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Many factors determine the quality of the growth and development of cotton. To compare their influences on the quality of the growth and development of cotton, nine different irrigation modes, including flood irrigation, drip irrigation under a film, and subsurface irrigation under a film, are considered at other lower limits as the influential factors and are regarded as the optimal indices in this paper. A synthetic assessment model is established according to relevant experimental results based on the AHP-TOPSIS theory, and the accelerated genetic projection pursuit algorithm to analyze and compare the different schemes, and the experimental results are compared with the theoretical results. The results show that subsurface irrigation under a film with a lower irrigation index limit of 70-75% of the field water capacity is the best scheme for the growth and development of cotton; with this scheme, the cotton production can be increased. The conclusions provide a specific theoretical basis for selecting future irrigation modes in arid areas. [ABSTRACT FROM AUTHOR]

Algorithm awareness, which is defined as the degree to which the user is aware of the presence of algorithms and the way in which they function, could influence how users behave online and interact. The main focus of this study is to understand how algorithm awareness moderates the association between usage motivations and addiction to TikTok videoclips among young people. An online questionnaire was designed and responses attained from 473 young people in China to explore the motivations for consuming video clips, their algorithm awareness levels, and the degree of addiction when using TikTok. The survey results confirm that there are six main factors that motivate young people to consume video clips on TikTok, of which the relaxing entertainment motivation and the information-seeking motivation receive higher scores. They also reveal that the level of addiction to TikTok is relatively high, whereas the level of algorithm awareness among young people remains at a relatively moderate level. Second, when investigating the motivations for use that lead to addiction, the motivations of information seeking, relaxing entertainment, and social interaction are found to be predictors of TikTok video clip addiction. Third, the moderating role of algorithm awareness, whose effects on interactions with information seeking and relaxing entertainment are significant, is studied, and it is found that increasing the level of algorithm awareness among young people could help reduce the addictive use of TikTok. [ABSTRACT FROM AUTHOR]

Sjögren syndrome (SS) is a systemic inflammatory autoimmune disease that involves exocrine glands. Shikonin is extracted from comfrey, which is conventionally used as an anti-tumor, antibacterial, and antiviral drug in China. However, the application of Shikonin in SS remains unreported. This study aimed to verify the potential functions of Shikonin in SS progression. Firstly, non-obese diabetic mice were used as the SS mouse model, with C57BL/6 mice serving as the healthy control. It was demonstrated that the salivary gland damage and inflammation were aggravated in the SS mouse model. Shikonin improved salivary gland function decline and injury in the SS mouse model. Moreover, Shikonin reduced inflammatory cytokines and immune infiltration in the SS mouse model. Further experiments discovered that Shikonin attenuated the MAPK signaling pathway in the SS mouse model. Lastly, inhibition of the MAPK signaling pathway combined with Shikonin treatment further alleviated the symptoms of SS. In conclusion, Shikonin ameliorated salivary gland damage and inflammation in a mouse model of SS by modulating the MAPK signaling pathway. Our findings indicate that Shikonin may be a useful drug for SS treatment. [ABSTRACT FROM AUTHOR]

In China, airports have a profound impact on people's lives, and understanding their dimensions has great significance for research and development. However, few existing airport databases contain such details, which can be reflected indirectly by the built-up land in the airport. In this study, a deep learning-based method was used for extraction of built-up land of airports in China using Sentinel-2 imagery and for further estimating their area. Here, a benchmark generation method is introduced by fusing two reference maps and cropping images into patches. Following this, a series of experiments were conducted to evaluate the network architectures and select the positive impact bands in Sentinel-2 imagery. A well-trained model was used to extract the built-up land for China airports, and the relationship between China airports' built-up land and the carrying capacity of air transportation was further analysed. Results show that ResUNet-a outperformed U-Net, ResUNet, and SegNet, and the B2, B4, B6, B11, and B12 bands of Sentinel-2 had a positive impact on built-up land extraction. A well-trained model with an overall accuracy of 0.9423 and an F1 score of 0.9041 and 434 China airports' built-up land was extracted. The four most developed airports are located in Beijing, Shanghai, and Guangzhou, which matches China's political and economic development. The area of built-up land influenced the passenger throughput and aircraft movements. The total area influenced the cargo throughput, and we found a certain correlation among the built-up land, carrying capacity, and nighttime light. [ABSTRACT FROM AUTHOR]

Purpose: The clinical features of eczema and dermatitis in the elderly have not been fully studied. To investigate the proportion and clinical features of geriatric eczema patients in mainland China. Patients and methods: A multicenter cross-sectional study conducted in outpatients with eczema from 39 tertiary hospitals in 15 provinces. Results: 1128 elderly patients (12.88%) had eczema and dermatitis. The mean age of those was 68.2 ± 6.8 years (range, 60-90 years) with a median course of 5.5 ± 8.9 years, which is much longer than that of non-geriatric patients (2.6 ± 4.1 years, p < 0.001). Compared to non-geriatric patients, more patients involved in extremities (76.2% vs 61.5%, p < 0.001) and trunk (37.2% vs 26.4%, p < 0.001), but less in head and neck (18.3% vs 30.4%, p < 0.001; 25.3% vs 20.6%, p < 0.001). 13.4% of eczema and dermatitis in the elderly was widespread, which is much higher than that of 8% in non-geriatric group (13.4% vs 8%, p < 0.001). 22.9% of geriatric eczema patients reported severe itching, which is much higher than that of 14% in counterparts (22.9% vs 14%, p < 0.001). A positive correlation was observed between age and severe itching (Spearman's rank correlation test, p < 0.001). More geriatric patients had xerosis (39.6% vs 30.4%, p < 0.001) and more lichenification was found (25.6% vs 13.3%, p < 0.001). Conclusion: More than 10% of eczema occurs in the elderly patients. Longer disease duration, more severe itching, more extremities and trunk involvement, and prone to widespread, xerosis, and lichenification make it a special entity which should be studied further. [ABSTRACT FROM AUTHOR]

Introduction: The original Rainbow Model of Integrated Care Measurement Tool (RMIC-MT) is based on the Rainbow Model of Integrated Care (RMIC), which provides a comprehensive theoretical framework for integrated care. The aim of this paper is to modify the original patient version of the RMIC-MT for the Chinese primary care context and validate its psychometric properties. Methods: The translation and adaptation processes were performed in four steps, forward and back-translation, experts review and pre-testing. We conducted a crosssectional study with 386 patients with diabetes attending one of 20 community health stations in the Nanshan district. We analyzed the distribution of responses to each item to study the psychometric sensitivity. Exploratory factor analysis with principal axis extraction method was used to assess the construct validity. Confirmation factor analysis was used to evaluate model fit of the modified version. Cronbach's alpha was used to ascertain the internal consistency reliability. Results: During the translation and adaptation process, all 24 items were retained with some detailed modifications. No item was found to have psychometric sensitivity problems. Five factors (person-centeredness, clinical integration, professional integration, team-based coordination, organizational integration) with 15 items were determined by exploratory factor analysis, accounting for 53.51% of the total variance. Good internal consistency was achieved with each item correlated the highest on an assigned subscale and Cronbach's alpha score of 0.890. Moderately positive associations (r= 0.4, p<0.01) between the score of the scale and these correlations indicate good construct validity. Conclusions: The results showed initial satisfactory psychometric properties for the validation of the Chinese RMIC-MT patient version. Its application in China will promote the development of people-centered integrated primary care. However, future studies with diverse samples crossing regions would be needed to test its psychometric properties for the various Chinese primary care contexts. [ABSTRACT FROM AUTHOR]

Background: The adverse reactions (ADRs) of targeted therapy were closely associated with treatment response, clinical outcome, quality of life (QoL) of patients with cancer. However, few studies presented the correlation between ADRs of targeted therapy and treatment effects among cancer patients. This study was to explore the characteristics of ADRs with targeted therapy and the prognosis of cancer patients based on the clinical data.Methods: A retrospective secondary data analysis was conducted within an ADR data set including 2703 patients with targeted therapy from three Henan medical centers of China between January 2018 and December 2019. The significance was evaluated with chi-square test between groups with or without ADRs. Univariate and multivariate logistic regression with backward stepwise method were applied to assess the difference of pathological characteristics in patients with cancer. Using the univariate Cox regression method, the actuarial probability of overall survival was performed to compare the clinical outcomes between these two groups.Results: A total of 485 patients were enrolled in this study. Of all patients, 61.0% (n = 296) occurred ADRs including skin damage, fatigue, mucosal damage, hypertension and gastrointestinal discomfort as the top 5 complications during the target therapy. And 62.1% of ADRs were mild to moderate, more than half of the ADRs occurred within one month, 68.6% ADRs lasted more than one month. Older patients (P = 0.022) and patients with lower education level (P = 0.036), more than 2 comorbidities (P = 0.021), longer medication time (P = 0.022), drug combination (P = 0.033) and intravenous administration (P = 0.019) were more likely to have ADRs. Those with ADRs were more likely to stop taking (P = 0.000), change (P = 0.000), adjust (P = 0.000), or not take the medicine on time (P = 0.000). The number of patients with recurrence (P = 0.000) and metastasis (P = 0.006) were statistically significant difference between ADRs and non-ADRs group. And the patients were significantly poor prognosis in ADRs groups compared with non-ADRs group.Conclusion: The high incidence of ADRs would affect the treatment and prognosis of patients with cancer. We should pay more attention to these ADRs and develop effective management strategies. [ABSTRACT FROM AUTHOR]

An improved two-sphere integration (TSI) technique has been developed to quantify black carbon (BC) concentrations in the atmosphere and seasonal snow. The major advantage of this system is that it combines two distinct spheres to reduce the scattering effect due to light-absorbing particles, and thus provides accurate determinations of total light absorption from BC collected on Nuclepore filters. The TSI technique can be calibrated using a series of 15 filter samples of standard fullerene soot. This technique quantifies the mass of BC by separating the spectrally resolved total light absorption into BC and non-BC fractions. To assess the accuracy of the improved system, an empirical procedure for measuring BC concentrations by a two-step thermal-optical method is also applied. Laboratory results indicate that BC concentrations determined using the TSI technique and theoretical calculations are well correlated, whereas the thermal-optical method underestimates BC concentrations by 35%-45%. Assessments of the two methods for atmospheric and snow samples revealed excellent agreement, with least-squares regression lines with slopes of 1.72 (r2 = 0.67) and 0.84 (r2 = 0.93), respectively. However, the TSI technique is more accurate in quantifications of BC concentrations in both the atmosphere and seasonal snow, with an overall lower uncertainty. Using the improved TSI technique, we find that light absorption due to BC plays a dominant role, relative to non-BC light absorption, in both the atmosphere (68.5%-95.9% of total light absorption) and seasonal snow (52.3%-93.3%) over northern China. [ABSTRACT FROM AUTHOR]

In most countries, the demand for integrated care for people with chronic diseases is increasing as the population ages. This demand requires a fundamental shift of health-care systems towards more integrated service delivery models. To achieve this shift in China, the World Health Organization, the World Bank and the Chinese government proposed a tiered health-care delivery system in accordance with a people-centred integrated care model. The approach was pioneered in Luohu district of Shenzhen city from 2015 to 2017 as a template for practice. In September 2017, China's health ministry introduced this approach to people-centred integrated care to the entire country. We describe the features of the Luohu model in relation to the core action areas and implementation strategies proposed and we summarize data from an evaluation of the first two years of the programme. We discuss the challenges faced during implementation and the lessons learnt from it for other health-care systems. We consider how to improve collaboration between institutions, how to change the population's behaviour about using community health services as the first point of contact and how to manage resources effectively to avoid budget deficits. Finally, we outline next steps of the Luohu model and its potential application to strengthen health care in other urban health-care systems. [ABSTRACT FROM AUTHOR]

Accurate luminescence ages of volcanically-baked clay are important for studying the eruptive history of young quaternary volcanoes. However, some unusual luminescence properties were found in some heated quartz extracted from volcanically-baked clay, i.e., slow decay rate, strong recuperation, etc., whose effects on equivalent dose have not been well studied. In this study, baked clay collected from Dayingshan volcano, Yunnan Province, southwest of China, were collected to investigate the effect of these special luminescence characteristics on equivalent dose. It was shown that the initial OSL signal of heated quartz was dominated by medium component with small Fast Ratio values (< 10), and pulse-annealing tests indicated that the medium component was thermally stable. The negative correlation between De and recuperation indicated that strong recuperation would lead to the underestimation of De when using the SAR-OSL method. Therefore, three different correction strategies were used to suppress or eliminate the effect of recuperation on De, namely: I) correction by the De-recuperation relation1; II) early background subtraction2; and III) increasing the excitation temperature. The corrected luminescence ages fitted well with independent 14C ages obtained by carbon chips. The accurate eruption history of Dayingshan volcano during the Quaternary was finally obtained at about 41-43 ka. [ABSTRACT FROM AUTHOR]

Natural organic matter (NOM) represents the major source of precursors for disinfection byproducts (DBPs), such as trihalomethanes (THMs) and haloacetic acids (HAAs), formed during disinfection of drinking water, but the molecular composition and reactivity of NOM remain not well understood. In this study, electrospray ionization coupled to Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR MS) was used to characterize the molecular composition of NOM of 20 source waters taken across China for the purpose of determining the major precursors of THMs and HAAs at molecular level. It was found that there is a core of NOM compositions that are ubiquitous in different source waters, which is supposed to be more relevant for NOM quality. Formation potentials (FP) of THMs and HAAs were determined for NOM from different source waters during chlorination. Spearman's rank correlation was used to link THMFP and HAAFP with the individual molecular composition of NOM. Significant correlation (P < 0.001) was found between DBPFP and the NOM molecules with a high O/C ratio and low H/C ratio, indicating these molecules could contribute greatly to the formation of THMs and HAAs during chlorination. The link of THMFP and HAAFP with individual NOM molecules may allow us to develop more effective treatment strategies to achieve the drinking water safety objective: effective disinfection of waterborne pathogens while minimizing toxic DBPs. [ABSTRACT FROM AUTHOR]

Background: The caesarean section rate has risen rapidly in China. The purpose of this retrospective study was to estimate caesarean section rates and indications by hospital facility level in Mainland China to investigate reasons contributing to the high rate.Methods: This cross-sectional hospital-based study collected data from 39 hospitals in three geographical regions in China, covering 14 different provinces, municipalities, and autonomous regions, including 20 tertiary health hospitals and 19 secondary hospitals. Data from all women who gave birth at these hospitals during 2011 were included.Results: A total of 112,138 women who gave birth after 24 weeks of gestation were surveyed. Of these pregnancies, 54.5% (61,084 cases) resulted in caesarean section, non-indicated caesarean section accounted for 38.4% of caesarean sections. Overall caesarean section rates were higher at the tertiary level hospitals (55.9%) compared to the secondary level hospitals (50.9%). The secondary level hospitals had higher rates of non-indicated caesarean section (48.9% of caesarean sections) compared to tertiary level hospitals (34.5% of caesarean sections). The rate of caesarean section on maternal request was higher in the secondary hospitals (16.6%) than in the tertiary hospitals (10%) (P < 0.001), as well as the caesarean section rate for CPD prior to labour. Operative vaginal deliveries were overall rare (1.2%) with 90.9% (1200/1320 cases) performed in the tertiary hospitals.Conclusions: Caesarean section on maternal request accounts for a large portion of China's high caesarean section rate, especially in the secondary hospitals. The first step to reduced caesarean section rates is to decrease the number of non-indicated caesarean sections. [ABSTRACT FROM AUTHOR]

Since China's adoption of reform and open-up policy in 1978, Jiangsu Province has achieved a fast economic development, with the average annual increasement rate of GDP per capita at 11.3% (counted with comparative price). In this process, the role of infrastructure in pushing the economic growth receives great attention. Study on the pushing effect of infrastructure on the economic growth will help the stipulation of proper infrastructure development strategy, so as to push forward economy and narrow the regional gap. In this paper, we investigates the comprehensive evaluation problems of regional economy development level in Jiangsu Province with 2-tuple linguistic information. Then we propose dependent 2-tuple linguistic Maclaurin symmetric mean (D2TLMSM) operator and then apply D2TLMSM operator for evaluating the regional economy development level in Jiangsu Province with 2-tuple linguistic information. At last, a practical example is proposed to test the effectiveness of the given method. [ABSTRACT FROM AUTHOR]

Background: Increases in health care utilization and costs, resulting from the rising prevalence of chronic conditions related to the aging population, is exacerbated by a high level of fragmentation that characterizes health care systems in China. There have been several pilot studies in China, aimed at system-level care coordination and its impact on the full integration of health care system, but little is known about their practical effects. Huangzhong County is one of the pilot study sites that introduced organizational integration (a dimension of integrated care) among health care institutions as a means to improve system-level care coordination. The purposes of this study are to examine the effect of organizational integration on system-level care coordination and to identify factors influencing care coordination and hence full integration of county health care systems in rural China. Methods: We chose Huangzhong and Hualong counties in Qinghai province as study sites, with only Huangzhong having implemented organizational integration. A mixed methods approach was used based on (1) document analysis and expert consultation to develop Best Practice intervention packages; (2) doctor questionnaires, identifying care coordination from the perspective of service provision. We measured service provision with gap index, overlap index and over-provision index, by comparing observed performance with Best Practice; (3) semi-structured interviews with Chiefs of Medicine in each institution to identify barriers to system-level care coordination. Results: Twenty-nine institutions (11 at county-level, 6 at township-level and 12 at village-level) were selected producing surveys with a total of 19 schizophrenia doctors, 23 diabetes doctors and 29 Chiefs of Medicine. There were more care discontinuities for both diabetes and schizophrenia in Huangzhong than in Hualong. Overall, all three index scores (measuring service gaps, overlaps and over-provision) showed similar tendencies for the two conditions. The gap indices of schizophrenia (> 5.10) were bigger for diabetes (< 2.60) in both counties. The over-provision indices of schizophrenia (> 3.25) were bigger than diabetes (< 1.80) in both counties. Overlap indices for the two conditions exceeded justified overlaps, especially for diabetes. Gap index scores for schizophrenia interventions at the township-level and over-provision index scores for diabetes interventions at both village- and township-level showed big differences between the two counties. Insufficient medical staff with appropriate competencies, lack of motivation for care coordination and related supportive policies as well as unconnected information system were identified as barriers to system-level care coordination in both counties. Conclusion: Findings demonstrate that organizational integration in Huangzhong has not achieved a higher level of care coordination at this stage. System-level care coordination is most problematic at village-level institutions in Hualong, but at county-level institutions in Huangzhong. These findings suggest that attention be given to other aspects of integration (e.g., clinical and service integration) to promote system-level care coordination and contribute to the full integration of health care system in the pilot county. [ABSTRACT FROM AUTHOR]

Background: Whether educational level influences the effects of health education is not clearly defined. This study examined whether the impact of a community-based dietary salt reduction program was affected by the level of education of participants.Methods: The China Rural Health Initiative Sodium Reduction Study (CRHI-SRS) was a cluster-randomized controlled trial conducted in 120 villages from five Northern Chinese provinces. The intervention comprised a village-wide health education program and availability of salt substitute at village shops. 24-h urine samples were collected among 1903 participants for primary evaluation of the intervention effect. A post-hoc analysis was done to explore for heterogeneity of intervention effects by education level using generalized estimating equations. All models were adjusted for age, sex, body mass index and province.Results: Daily salt intake was lower in intervention than in control at all educational levels with no evidence of a difference in the effect of the intervention across different levels of education. P value for the interaction term between education level and the intervention was 0.35. There was likewise no evidence of an interaction for effects of the intervention on potassium intake (p = 0.71), the sodium to potassium ratio (p = 0.07), or knowledge and behaviors related to salt (all p > 0.05).Conclusions: The study suggests that the effects of the intervention were achieved regardless of the level of education and that the intervention should therefore be broadly effective in rural Chinese populations.Trial Registration: The trial was registered with clinicaltrial.gov ( NCT01259700 ). [ABSTRACT FROM AUTHOR]

Temperature field data from the steel truss arch girder and longitudinal displacement data from six groups of rubber bearings were collected by the structural health monitoring system for the Dashengguan Yangtze Bridge. By using long-term monitoring data, two correlations are investigated: the linear correlation between the longitudinal displacement and the temperature field (including uniform temperature and temperature gradient); and the linear correlation of the longitudinal displacements in different locations. A multivariate linear regression equation is used to model the first correlation, and a Lagrange polynomial interpolation is used to model the second correlation. The final mathematical models, representing the healthy state of the bearings, can be applied to simulate the longitudinal displacements of the main girder. Furthermore, the change regularity of longitudinal displacements for the degraded rubber bearings is revealed taking advantage of a hysteretic model and presumed envelope curves of frictions caused by bearing degradation. A method of detection and location for the degraded bearings is proposed in four detailed steps, and the numerical results demonstrate that this method is effective. [ABSTRACT FROM AUTHOR]

BACKGROUND: Metals in single spot urine samples are often used to estimate individual exposure in human studies. However, measurements in urine could vary greatly over time due to variable exposure, potentially leading to exposure misclassification. OBJECTIVE: We examined the variability of metal levels in the urine of 11 men who provided 529 samples on 8 days during a 3-month period, which corresponds to the duration of spermatogenesis. METHOD: The urinary levels of arsenic (As), cadmium (Cd), cobalt (Co), copper (Cu), lead (Pb), molybdenum (Mo), and nickel (Ni) were measured using inductively coupled plasma-mass spectrometry. We calculated the intraclass correlation coefficients (ICCs) to assess the reproducibility of metal measures and computed the sensitivity and specificity to evaluate how well spot urine samples determined the individuals' 3-month average exposure. RESULTS: Fair to good reproducibility was observed for the serial measurements of Cd (ICC = 0.53) in spot samples collected during the 3-month period, whereas the serial measurements of As, Co, Cu, Pb, Mo, and Ni showed poor reproducibility (ICCs = 0.01-0.29). Use of single spot urine samples to classify the high (top 33%) 3-month average metal levels had uniformly high specificities (0.70-0.84) but relatively low sensitivities (0.40-0.57), except for Cd (0.77). The minimum number of specimens (k) required to estimate the participant-specific mean for the seven metals within 20% of the "true" values ranged from 3 for Cd to 27 for Ni. CONCLUSIONS: The high variability observed in the urinary levels of As, Co, Cu, Pb, Mo, and Ni suggests that a single measurement provides only a brief snapshot in time of the exposure levels of an individual, which can result in a moderate degree of exposure misclassification. [ABSTRACT FROM AUTHOR]

We collected 92 snow samples from 13 sites across northeastern China from January 7 to February 15, 2014. The surface snow samples were analyzed for the major water-soluble ions ( SO42- , NO 3 − , F – , Cl – , Na + , K + , Ca 2+ , Mg 2+ , and NH 4 + ) and trace element (Al, As, Mn, V, Cd, Cu, Pb, Zn, Fe, Cr, and Ni). The results indicated that the higher concentrations of NO 3 − and SO 4 2 − and the trace elements Zn, Pb, Cd, Ni, and Cu were likely attributable to enhanced local industrial emissions in East Asia especially in China. In addition, snow samples characterized by higher enrichment factors of trace elements (Cu, Cd, As, Zn, Pb) were indicative of an anthropogenic source. Emissions from fossil fuel combustion and biomass burning were likely important contributors to the chemical elements in seasonal snow with long-range transport. On the other hand, the large attribution of K + appeared in the higher latitude demonstrated that biomass burning was a dominated factor of the chemical species in seasonal snow in the higher latitude of China than that in the lower latitude. Finally, an interannual comparison with the 2010 China snow survey also confirmed the source attributions of chemical speciation in seasonal snow in these regions. [ABSTRACT FROM AUTHOR]

Introduction: We simulate and analyze Total Health Expenditure (THE) in financial sources and other economic indicators (such as THE per capita, GDP, etc.) in a province of China from 2002 to 2012 on System Dynamics. Methods: Based on actual data and certain mathematical methods, we use system dynamic software to construct a logic model for THE and changing proportions, and thus simulate the actual conditions of development and changes in THE. Results: According to the simulation results, the government possess the largest investment in the average annual growth rate of THE, which was 25.16 % in 2012. Social investment comprises the majority of the possession ratio, which was up to 41.20 %. Conclusions: The personal investment growth rate decreased by almost 21 %, but the total amount of personal investment increased by 28075 million yuan, which is far higher than the increase in government investment. Individuals are still the main carriers of health care expenses. The equity of health financial sources is still poor. The System Dynamics method used in this paper identifies a dynamic measurement process, provides a scientific basis for simulation and analysis of the changes in THE and its key constraining factors, as well as put forward suggestions for the improvement of equity of health financial sources. [ABSTRACT FROM AUTHOR]

This study aimed to explore the survival of AIDS patients treated with traditional Chinese medicine (TCM) in addition to combined antiretroviral therapy (cART) and of AIDS patients treated with cART. Data of patients taking cART between 30 October 2003 and 30 October 2004 in the National TCM HIV Treatment Trial Program area were retrospectively analyzed, with follow-up from 30 October 2004 to 30 October 2012. The log-rank test was used to compare survival between the two groups. A Cox proportional hazards model was used to determine hazard ratios to identify prognostic factors. The study included 521 patients in the TCM + cART group followed up for 3548 person-years and 375 patients in the cART group followed up for 2523 person-years. Mortality rates were 3.2/100 person-years and 4.2/100 person-years in the TCM + cART and cART groups, respectively. The difference in survival was significant. After adjusting for explanatory variables, the mortality rate of AIDS patients in the cART group was 1.7 times higher than in the TCM + cART group. Male sex, older age, little education, and lower CD4 cell count were risk factors for mortality. TCM intervention in addition to cART could increase survival of AIDS patients. [ABSTRACT FROM AUTHOR]

Administrative division adjustments (hereinafter referred to as ADA) proceed throughout China's rapid urbanization, especially during the process of metropolitanization. It has become an integral part of the transformation of China's urban and regional governance. Based on an analysis of ADA cases at the metropolitan level since 1997, this paper suggests that the stages and characteristics of ADA in China are closely related to the metropolitanization process. The internal dynamics and external constraints jointly created two stages of ADA at the metropolitan level in China, namely, a first stage from 1997 to 2007 and a second stage from 2008 to now. In the first stage, ADA primarily aimed at turning counties into districts, to meet the metropolis' demands for expansion. In the second stage, local governments laid equal stress on the two approaches of ADA, i.e., turning counties into districts and district restructuring. Such a change corresponded to the diversification of development demands of the metropolitan area. The evolution of ADA from the first stage to the second not only reflects the changing characteristics of metropolitanization at different times, but also demonstrates the viability of ADA as a means to improve the governance structure of the metropolitan area. ADA at the metropolitan level in China since 1997 basically accommodates the development of space and governance in the metropolitan area, which promotes the rapid development of a large metropolitan area. [ABSTRACT FROM AUTHOR]

Background: China's New Cooperative Medical Scheme (NCMS), launched in 2003, was intended to prevent the impoverishment due to catastrophic illness costs. Previous studies have been conducted on the “design flows" of the NCMS, for example, the irrational insurance benefit package. But after several years of implementation, very little has been known about the improvements made by the NCMS and rural residents' attitudes toward it. This article specifically focused on the improvements of healthcare services and the enrollees' choices of providers since the implementation of the NCMS in Liaoning province. Methods: We conducted a one-on-one interview with healthcare officials in order to get a better understanding of the NCMS policies of the local area. We conducted a door-to-door survey in 3 counties, 21 villages and 602 households to gauge population characteristics, respondents' healthcare preferences, satisfaction levels with providers, and their attitudes towards designated healthcare institutions. Results: We found that 43.6% of the respondents believed the NCMS brought more convenience to receive healthcare services. 35.2% of the rural residents thought the NCMS work ineffectively, mainly due to the high healthcare costs. 72.3% of the respondents preferred the county hospitals when they got severe diseases, mainly for the reason of better skills and more advanced equipment, while they preferred village clinics (56.5%) and township hospitals (23.2%) when they got minor diseases mainly for the reason of convenience. Conclusion: We concluded that the NCMS improved the situation of hard to receive healthcare services but did not reduce the high healthcare fees. Furthermore, participants were unsatisfied with the NCMS designated hospitals. Based on our findings, a number of remedial actions were proposed, including redistributing healthcare resources, developing more domestic medical equipment to lower the treatment costs, and establishing a new talent flow mode. [ABSTRACT FROM AUTHOR]

Grey resource model is the core model in the grey ecological resource exploitation theory for describing and forecasting development stages of resource efficiency. In order to define the application range of grey resource model, this study deduces the ranges of secondary parameter packages based on the coverage operations of grey numbers, and then deduces that of the development coefficient. Finally the admissible region of non-homogeneous class ratio for grey resource model is obtained in the form of both mathematical formula and numerical simulation of China's wind power industry and science & technology industry. [ABSTRACT FROM AUTHOR]

To investigate canines carrying pathogens associated with human illness, we studied their roles in transmitting and maintaining pathogenic Yersinia spp. We examined different ecological landscapes in China for the distribution of pathogenic Yersinia spp. in Canis lupus familiaris, the domestic dog. The highest number of pathogenic Yersinia enterocolitica was shown from the tonsils (6.30%), followed by rectal swabs (3.63%) and feces (1.23%). Strains isolated from plague free areas for C. lupus familiaris, local pig and diarrhea patients shared the same pulsed-field gel electrophoresis (PFGE) pattern, indicating they may be from the same clone and the close transmission source of pathogenic Y. enterocolitica infections in these areas. Among 226 dogs serum samples collected from natural plague areas of Yersinia pestis in Gansu and Qinghai Provinces, 49 were positive for F1 antibody, while the serum samples collected from plague free areas were all negative, suggested a potential public health risk following exposure to dogs. No Y. enterocolitica or Yersinia pseudotuberculosis was isolated from canine rectal swabs in natural plague areas. Therefore, pathogenic Yersinia spp. may be regionally distributed in China. [ABSTRACT FROM AUTHOR]

The grey dynamic model by convolution integral with the first-order derivative of the 1-AGO data and n series related, abbreviated as GDMC(1, n), performs well in modelling and forecasting of a grey system. To improve the modelling accuracy of GDMC(1, n), n interpolation coefficients (taken as unknown parameters) are introduced into the background values of the n variables. The parameters optimization is formulated as a combinatorial optimization problem and is solved collectively using the particle swarm optimization algorithm. The optimized result has been verified by a case study of the economic output of high-tech industry in China. Comparisons of the obtained modelling results from the optimized GDMC(1, n)model with the traditional one demonstrate that the optimal algorithm is a good alternative for parameters optimization of the GDMC(1, n) model. The modelling results can assist the government in developing future policies regarding high-tech industry management. [ABSTRACT FROM AUTHOR]

Etomidate (ET), a hypnotic agent used for the induction of anesthesia, is rapidly metabolized to etomidate acid (ETA) in the liver. Recently, ET has become one of the most serious alternative drugs of abuse in China. Therefore, an urgent need exists to develop a fast and convenient analysis method for monitoring ET. The current work presents a simple, fast, and sensitive direct injection method for the determination of ET and ETA in wastewater. After the optimization of the ultra-performance liquid chromatography-tandem mass spectrometry and sample filtration conditions, the method exhibited satisfactory limits of detection (1 ng/L) and good filtration loss. The validated method was successfully applied to determine the concentrations of ET and ETA in wastewater samples (n = 245) from several wastewater treatment plants in China. The concentrations of the targets in positive samples ranged from less than the lower limits of quantitation to 47.71 ng/L. The method can meet ET monitoring and high-throughput analysis requirements. [ABSTRACT FROM AUTHOR]

Background and Objectives: Stroke is the most common neurological disease in China and regulation of lipid levels is important for secondary prevention. This study aimed to investigate the practice of lipid lowering agents immediately after and one month following ischemic stroke in China, and to determine the factors affecting the practice. Methods: A total of 857 patients with acute ischemic stroke were enrolled from 11 hospitals in the Qingdao area, Northern China. Data pertaining to the patients' demographic, clinical data, and treatment before and after the stroke were recorded. Univariate and multivariate logistic regression analyses were used to determine the factors associated with the treatment at two time points: at the acute stage and at one month follow-up. Results: The frequency of lipid lowering therapy was 50.3% (431/857) at acute stage and 41.5% (306/738) at one month. Lipid lowering therapy at acute stage was independently and positively associated with a history of hyperlipidemia((P=0.002, OR (95%CI): 3.784 (1.610-8.898)) and excess alcohol consumption (P=0.005, OR (95%CI): 1.928 (1.214-3.062)), partial anterior circulation infarct classification (P=0.000, OR (95%CI): 1.974 (1.370-2.767)), and low-density lipoprotein levels ((P=0.000, OR (95%CI): 1.426 (1.170-1.739)). Lipid lowering therapy at one month follow-up was independently and positively associated with lipid lowering therapy at acute stage ((P=0.000, OR (95%CI): 18.275 (11.476- 29.101)), and negatively with the Modified Rankin Scale ⩾4 at follow-up ((P=0.030, OR (95%CI): 0.568 (0.341-0.948)). Conclusions: Lipid lowering therapy was found to be used in about half of patients during acute and early secondary prevention of ischemic stroke in the Qingdao area of Northern China. There should be more education efforts to the health care professionals and public to increase its use. [ABSTRACT FROM AUTHOR]

In recent years, export value-added tax (VAT) refund rebate and export tax (EVRRET) measures have been adopted for energy-intensive products in China. They are proclaimed to be climate policy, yet there is no explicit and unique carbon cost set on export, and the implicit export carbon tax rates vary dramatically across sectors and over different periods. A method is provided to introduce an explicit and unique carbon cost into the current EVRRET. By setting a comparable carbon cost (US$20/tCO2 and US$30/tCO2) for eight major energy-intensive sectors to which the EVRRET is widely applied, it derives the corresponding ad valorem average rate for each sector. The introduction of a carbon cost into export VAT refund rebate policy would not increase the current export VAT refund rebate rate (except for the chemical sector), but would simply define a ceiling. However, the same introduction into the export tax policy would lead to an overall increase in sectoral export tax rates. In terms of competitiveness and World Trade Organisation concerns, the better option for introducing a carbon cost into Chinese exports would be through reforming export VAT refund rebate policy. [ABSTRACT FROM AUTHOR]

The predominant bioserotypes of pathogenic Yersinia enterocolitica in China are 2/O: 9 and 3/O: 3; no pathogenic O: 8 strains have been found to date. Multiple-Locus Variable-Number Tandem-Repeat Analysis (MLVA) based on seven loci was able to distinguish 104 genotypes among 218 pathogenic Y. enterocolitica isolates in China and from abroad, showing a high resolution. The major pathogenic serogroups in China, O: 3 and O: 9, were divided into two clusters based on MLVA genotyping. The different distribution of Y. enterocolitica MLVA genotypes maybe due to the recent dissemination of specific clones of 2/O: 9 and 3/O: 3 strains in China. MLVA was a helpful tool for bacterial pathogen surveillance and investigation of pathogenic Y. enterocolitica outbreaks. [ABSTRACT FROM AUTHOR]

China's average household saving rate is one of the highest in the world. One popular view attributes the high saving rate to fast-rising housing prices and other living costs in China. This article uses simple economic logic to show that rising housing prices and living costs per se cannot explain China's persistently high household saving rate. Although borrowing constraints and demographic changes can help translate housing prices to the aggregate saving rate, quantitative simulations using Chinese data on household income, housing prices, and demographics indicate that rising mortgage costs contribute at most 5 percentage points to the Chinese aggregate household saving rate, given the down payment structure of China's mortgage markets. [ABSTRACT FROM AUTHOR]

mospheric nitrogen (N) deposition is a serious problem on the North China Plain (NCP) because it imposes a considerable nutrient burden on the local environment. However, it also makes a substantial contribution to agricultural crop N requirements. The integrated total N input (ITNI) system is a method to quantify total atmospheric N deposition by using N-labeled monitor plants grown in pots. The effect of pot surface area and variety of indicator plant on the amount of airborne N input quantified by the ITNI system was investigated in this study. Total N deposition to the soil-maize/soil-wheat plant system at key growth stages was also quantified to improve N-fertilizer recommendations. When indicator plants having a high space requirement were used a correction factor was needed and this could be obtained only by simulating commercial field conditions, especially plant density, because the factor depends largely on pot area or the difference in plant density between pot conditions and field conditions. The total airborne N input measured by the ITNI system was not influenced by the variety of monitoring plant. N deposition was 20-25 kg N ha during growth from three expanded leaf to ten expanded leaf and also from ten expanded leaf to maturity of maize. N deposition was 29.1 kg N ha between planting and the jointing stage and 10.1 kg N ha from jointing to maturity of wheat. This high measured N deposition indicates that N deposition should be taken into account when calculating the N fertilizer requirements of maize and wheat in this region. [ABSTRACT FROM AUTHOR]

A computational case study is presented of the flooding in urban Jiujiang due to the Yangtze River dike break in August 1998. A shallow water hydrodynamic model was deployed based on the weighted average flux -- total variation diminishing (WAF-TVD) finite volume algorithm. A series of numerical modelling was conducted to identify the influences of the mesh resolution and model parameterisation on the flood propagation. Three mesh resolutions (2, 5 and 10 m) were used, and spatially distributed roughness was specified based on land-use classification. Due to the highly irregular topography and densely distributed buildings, the flood propagation is largely hindered. The numerical results show that an area of merely 6 km² was inundated at 6 h following the dike break with a discharge of 400 m3/s. Mesh resolution and roughness parameterisation have considerable effects on the flood propagation, whereas the impact of turbulent eddy viscosity is negligible. A coarser mesh could result in a larger inundation area (10%), and a lumped roughness may produce an appreciable overestimation of the inundation area in the initial period of the flood propagation. This observation highlights the significance of mesh resolution and also physically meaningful estimation of the roughness for urban flood modelling. [ABSTRACT FROM AUTHOR]

Searching for early angiosperms is a riveting activity in botany because it helps to resolve the phylogenetic relationships among seed plants and among angiosperms themselves. One of the challenges for this job is what the target fossils look like. Most possibly early angiosperms may elude our scrutiny with gymnospermous appearances. This possibility becomes a reality in a Jurassic plant, Solaranthus gen. nov, which bears a peltaspermalean appearance and enclosed ovules. According to knowledge available hitherto, the latter feature makes it an angiosperm. However, such a feature is more likely to be eclipsed by its gymnospermous appearance. The early age and unexpected character assemblage of Solaranthus urge for a fresh look on the assumed-simple relationship between angiosperms and gymnosperms. Its resemblance to the order Peltaspermales favors the Mostly Male Theory. [ABSTRACT FROM AUTHOR]

A new approach is proposed to determine the distributed threshold rainfall for flash flooding to support practical flood warning. It is built upon a two-dimensional full hydrodynamic model incorporating rainfall, infiltration loss and boundary resistance. Numerical solution of the governing equations of the model is achieved under an operator-splitting framework, the second-order total-variation-diminishing version of the weighted-average-flux method along with the Harten-Lax-van Leer contact wave (HLLC) approximate Riemann solver for the homogeneous equations, and a Runge-Kutta scheme for the ordinary differential equations of the source terms. The applicability of the new approach is demonstrated as applied to real flash flooding-prone areas in Hunan Province, China. The threshold rainfall for flash flooding, resulting from rainfall of durations from 1 h to 6 h, is found to be locally less than 100 mm or even 50 mm. This means a high risk of flash flooding in the local areas, and therefore effective measures are necessary to avoid loss of property and life. The present work should find general application in support of practical flash flood warning in catchments with the necessary topography and soil and geological data available. [ABSTRACT FROM AUTHOR]

Problematospermum is a distinctive but enigmatic seed known mainly from the Jurassic and Cretaceous sediments. Numerous new specimens of Problematospermum ovale from two localities in the Middle Jurassic Jiulongshan Formation of China (Sanjiaocheng Village in western Liaoning and Daohugou Village in eastern Inner Mongolia) provide improved information on the structure of Problematospermum. It has an ovoid body with a long apical tube and bears a tuft of filamentous appendages at the base. While Problematospermum was interpreted previously as a disseminule of an angiosperm or angiosperm-like plant, the new specimens show closer similarities to seeds of the Bennettitales, Erdtmanithecales, and Gnetales. However, the unusual features of Problematospermum imply pollination and dispersal biology different from what has so far been known for key lineages of seed plants. [ABSTRACT FROM AUTHOR]

One paradoxical reality of today's China is that urban citizenship does not necessarily go to those who have already moved to the city. Rural migrants are now allowed to work in cities but are deprived of a wide range of entitlements. Taking Shanghai, the most populous city in the world's most populous country, as a case study, this article establishes significant empirical content to elucidate how the notion of urban citizenship is interpreted in China, what criteria are applied for granting the urban citizenship, to what extent the entitlements of migrants in cities are comparable to those of the bona fide urban residents, and whether the lack of urban citizenship influences migrants' integration into host cities. Empirical investigation shows that granting of the urban hukou (household registration) is based largely on migrants' contribution to, rather than simply on their presence in, the host city. In the context of reform-era China, urban citizenship is used by city government not only to exclude some members of society from accessing urban welfare but also to make the urban economy more competitive by grabbing capital and human resources possessed by migrants. [ABSTRACT FROM AUTHOR]

Background: Yersinia enterocolitica is an enteric pathogen that invades the intestinal mucosa and proliferates within the lymphoid follicles (Peyer's patches). The attachment invasion locus (ail) mediates invasion by Y. enterocolitica and confers an invasive phenotype upon non-invasive E. coli; ail is the primary virulence factor of Y. enterocolitica. The ferrioxamine receptor (foxA) located on the Y. enterocolitica chromosome, together with its transport protein, transports a siderophore specific for ferric ion. Currently, ail is the primary target gene for nucleic acid detection of pathogenic Y. enterocolitica. Results: The genes ail and foxA in 271 pathogenic and 27 non-pathogenic Y. enterocolitica strains isolated from China and 10 reference strains were sequenced, aligned, compared to the ail and foxA sequences of Yersinia enterocolitica subsp. enterocolitica 8081 (Genbank: NC•008800), and analyzed for sequence polymorphism. The ail from the 282 strains showed 3 sequence patterns: 277 strains of serotypes O:3, O:9 and O:5, 27 with identical nucleic acid sequences formed pattern A1; 4 strains of serotype 1B/O:8 with identical nucleic acid sequences formed pattern A2; and one Chinese isolate 2/O:9 formed pattern A3. In the primary coding region of the foxA ORF (Genebank: X60447 nt 433-1866; nt 28 to 1,461 in the ORF), the sequences formed 3 groups and were further divided into 8 sequence patterns. Conclusion: The ail and foxA loci of pathogenic Y. enterocolitica have been analyzed. The ail sequence was highly conserved among the same serotype strains from different sources; and foxA was highly conserved among the pathogenic strains, although there was some sequence diversity. Fewer strains were used from outside China, which is a limitation of the study. [ABSTRACT FROM AUTHOR]

Monoconidial isolates of 33 carbendazim-sensitive isolates and 31 carbendazim-resistant isolates of Fusarium graminearum were selected from three regions of China for vegetative compatibility group (VCG) analysis. A total of 213 and 224 nil mutants were recovered from the 33 sensitive and the 31 resistant isolates, respectively. Of all the nit mutants, the frequency of the different phenotypes was 44.6, 46.5, 5.7, and 3.2% for nit1, nit3, nitM, and nitA, respectively. VCG analysis identified 30 different VCOs among the 33 sensitive- and the 31 carbendazim-resistant isolates, with VCG diversity 0.91 and 0.97, respectively. Both, a car- bendazim-sensitive and a -resistant isolate from the same field belonged to the same VCG. In all then, a total of 59 VCGs were identified among the 64 isolates with an overall VCG diversity 0.92. Direct hyphal fusion was observed in six pairs of vegetatively compatible complements, which is evidence of heterokaryon formation. It was hypothesized that carbendazim resistance could not be transferred by hyphal fusion or there is a small chance to be transferred between two compatible isolates. Three stable sexual recombinants of F graminearum were randomly chosen from each of the three genetic crosses to study their biological properties. There were no significant differences in mycelial linear growth and pathogenicity between recombinants and their parents, but they differ in sporulation ability and capacity to produce perithecia. We concluded that sexual recombination presumably played a role in the development of carbendazim resistance under field conditions. [ABSTRACT FROM AUTHOR]

Background: The origin of angiosperms has been under debate since the time of Darwin. While there has been much speculation in past decades about pre-Cretaceous angiosperms, including Archaefructus, these reports are controversial. The earliest reliable fossil record of angiosperms remains restricted to the Cretaceous, even though recent molecular phylogenetic studies suggest an origin for angiosperms much earlier than the current fossil record. Results: In this paper, after careful SEM and light microscopic work, we report fossils with angiospermous traits of the Jurassic age. The fossils were collected from the Haifanggou Formation (middle Jurassic) in western Liaoning, northeast China. They include two female structures and an associated leaf on the same slab. One of the female structures is physically connected to the apex of a short shoot. The female organs are borne in pairs on short peduncles that are arranged along the axis of the female structure. Each of the female organs has a central unit that is surrounded by an envelope with characteristic longitudinal ribs. Each central unit has two locules completely separated by a vertical septum. The apex of the central unit is completely closed. The general morphology places these fossils into the scope of Schmeissneria, an early Jurassic genus that was previously attributed to Ginkgoales. Conclusion: Because the closed carpel is a character only found in angiosperms, the closed apex of the central unit suggests the presence of angiospermy in Schmeissneria. This angiospermous trait implies either a Jurassic angiosperm or a new seed plant group parallel to angiosperms and other known seed plants. As an angiosperm, the Liassic age (earliest Jurassic) of Schmeissneria microstachys would suggest an origin of angiosperms during the Triassic. Although still uncertain, this could have a great impact on our perspective of the history, diversity and systematics of seed plants and angiosperms. [ABSTRACT FROM AUTHOR]

BACKGROUND: Polyunsaturated fatty acids (PUFAs) have been shown to protect against fine particulate matter <2.5 μm in aerodynamic diameter (PM2.5)-induced hazards. However, limited evidence is available for respiratory health, particularly in pregnant women and their offspring. OBJECTIVES: We aimed to investigate the association of prenatal exposure to PM2.5 and its chemical components with allergic rhinitis (AR) in children and explore effect modification by maternal erythrocyte PUFAs. METHODS: This prospective birth cohort study involved 657 mother–child pairs from Guangzhou, China. Prenatal exposure to residential PM2.5 mass and its components [black carbon (BC), organic matter (OM), sulfate (SO42- ), nitrate (NO3 - ), and ammonium (NH4 +)] were estimated by an established spatiotemporal model. Maternal erythrocyte PUFAs during pregnancy were measured using gas chromatography. The diagnosis of AR and report of AR symptoms in children were assessed up to 2 years of age. We used Cox regression with the quantile-based g-computation approach to assess the individual and joint effects of PM2.5 components and examine the modification effects of maternal PUFA levels. RESULTS: Approximately 5.33% and 8.07% of children had AR and related symptoms, respectively. The average concentration of prenatal PM2.5 was 35.50 ± 5.31 μg/m³. PM2.5 was positively associated with the risk of developing AR [hazard ratio (HR)= 1.85; 95% confidence interval (CI): 1.16, 2.96 per 5 μg/m³] and its symptoms (HR = 1.79; 95% CI: 1.22, 2.62 per 5 μg/m³) after adjustment for confounders. Similar associations were observed between individual PM2.5 components and AR outcomes. Each quintile change in a mixture of components was associated with an adjusted HR of 3.73 (95% CI: 1.80, 7.73) and 2.69 (95% CI: 1.55, 4.67) for AR and AR symptoms, with BC accounting for the largest contribution. Higher levels of n-3 docosapentaenoic acid and lower levels of n-6 linoleic acid showed alleviating effects on AR symptoms risk associated with exposure to PM2.5 and its components. CONCLUSION: Prenatal exposure to PM2.5 and its chemical components, particularly BC, was associated with AR/symptoms in early childhood. We highlight that PUFA biomarkers could modify the adverse effects of PM2.5 on respiratory allergy. [ABSTRACT FROM AUTHOR]

Introduction: After the collapse of the integrated three-tier health care system in rural China during the 1980s, patients could seek health care at their institution of choice without referral. This resulted in cost-escalation and inefficient use of health care resources. The government of Huangzhong county is trying to rebuild integrated health care systems by constructing a medical consortium and strengthening collaboration among institutions. But little evidence exists about which institution to collaborate with and the types of collaboration. This study aims to provide suggestions for constructing the medical consortium in Huangzhong county, by visualizing an inpatients readmission network based on patients' preference and analyzing institutional relationships' effects on it. Method: Case-study methodology was employed to analyze health care utilization in Huangzhong county. Thirteen institutions, nine of them inside the county, four outside the county were included in the study. Information on between-institution relationships perceived patient referrals, population and patient information sharing, and joint training was collected using a modified version of Provan's instrument. Data about institution level township, county, city and province and location were collected by questionnaire. Over 20,000 records of inpatients who sought service in the thirteen institutions in 2013, were provided by the health insurance system. Among them, 255 were patients who attended a second or third institution for the same condition in the two week period following initial admission. Social network analysis was used to visualize the inpatient flow, and Quadratic Assignment Procedure correlation and regression were employed to identify factor determinants. Results: The density of the inpatient flow network was 0.269. The proportion of the inpatient readmission flow from county hospitals to provicial hospitals was 57.3. Using a reclusion criteria of p<0.05, perceived patient referrals, population and patient information sharing, big institutional level gaps and distance over 30kms were statistically significant. The R2 of the QAP regression was 0.245. Regression coefficients showed the greatest positive impact on inpatient flow was patient information sharing coefficient:+0.307, followed by perceived patient referrals coefficient:+0.200. The estimated coefficient of "distance over 30kms" is negative coefficient:-0.012. Conclusion: Referral networks perceived by institution leaders, and hence based on trust, are strongly associated with inpatient readmission flow. Information sharing is also inpatients preferred collaboration among institutions. In addition, inpatients tend to readmitted to higher-level institutions within 30km. Lessons learned: Besides township&county-leve institutions inside of the county, hospitals in higher levels within 30km are also suggested to be adopted in the medical consortium. Moreover, it is necessary to promote trust and information sharing among institutions in the medical consortium. Limitations: These conclusions for Huangzhong county cannot be generalised to other health care systems, but the case study methodology could be employed in other systems, to promote institutinonal collaboration and health care system integration. [ABSTRACT FROM AUTHOR]

Introduction: Emerging from the epidemiological transition and the accelerated population aging process, a fragmented healthcare delivery system with little effective collaboration among institutions in different tiers of the system cannot meet the demands of the population in China, especially the elderly with chronic diseases. The report by WHO in 2016 and the guideline by the General Office of the State Council in April 2017 proposed medical consortia to achieve people-centered integrated care in China. On Sep 1st 2017, China's National Health Planning Commission introduced the Luohu model to the whole country and encouraged all urban cities to learn from Luohu. Policy context and objective: Patients, who do not trust the service quality of district hospitals and community health stations CHSs, have to seek services in the crowded city hospital. "Line up for 3 hours, treatment for 3 minutes" became a problem. "Less illness, less hospital admissions, lower financial burdens, and better services" are the goals of Luohu health reform. Objectives of this study are to introduce strategies and evaluation results structure, process and outcome of the Luohu case during Aug 2015-Aug 2017. Highlights: There are three core strategies for integration in Luohu. First, the establishment of the hospital group as an independent corporation with six resource-sharing centers and six administrative centers in Aug 2015. Second, development of a new health insurance policy "Global budget, balance retained". Third, building family doctor teams in CHSs. Under these strategies, integrated care systems for the elderly and patients with chronic disease have emerged. Eleven detailed strategies summarized by the Rainbow Model will be introduced at the conference. Structure and process evaluations showed increases in health resources and care provision in CHSs and collaboration between hospitals and CHSs in terms of two-way referrals of patients. Outcome evaluation was conducted with Triple Aims. During the two years, the case management rates of patients with diabetes and hypertension has increased. However, there are more new cases of several diseases because of screening and early detection programs. Patients were more satisfied with care in Luohu. But, expenditure have exceeded global budgets and there has been no balance of health insurance funds in the hospital group in the past two years. Comments on transferability: The Luohu model was introduced across the country on Sep 1st 2017, and this was followed by more than 1500 policy makers from health and other social sectors covering 321 cities receiving on-site learning. Its three core strategies were transferable in most urban district health care systems of China. Conclusions: There are four lessons from Luohu model. First, engagement of all stakeholders is essential for designing and implementing the reform, especially multiple administrations and residents. Second, organizational integration is a prerequisite for integrated care in China nowadays. Third, care integration must occur simultaneously with payment reform under the health insurance program. Fourth, normative integration for changing behaviors of physicians and institutions is required. Discussion: Although the Luohu model was introduced to all urban cities of China, its policy influence is uncertain. [ABSTRACT FROM AUTHOR]