-processing. In this paper, a deep learning system to solve the complex image classification problem is developed by Convolutional Neural Networks (CNNs) of deep learning which can learn the features automatically. Systematic experiments have been performed for both systems. For microscopic documents, feature based SVM system outperforms the deep learning system with limited gap. For scanned documents, both system can achieve equally well with high accuracy. Both systems should be constantly evaluated and compared for the best interest in universal utilization.

Carbon-Rich Nanomaterials: Fascinating Hydrogen and Oxygen Electrocatalysts.

Hydrogen energy is commonly considered as a clean and sustainable alternative to the traditional fossil fuels. Toward universal utilization of hydrogen energy, developing high-efficiency, low-cost, and sustainable energy conversion technologies, especially water-splitting electrolyzers and fuel cells, is of paramount significance. In order to enhance the energy conversion efficiency of the water-splitting electrolyzers and fuel cells, earth-abundant and stable electrocatalysts are essential for accelerating the sluggish kinetics of hydrogen and oxygen reactions. In the past decade, carbon-rich nanomaterials have emerged as a promising class of hydrogen and oxygen electrocatalysts. Here, the development and electrocatalytic activity of various carbon-rich materials, including metal-free carbon, conjugated porous polymers, graphdiyne, covalent organic frameworks (COFs), atomic-metal-doped carbon, as well as metal-organic frameworks (MOFs), are demonstrated. In particular, the correlations between their porous nanostructures/electronic structures of active centers and electrocatalytic performances are emphatically discussed. Therefore, this review article guides the rational design and synthesis of high-performance, metal-free, and noble-metal-free carbon-rich electrocatalysts and eventually advances the rapid development of water-splitting electrolyzers and fuel cells toward practical applications.

TLDA: An Efficient Two-Layered Data Authentication Mechanism for Content-Centric Networking

Content-Centric Networking (CCN) is a new networking paradigm for the future Internet, which shifts the communication paradigm from host-centric to data-centric. In CCN, contents are routed by their unique names and they are stored in network nodes by units of segment during transmission for future usage. Since contents are stored in network nodes in a distributed manner, security is built into CCN data packets by embedding a public key signature to enable any content requesters to verify authenticity and integrity of contents. However, the use of public key signatures for authenticating CCN data packets incurs significant overhead regarding computation and communication, which limits universal utilization of CCN. Furthermore, this can lead to a new kind of DDoS attacks. Even though CCN adopts an aggregate signature method based on Merkle Hash Tree (MHT) in its reference implementation, it still incurs large amount of overhead. This paper presents TLDA, an efficient Two-Layered Data Authentication mechanism, which can considerably reduce overhead of computation and communication for authenticating data segments in CCN. For efficiency of computation and communication, TLDA newly introduces the concept of authentication Meta part consisting of data segments’ hash values. To a great extent TLDA not only reduces the computation and communication overhead compared with CCN’s basic authentication method, but also provides robustness against transmission loss and out-of-order transmission. We have implemented TLDA and demonstrated that it provides 74.3% improved throughput and 36.557% reduced communication overhead compared to those of the original CCNx library developed by PARC when transmitting a 128Mbyte content in units of 1Kbyte segment with RSA-2048 and SHA-256 as its signature algorithm and hash algorithm, respectively.

Recyclable adsorbent of BiFeO3/Carbon for purifying industrial dye wastewater via photocatalytic reproducible

It is essential to prepare highly-efficiency reproducible adsorbent for purifying industrial dye wastewater. In this work, biscuit with a layered porous structure as a template is applied to prepare a photocatalytic recyclable adsorbent of BiFeO3/Carbon nanocomposites for purifying simulative industrial dye wastewater. It is found that the structure of the prepared BiFeO3/Carbon nanocomposite is related to the natural structure of the biscuit, annealing temperatures and immersing times, demonstrated by XRD, TEM, UV-Vis and adsorptive activities. Kinetics data shows that the adsorption rate of the adsorbent to the dye is rapid and fitted well with the pseudo-second-order model, that more than 80% of dyes can be removed in the beginning 30 min. The adsorption isotherm can be perfectly described by the Langmuir model as well. It can be seen from the adsorption data that the adsorption performance can reach over 90% at pH = 2–12, which can imply its universal utilization. The prepared BiFeO3/Carbon nanocomposites have also displayed excellent capacities (over 90% within 30 min) for adsorption of seven different dyes and their mixed one. According to the five times photocatalytic reproducible experiments, it is proved that BiFeO3/Carbon nanocomposites show the excellent stability and reproduction for purifying simulative industrial dyes, even the sample have been placed for one year. These research results indicate that the adsorbent BiFeO3/Carbon can be a suitable material used in treating industrial dye wastewater potentially.

Effector Mechanisms of Neutrophils within the Innate Immune System in Response to Mycobacterium tuberculosis Infection.

Neutrophils have a significant yet controversial role in the innate immune response to Mycobacterium tuberculosis (M. tb) infection, which is not yet fully understood. In addition to neutrophils’ well-known effector mechanisms, they may also help control infection of M. tb through the formation of neutrophil extracellular traps (NETs), which are thought to further promote the killing of M. tb by resident alveolar macrophages. Cytokines such as IFN-γ have now been shown to serve an immunomodulatory role in neutrophil functioning in conjunction to its pro-inflammatory function. Additionally, the unique transcriptional changes of neutrophils may be used to differentiate between infection with M. tb and other bacterial and chronic rheumatological diseases such as Systemic Lupus Erythematosus. Adversely, during the innate immune response to M. tb, inappropriate phagocytosis of spent neutrophils can result in nonspecific damage to host cells due to necrotic lysis. Furthermore, some individuals have been shown to be more genetically susceptible to tuberculosis (TB) due to a “Trojan Horse” phenomenon whereby neutrophils block the ability of resident macrophages to kill M. tb. Despite these aforementioned negative consequences, through the scope of this review we will provide evidence to support the idea that neutrophils, while sometimes damaging, can also be an important component in warding off M. tb infection. This is exemplified in immunocompromised individuals, such as those with human immunodeficiency virus (HIV) infection or Type 2 diabetes mellitus. These individuals are at an increased risk of developing tuberculosis (TB) due to a diminished innate immune response associated with decreased levels of glutathione. Consequently, there has been a worldwide effort to limit and contain M. tb infection through the use of antibiotics and vaccinations. However, due to several significant limitations, the current bacille Calmette-Guerin vaccine (BCG, vaccine against TB) does not meet the criteria for universal utilization for all ages and populations across the globe. New research involving neutrophils has yielded a new vaccine called M. smegmatis-Ag85C-MPT51-HspX (mc2-CMX) that has been shown to elicit a humoral and cellular response against M. tb in mice that is superior to the BCG vaccine.

Universal Parameter Optimization of Density Gradient Ultracentrifugation Using CdSe Nanoparticles as Tracing Agents.

Density gradient ultracentrifugation (DGUC) has recently emerged as an effective nanoseparation method to sort polydispersed colloidal NPs mainly according to their size differences to reach monodispersed fractions (NPs), but its separation modeling is still lack and the separation parameters' optimization mainly based on experience of operators. In this paper, we gave mathematical descriptions on the DGUC separation, which suggested the best separation parameters for a given system. The separation parameters, including media density, centrifuge speed and time, which affected the separation efficiency, were discussed in details. Further mathematical optimization model was established to calculate and yield the "best" (optimized) linear gradient for a colloidal system with given size and density. The practical experiment results matched well with theoretical prediction, demonstrating the DGUC method, an efficient, practical, and predictable separation technique with universal utilization for colloid sorting.

Conservative management of adult small bowel intussusception detected at abdominal computed tomography

The incidence of adult small bowel intussusception detected at CT has increased with advanced imaging techniques and universal utilization of CT scan. We aimed to identify factors that could predict the necessity of surgical intervention in adult patients with small bowel intussusception detected at CT during the past decade. There were 39 cases of adult small-bowel intussusception detected at CT from January 2004 to June 2014. The data on clinical factors, radiological factors and outcomes were collected by retrospectively reviewing all available medical records. Patients were classified as surgical group and conservative group according to the outcome. Association between predictive factors and outcome was assessed by Fisher's exact test and logistic regression models. Among a total of 39 patients, there were 32 patients (82%) in the conservative group and 7 patients (18%) in the surgical group. Spontaneous reduction was confirmed at short-term follow-up studies (abdominal ultrasonography [n=14], single contrast small bowel series [n=14], CT [n=4]) in the conservative group. No recurrence occurred during the median follow-up period of 14.1 months (range, 0-67.5 months). Patients in the surgical group had significantly higher white blood cell (WBC) counts (OR 1.001, p=0.048), more frequent obstruction (n=4 vs. n=4, p=0.022) or leading point (n=5 vs. n=0, p<0.001) and longer intussuception length (OR 1.929, p=0.032). Factors associated with the necessity to resort to surgical intervention in adults with small bowel intussusceptions were higher WBC counts, presence of obstruction or leading point, and longer intussuception length. Conservative management can be considered with short-term follow-up for those without these predictive factors.

РОЛЬ ВНИИ РАСТЕНИЕВОДСТВА ИМ. Н.И.ВАВИЛОВА В ИНИЦИАЦИИ И СТАНОВЛЕНИИ НОВЫХ НАПРАВЛЕНИЙ В СЕЛЕКЦИИ ОЗИМОЙ РЖИ В РОССИИ

Scientific investigations conducted at VIR during 1960-2014 to identify sources of new promising and economically useful traits in rye resulted in the development of genetic donors of such traits capable of increasing breeders’ work efficiency. These results helped to initiate the development of new priority trends in winter rye breeding, such as breeding of heterosis hybrid cultivars, semi-dwarf non-lodging cultivars, cultivars resistant to fungal diseases, semi-dwarf forms with higher productivity on the basis of plant photosynthesis potential optimization, and rye cultivars with low pentosan content for universal utilization.

An Experimental Study on Smoke Reduction Effect of Post Injection in Combination With Pilot Injection for a Diesel Engine

With the universal utilization of the common-rail injection system in automotive diesel engines, the multistage injection strategies have become typical approaches to satisfy the increasingly stringent emission regulations, and especially the post injection has received considerable attention as an effective way for reducing the smoke emissions. Normally the post injection is applied in combination with the pilot injection to restrain the NOx emissions, smoke emissions, and combustion noise simultaneously, and the pilot injection condition affects the combustion process of the main injection and might affect the smoke reduction effect of the post injection. Thus this study aims at obtaining the post injection strategy to reduce smoke emissions in a diesel engine, where post injection is employed in combination with pilot injection. The experiments were performed using a single-cylinder diesel engine under various conditions of pilot and post injection with a constant load at an IMEP of 1.01 MPa, fixed speed of 1500 rpm, and NOx emissions concentration of 150 ± 5 ppm that was maintained by adjusting the EGR ratio. The injection pressure was set at 90 MPa at first, and then it was varied to 125 MPa to evaluate the effects of post injection on the smoke reduction in the case of higher injection pressure. The experimental results show that small post injection quantity with a short interval from the end of main injection causes less smoke emissions. And larger pilot injection quantity and later pilot injection timing lead to higher smoke emissions. And then, to explore and interpret the smoke emissions tendencies with varying pilot and post injection conditions, the experimental results of three-stage injection conditions were compared to those of two reference cases, which only included the pilot and main injection, and the interaction between main spray flames and post sprays was applied for analysis. Based on the comparative analysis, the larger smoke reduction effect of post injection was observed with the larger pilot injection quantity, while it is not greatly influenced by pilot injection timing. In addition, the smoke emissions can be reduced considerably by increasing the injection pressure, however the smoke reduction effect of post injection was attenuated. And all of these tendencies were able to be interpreted by considering the intensity variation of the interaction between main spray flames and post sprays.

The Checklist Manifesto

The Checklist Manifesto

Improved Malaria Case Management through the Implementation of a Health Facility-Based Sentinel Site Surveillance System in Uganda

BackgroundHeath facility-based sentinel site surveillance has been proposed as a means of monitoring trends in malaria morbidity but may also provide an opportunity to improve malaria case management. Here we described the impact of a sentinel site malaria surveillance system on promoting laboratory testing and rational antimalarial drug use.Methodology/Principal FindingsSentinel site malaria surveillance was established at six health facilities in Uganda between September 2006 and January 2007. Data were collected from all patients presenting to the outpatient departments including demographics, laboratory results, diagnoses, and treatments prescribed. Between the start of surveillance and March 2010, a total 424,701 patients were seen of which 229,375 (54%) were suspected of having malaria. Comparing the first three months with the last three months of surveillance, the proportion of patients with suspected malaria who underwent diagnostic testing increased from 39% to 97% (p<0.001). The proportion of patients with an appropriate decision to prescribe antimalarial therapy (positive test result prescribed, negative test result not prescribed) increased from 64% to 95% (p<0.001). The proportion of patients appropriately prescribed antimalarial therapy who were prescribed the recommended first-line regimen artemether-lumefantrine increased from 48% to 69% (p<0.001).Conclusions/SignificanceThe establishment of a sentinel site malaria surveillance system in Uganda achieved almost universal utilization of diagnostic testing in patients with suspected malaria and appropriate decisions to prescribed antimalarial based on test results. Less success was achieved in promoting prescribing practice for the recommended first-line therapy. This system could provide a model for improving malaria case management in other health facilities in Africa.

Ray: Simultaneous Assembly of Reads from a Mix of High-Throughput Sequencing Technologies

An accurate genome sequence of a desired species is now a pre-requisite for genome research. An important step in obtaining a high-quality genome sequence is to correctly assemble short reads into longer sequences accurately representing contiguous genomic regions. Current sequencing technologies continue to offer increases in throughput, and corresponding reductions in cost and time. Unfortunately, the benefit of obtaining a large number of reads is complicated by sequencing errors, with different biases being observed with each platform. Although software are available to assemble reads for each individual system, no procedure has been proposed for high-quality simultaneous assembly based on reads from a mix of different technologies. In this paper, we describe a parallel short-read assembler, called Ray, which has been developed to assemble reads obtained from a combination of sequencing platforms. We compared its performance to other assemblers on simulated and real datasets. We used a combination of Roche/454 and Illumina reads to assemble three different genomes. We showed that mixing sequencing technologies systematically reduces the number of contigs and the number of errors. Because of its open nature, this new tool will hopefully serve as a basis to develop an assembler that can be of universal utilization (availability: http://deNovoAssembler.sf.Net/). For online Supplementary Material , see www.liebertonline.com.

Costi sanitari di un programma vaccinale: analisi di minimizzazione dei costi

The global cost of a vaccination program is made up by many more cost components than the acquisition expense, although the former is the first cost usually taken into consideration when comparing two or more alternatives. The present article analyses the economical impact consequent to the use of two different hexavalent vaccine formulations (Hexavac, liquid ready for injection, and Infanrix Hexa, dry, to be re-hydrated) available on the Italian market for the mandatory vaccination of newborns during their first year of life. The cost minimization analysis was conducted considering only differential costs, i.e. those costs than can differ with the use of one of the two products, and not those common to the two competing products, such as acquisition cost (33 euro in average for both), the costs for the organization, the call of the infants to be vaccinated, etc.. The differences among the considered alternatives detected by this study regard the work for the preparation and administration of the vaccines, the quantity of special waste they produce and the incidence of serious febrile reactions leading to pharmacological treatment and physician consultation (body temperature &gt; 40°C). The liquid formulation resulted more convenient in terms of cost for nurse work (0,63 euro saved per patient), waste disposal, and adverse reactions management. The robustness of these results was confirmed by sensitivity analysis and an estimate of the global saving for the Italian health system associated with the universal utilization of the liquid formulation is furnished.

Opportunistic Discovery of Occult Disease by Use of Test Panels in New, Symptomatic Primary Care Outpatients: Yield and Cost of Case Finding

Diagnostic test panels have been advocated by the Japan Society of Clinical Pathology for evaluation of presenting complaints of new outpatients in primary care medicine. The tests have additional potential utility for opportunistic finding of asymptomatic diseases, but data are lacking on the number of new conditions identified by the test panels and on the cost per identified case. We studied 540 new, symptomatic patients at the Comprehensive Medicine Clinics of National Defense Medical College during 1991-1997. All underwent testing with the "Essential Laboratory Tests" panel (2) [ELT(2) panel]. This panel includes hematologic tests, urinalysis, total protein, C-reactive protein, albumin, cholesterol, triglycerides, glucose, urea nitrogen, creatinine, uric acid, serum protein fractionation, six enzymes, and optional tests, including x-rays, electrocardiogram, and fecal occult blood. The ELT(2) panel uncovered 276 additional diagnoses of asymptomatic disease or abnormal health status. The most frequent occult condition was hyperlipidemia (100 cases) followed by liver dysfunction (53 cases). Clinical efficiency of the panel (occult diseases/patient) varied depending on the category of tentative initial diagnosis, with the highest efficiency in patients with cardiovascular disease. We created smaller panels by combining 11 basic tests [called the ELT(1) baseline panel] with one or more additional tests from the ELT(2) and analyzed their cost-effectiveness. Addition of four tests (total cholesterol, alanine aminotransferase, glucose, and uric acid) improved both clinical efficiency (0.41 occult disease/patient) and economic efficiency [ 2372 yen (approximately $22.50 US)/occult disease] at a cost-effectiveness of 177 yen per incremental case of occult disease. Addition of further tests decreased cost-effectiveness. Although the ELT(2) panel has supplemental utility for opportunistic screening of some significant, occult diseases and conditions, universal utilization of the full panel is not supported by the cost-effectiveness found in this study.

Arthur I. Holleb, M.D.

Arthur I. Holleb, M.D.

Use of radioiodine urinalysis for effective thyroid blocking in the first few hours post exposure.

A useful correlation between maximum thyroid uptake and radioiodine urine levels at different times after exposure was developed in order to determine when the intervention with an adequate blocking agent might still be effective. In an animal model (dog), six different doses were administered in the range of 100-600 kBq. The best correlation was found between the 125I uptake after 48 h (T-48) and urine radioactivity 4-6 h (U-4, U-5, U-6) after exposure. For the case of U-4, the equation Y(T-48) = 0.790 X(U-4) + 2.973 (r = 0.974 with a level of significance of p < 0.001) was obtained. An analogous study, carried out in humans (n = 20) to whom 1311 was administered, showed a similar correlation and level of significance: Y(T-24) = 1.162 X(U-4)+3.263 (r = 0.926; p < 0.001). The validity of this correlation was confirmed in four volunteers who received small doses of 125I(25-100 kBq), with good agreement between measured and extrapolated thyroid uptake and a mean difference of less than 10% (CV = 16.2%). Three different blocking agents were then tested in the same dog: potassium iodide, potassium perchlorate, and a thionamide (Tapazole). The blocking action of the first two compounds was about 90%, as opposed to only 48% for the third compound. Potassium iodide was chosen for its limited side effects and more universal utilization. The final study, carried out with four different doses, indicated that 25 mg of KI is the ideal amount to be administered to the dog. This corresponds to approximately 100 mg for a 70 kg human being (i.e., 1.4 mg kg(-1)). This dose, when administered to a volunteer 4 h after exposure, provided a thyroid blocking of 68%.

Autonomy and practice: the case of complementary practitioners in the UK.

1. To identify the level of acceptance of the principle of British Medical Association (BMA) participation in the formulation of practice guidelines for complementary medicine amongst currently active non-orthodox practitioners in the UK. 2. To identify the level of support for individual BMA proposals. 3. To identify similarities and differences of attitude to the proposals between practitioners of selected non-orthodox therapies. A postal survey of 1000 practitioners of complementary medicine. The UK between late 1993 and early 1994. One thousand currently practising UK complementary therapists from 4 groups-chiropractic, "lay" homeopathy, medical herbalism and reflexology. Systematic sampling (every nth practitioner) was used to select 250 respondents from membership lists of relevant representative bodies. The reponse rate was 57%. The principle of BMA participation in policy formation was accepted by the vast majority of respondents, although 87.7% stipulated that this should not constitute a major role. Each of the individual BMA proposals received majority support. Acceptance rates varied from 59.7% to 92.9%. Statistically significant differentiation between therapies was recorded on certain proposals. The revised stance of the BMA is finding a potentially receptive audience amongst UK complementary practitioners. There is a large amount of common ground between the proposals and what is acceptable to practitioners. However, the situation is complicated by intra-sectoral differentiation. Particular therapy and issue-specific barriers exist to the universal utilization of the kind of measures proposed.

Premedication for upper gastrointestinal endoscopy

Premedication is not essential to endoscopy but patient tolerance is clearly improved and, thus, ease of examination. Although comparable results can be achieved through nonpharmacologic means, the time and effort involved precludes their widespread use. Despite near universal utilization of premedication in endoscopy, the associated risk is difficult to determine from the available literature. The reported data reveal nominal risk yet must be viewed as minimums. The ideal drug with predictable clinical effects, minimal postprocedure impairment, little respiratory compromise, and proven antagonist is not yet available. Although midazolam seems to represent an advance, recent emphasis on respiratory depression is particularly troublesome. Studies evaluating various agents have suffered from lack of quantitation of such parameters as patient tolerance, ease of examination, and postprocedure impairment. Development of proven standards for these parameters would have to occur before a definitive double-blind randomized trial could be undertaken. Suggested means of assessing these parameters are listed in Table I. Improvement in major morbidity would be difficult in light of its low incidence. As the search for the ideal drug continues, endoscopists must continue to use drugs whose full effects are incompletely understood. The ability to increase patient comfort must be balanced with the small, but ever present, risk of morbidity and mortality.