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Swarm intelligence optimization algorithm has been proved to perform well in the field of parameter optimization. In order to further improve the performance of intelligent optimization algorithm, this paper proposes an improved and adaptive tunicate swarm algorithm (IMATSA) based on tunicate swarm algorithm (TSA). IMATSA improves TSA in the following four aspects: population diversity, local search convergence speed, jumping out of local optimal position, and balancing global and local search. Firstly, IMATSA adopts Tent map and quadratic interpolation to initialize population and enhance the diversity. Secondly, IMATSA uses Golden-Sine algorithm to accelerate the convergence of local search. Thirdly, in the process of global development, IMATSA adopts Levy flight and the improved Gauss disturbance method to adaptively improves and coordinates the ability of global development and local search. Then, this paper verifies the performance of IMATSA based on 14 benchmark functions experiment, ablation experiment, parameter optimization experiments of Support Vector Machine (SVM) and Gradient Boosting Decision Tree (GBDT), Wilcoxon signed rank test and image multi-threshold segmentation experiment with the performance metrics are convergence speed, convergence value, significance level P-value, Peak Signal-to-Noise Ratio (PSNR) and Standard Deviation (STD). Experimental results show that IMATSA performs better in three kinds of benchmark functions; each component of IMATSA has a positive effect on the performance; IMATSA performs better in parameter optimization experiments of SVM experiment and GBDT; there is significant difference between IMATSA and other algorithms by Wilcoxon signed rank test; in image segmentation, the performance is directly proportional to the number of thresholds, and compared with other algorithms, IMATSA has better comprehensive performance. [ABSTRACT FROM AUTHOR]

Abstract The global refugee crisis and the increased number of refugees seeking asylum in Canada has led the federal government to enact a series of policy reforms related to refugee healthcare coverage and spending. This paper provides a critical review of the Interim Federal Health Program (IFHP), drawing on concepts from social justice, migration, and market-oriented theories while examining policy rhetoric, legal ramifications, and media portrayals. The recommendations in this article aim to reduce health inequities and healthcare access barriers for the refugee population in Canada. Findings suggest Canadian federal policies have contributed to refugee health disparities. [ABSTRACT FROM AUTHOR]

In order to improve the accuracy and performance of traditional image threshold segmentation algorithm, this paper proposes a multithreshold segmentation method named improved Harris hawk optimization (IMHHO). Firstly, IMHHO adopts Tent map and elite opposition-based learning to initialize population and enhance the diversity. Secondly, IMHHO uses quadratic interpolation to generate new individuals and enhance the local search ability. Finally, IMHHO adopts improved Gaussian disturbance method to disturb optimal solution, which coordinates the local and global search ability. Then, the performance of IMHHO is tested based on 14 benchmark functions. In image segmentation, different algorithms are tested to compare the comprehensive performance based on Otsu and Renyi entropy. Experiments show that IMHHO performs better in the three kinds of benchmark functions; the segmentation effect is directly proportional to the number of thresholds; compared with other algorithms, IMHHO has better comprehensive performance. [ABSTRACT FROM AUTHOR]

This study explores the disparities in older adults' self-rated health within the urban landscape of China. Drawing on the 1% national population survey of China in 2015, it highlights how variations in city development contribute to geographical health disparities among older residents. In the era of the decentralized fiscal system, a crucial mechanism identified is the role of cities' local fiscal revenue in connecting their socioeconomic development and the health status among older adults. Despite efforts by cities in lower socioeconomic positions to increase fiscal expenditure and address deficits through central transfer payments, they prove inadequate in effectively mitigating population health disparities. The prioritization of economic growth and neglect of public service provision responsibilities are fundamental causes within this fiscal framework. The findings underscore the urgent need for increased central transfer payments in public services to address the growing disparities in older adults' health. • Revealing health disparity among urban older adults amidst fiscal decentralization. • Local fiscal revenue connecting cities' development and individual health. • Ineffectiveness of local fiscal expenditure and deficit in alleviating disparities. • Urgency for leveraging public transfer payments toward public health services. [ABSTRACT FROM AUTHOR]

Canada’s old age security (OAS), a flat-benefit public pension, is internationally lauded as an accessible and effective safety net for seniors. This paper explores discrepancies in OAS uptake using Canadian Census data from 1996 to 2011. Our findings demonstrate disparities in OAS uptake based on immigration status, language proficiency, and visible minority status, disputing claims of “universal” OAS provision. Multivariate analyses confirm a strong “immigrant effect,” with being in Canada for 20 years or less leading to lower rates of OAS utilization. They also confirm that those not proficient in Canada’s official languages are less likely to receive OAS benefits. However, the influence of racialized minority status is found to be spurious; after controlling for immigration status and official language proficiency, many racialized minority senior groups have higher odds of receiving OAS than White Canadians. We conclude with a brief discussion of the tradeoffs involved in considering a potential removal of OAS eligibility barriers for immigrants in Canada. [ABSTRACT FROM PUBLISHER]

Aim: To examine the job satisfaction of nurses who are caring for older adults in healthcare settings in Shanghai, and to explore the underlying factors in order to explain and predict nurses’ job satisfaction. Background: China has the largest elderly population in the world, and its population is aging rapidly. Studies on job satisfaction of nurses providing care for the elderly in China can help to identify problem areas and develop strategies for the improvement of nurses’ working conditions. However, to date, this subject matter has not been thoroughly studied in the Chinese context. Previous studies in other countries show that many factors impact nurses’ job satisfaction, with the practice environment being a critical factor. There is a serious nursing shortage in China, especially in the big cities such as Shanghai. Given the increasing care demand of the aging population, learning about the job satisfaction level among nurses who are caring for older adults can provide essential information to help attract and retain nurses in this specialty area. Methods: A cross-sectional survey was conducted among 444 nurses in 22 elderly care institutions in Shanghai. The Chinese version of the Index of Work Satisfaction (IWS) and the Nursing Practice Environment Scale were instruments used. Inferential statistical tests used to analyze the data included Spearman correlation analysis, one-way analysis of variance, and hierarchical regression tests. Results: The average overall IWS (part B) score was 135.21 ± 19.34. Personality, job and organizational characteristics were found to be the most influential factors, and the practice environment was identified as having the strongest impact on job satisfaction (Beta = 0.494). Conclusion: Job satisfaction level among nurses who are caring for older adults in Shanghai is moderate, but the data suggest that this could be greatly increased if the nursing practice environment was improved. [ABSTRACT FROM AUTHOR]

The prescribing behavior to prescribe high-priced drugs has been hypothesized to be related to the increasing drug expenditures in China, but little empirical evidence exists. The purpose of this study was to examine whether Chinese physicians, driven by financial incentives, tend to prescribe high-priced drugs. The 2000–2008 drug data in the Yangtze River Basin Hospitals' Drug Use Analysis System were analyzed to examine the prescription patterns of penicillins and cephalosporins in Shanghai. Among the top-100 drugs (by volume), cephalosporins cost as 1.1– 2.3 times as penicillins and their volume was 1.7–18.2 times. Revenues generated from prescribing cephalosporins were 3.4–24.2 times as those from prescribing penicillins. The tendency of prescribing relatively high-priced drugs was observed given the same chemical name, dosage, and specification but different trade names. Furthermore, high-priced drugs remained on the top-100 list with increasing volumes, while some lower-priced drugs exited from the list due to decreases in volumes. Facing the policy dilemmas, the Chinese government needs to implement a new financially rewarding system in which hospitals and physicians are able to achieve financial gains in a cost-effective way including prescribing similar drugs with lower prices. Reforming hospitals' payment methods is necessary and feasible to reshape financial incentives of healthcare providers. The combination of the global budget policy and financial incentive measures would be likely to change providers' prescribing behaviors towards a cost-effective direction. [ABSTRACT FROM AUTHOR]

Background: Research indicates the adverse impacts of perceived discrimination on health, and discrimination inflamed by the COVID-19 pandemic, a type of social exclusion, could affect the well-being of the Chinese diaspora. We analyzed the relationship and pathways of perceived discrimination's effect on health among the Chinese diaspora in the context of the pandemic to contribute to the literature on discrimination in this population under the global public health crisis. Methods: We analyzed data from 705 individuals of Chinese descent residing in countries outside of China who participated in a cross-sectional online survey between April 22 and May 9, 2020. This study utilized a structural equation model (SEM) to evaluate both direct and indirect effects of perceived discrimination on self-rated health (SRH) and to assess the mediating roles of psychological distress (namely, anxiety and depression) and social support from family and friends. Results: This online sample comprised predominantly young adults and those of relatively high socioeconomic status. This study confirmed the total and direct effect of recently perceived discrimination on SRH and found the indirect effect was mainly mediated by depression. Mediating roles of anxiety and social support on the discrimination-health relationship were found insignificant in this SEM. Conclusions: Our findings suggest discrimination negatively affected the well-being of the Chinese diaspora, and depression acted as a major mediator between the discrimination-health relationship. Therefore, interventions for reducing discrimination to preserve the well-being of the Chinese diaspora are necessary. Prompt intervention to address depression may partially relieve the disease burden caused by the surge of discrimination. [ABSTRACT FROM AUTHOR]

Objective: Self-rated health represents a reliable and important health measure related to general health and quality of life. This study aimed to identify the differences of health states of rural residents in a lower middle income setting in China and its associated factors. Methods: A descriptive study of a stratified random sample of 3870 individuals was conducted in rural Anhui during 2015. We investigated the influence of five independent variables: individual demographic characteristics, family factors, social capital traits, physical health conditions and healthy lifestyle habits of participants who self-related their health as good. A chi-square test and ordinal logistic regression analyses were used to identify the relationship of these variables and self-rated health. Results: The study found that respondents who negatively rated their health often were female, elderly, poor, lived alone, had low levels of education, inadequate social support, poor physical health, used healthcare services and lived in the lower economic regions. We found no significant correlations between self-rated health and employment, marital status, medical insurance, or exercise frequency. Surprisingly, smoking and drinking also seemed to be unrelated to poor self-reported health. Conclusion: Health differences based on region were apparent in rural China. We highlighted the possible impacts of income, age, physical health, education, advanced age, and social support on health. The results from this study could inform the delivery of appropriate health and social healthcare interventions to promote rural residents' health and quality of life. [ABSTRACT FROM AUTHOR]

Background: The increasing trend of Caesarean section (CS) in childbirth has become a global public health challenge. Previous studies have proposed financial intervention strategies for reducing CS rates by limiting caesarean delivery on maternal request (CDMR). This study synthesizes such strategies while evaluating their effectiveness.Methods: The sources of data for this study are Cochrane Library, PubMed, EMBASE, and CINAHL. The publication period included in this study is from January 1991 to November 2018. The financial intervention strategies are divide into two categories: healthcare provider interventions and patient interventions. Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) was employed to assess the risk of bias of included studies. The outcome of each study was evaluated with Grades of Recommendation, Assessment, Development and Evaluation (GRADE) through the GRADEpro Guideline Development Tool software.Results: Nine studies were included in this systematic review: five with high certainty evidence (HCE), three with moderate certainty evidence (MCE), and one with low certainty evidence (LCE). Of the nine studies, seven are centered on the effect of provider-side interventions. Three of the HCE studies found that the diagnosis-related group payment system, risk-adjusted capitation, and equalizing fee for both facilities and physicians were effective intervention strategies. One HCE and one MCE study showed that only equalizing facility fees between vaginal and CS deliveries in healthcare service settings had no significant effect on reducing the CS rate. The MCE study showed that case payment had a negative effect on reducing the CS rates. One LCE study revealed that the effect of a global budget system was uncertain, and one HCE and one MCE study focused on combining both provider and patient-side interventions. However, equalizing fees for vaginal and CS deliveries and a co-payment policy for CDMRs failed to reduce the CS rate.Conclusions: The effectiveness of risk-adjusted payment methods appears promising and should be the subject of further research. Financial interventions should consider stakeholders' characteristics, especially the personal interests of doctors. Finally, high-quality randomized control trials and comparative studies on different financial intervention methods are needed to confirm or refute previous studies' outcomes. [ABSTRACT FROM AUTHOR]

This paper proposes a decoupled AC/DC power flow approach for multi-terminal HVDC systems. The proposed method simplifies the power flow computation of multi-terminal HVDC systems while accurately reflecting the operation and control characteristics of VSC (voltage source converter) stations in a HVDC network. In the DC network, the power flow calculation is conducted based on a slack DC bus VSC station and power commends issued to other VSC stations from the power system control center. Then, in the AC power flow calculation, VSC stations are treated as special AC generators that can generate and absorb power from the AC grid in active and reactive power or active power and bus voltage control mode. For validation purpose, the conventional unified power flow method for multi-terminal HVDC systems is built. The paper compares the proposed method with the unified power flow method for an 8-bus multi-terminal HVDC system based on MATPOWER. Then, more case studies for different VSC control modes are conducted and evaluated for the 8-bus system. Afterwards, the proposed method is applied to the power flow study of a more practical and complicated multi-terminal HVDC system based on the IEEE 118-bus system. [ABSTRACT FROM AUTHOR]

Background: As the most populous nation in the world, China has now becoming an emerging ageing society. Shanghai is the first city facing the challenge of ageing demographics. Against this background, a study that employs self-rated health (SRH) assessment system was designed to explore the health status of Shanghai elders, and learn their attitudes toward health issues; as well as to investigate the determinants of SRH among Shanghai elders. Understanding SRH is crucial for finding appropriate solutions that could effectively tackle the increasing eldercare demand.Methods: This study adopted a quantitative research strategy. Using a multistage stratified cluster sampling method, we conducted a questionnaire survey in August 2011 in Shanghai, which collected 2001 valid survey responses. SRH assessments were categorized by five levels: very good, fairly good, average, fairly poor, or poor. The respondents' functional status was evaluated using the Barthel index of activities for daily living. In the data analysis, we used chi-squared test to determine differences in socio-demographic characteristics among various groups. Along with statistics, several logistic regression models were designed to determine the associations between internal influence factors and SRH.Results: Younger age (χ2 = 27.5, p < 0.05), male sex (χ2 = 11.5, p < 0.1), and living in the suburbs (χ2 = 55.1, p < 0.05) were associated with better SRH scores. Higher SRH scores were also linked with health behaviour of the respondents; namely, do not smoke (χ2 = 18.0, p < 0.1), do not drink (χ2 = 18.6, p < 0.1), or engage in regular outdoor activities (χ2 = 69.3, p < 0.05). The respondents with better social support report higher SRH scores than those without. Respondents' ability to hear (χ2 = 38.7, p < 0.05), speak (χ2 = 16.1, p < 0.05) and see (χ2 = 78.3, p < 0.05) impacted their SRH scores as well. Meanwhile, chronic illness except asthma was a major influence factor in low SRH score. Applying multiple regression models, a series of determinants were analysed to establish the extent to which they contribute to SRH. The impact of these variables on SRH scores were 6.6% from socio-demographic and health risk behaviours, 2.4% from social support, 8.5% from mental health, 20% from physical conditions, and13% from chronic diseases.Conclusions: This is the first study that examines the determinants of SRH among Shanghai elders. Nearly 40% of our study's respondents reported their health status as "good". The main determinants of SRH among elders include living condition, health risk behaviour, social support, health status, and the economic status of the neighbourhood. [ABSTRACT FROM AUTHOR]

This paper presents an optimal building energy management strategy for the demand response of multi-thermal-zone buildings in the smart electricity grid environment. The proposed method includes a machine learning model, based on a neural network, for a building heating ventilation and air conditioning system. The learned model is then applied to an optimization problem to determine the optimal management scheduling of building loads. The goal of the optimization problem is to minimize building electricity costs and reduce the overall building energy consumption during peak load hours while satisfying human comfort demand. To overcome the coupling issue between the building internal-heat-gain loads and the building heating ventilation and air conditioning system, an iterative algorithm is proposed to solve the optimization problem. In each iteration, a mixed-integer linear programming technique is used to solve a sub-optimization problem for the building internal-heat-gain loads and its results are then applied to another sub-optimization problem, solved by using a particle swarm technique, for the building heating ventilation and air conditioning system. The iterative optimization algorithm stops when convergence between the optimization for the building heating ventilation and air conditioning system and the optimization for the building internal-heat-gain loads is properly reached. EnergyPlus is used to build and simulate complex buildings with multiple-thermal zones according to real-life conditions. The simulation model is also used to test and evaluate the effectiveness of the proposed machine-learning model and the iterative optimization algorithm and the improvement of building energy management in terms of energy consumption efficiency, cost saving, and satisfaction of human comfort. • A Machine-learning based strategy for energy management of multi-thermal zone buildings. • A combination of machine learning and optimization techniques for buildings. • A consideration of human comfort demands into learning-based energy optimization. • An integration of building energy management with demand response for smart grid. [ABSTRACT FROM AUTHOR]

• NTSMC-based cascaded control for a DC/DC converter to increase the robustness. • A VIC method to increase the inertia of the DC/DC converter-interfaced DG unit. • Synchronization control to satisfy the plug-and-play of a buck-boost converter. • Hardware experimental results demonstrate the improved performance. To deal with the issues caused by the high integration of renewable resources, the parallel operation of the converters is generally required to improve the system stability and reliability. To support the parallel operation of buck-boost DC/DC converters, they are generally regulated by a cascaded control strategy, which includes droop control loop, and nested proportional-integral (PI) based voltage and current control loops. However, it can provide barely inertia support and needs precise system model to reach the desired performance. In order to overcome these drawbacks, this paper proposes a novel cascaded control strategy for parallel operation of buck-boost DC/DC converters. The proposed cascaded control strategy involves a voltage synchronization loop, a virtual inertia control (VIC) loop, and two nested NTSMC based voltage and current control loops. The voltage synchronization controller can enable the plug and play requirements by synchronizing the output voltage of the converter with the voltage at the point of common coupling (PCC) before connecting a DC/DC converter to the DC microgrid. The VIC can improve the inertia of the converter-interfaced DGs. The nested-loop NTSMC based voltage and current controller can improve the robustness of converter system. Hardware experiments demonstrate the improved performance of the proposed control strategy. [ABSTRACT FROM AUTHOR]