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Background The current training content of continuing education in general practice cannot meet the needs of clinical practice, as well as the lacking of thinking and characteristics of general practice in teaching faculty and evaluation methods. Objective To explore the training of clinical thinking in general practice through continuing education, so as to solve practical problems and improve working competence of general practitioners (GPs) . Methods The design of the 8th GPs' practice ability training workshop course was optimized based on the literature reading and feedback from the continuing education course of GPs' practice ability workshop in November 2020, and a questionnaire survey was conducted through the "wenjuanxing" platform among 200 GPs who participated in the 8th workshop course to evaluate the overall and various levels of improvement in their clinical thinking ability and working competence. Results A total of 200 questionnaires were distributed, and 172 valid questionnaires were collected, with a recovery rate of 86.0%. After the training, 52.3% (90/172) and 21.5% (37/172) of the GPs had improved and greatly improved their overall clinical thinking ability in general practice, respectively, and 56.4% (97/172) and 22.1% (38/172) showed improvement and great improvement in overall working competence. There was a statistically significant difference in the improvement of clinical thinking ability and working competence among GPs with different professional titles and job types after training (P

To fully mobilize small hydropower resources in the virtual power plants to operate collaboratively， improve operational controllability， and reduce carbon emissions， a low-carbon operation strategy of virtual power plants （VPPs） considering the spatiotemporal coupling characteristics of small hydropower is proposed. Firstly， based on the network theory of node parameter modeling， a matrix collection characterizing the spatiotemporal coupling characteristics among multiple hydropower plants is proposed to facilitate efficient storage and convenient recall of information. Secondly， a low-carbon operation model of VPPs considering the spatiotemporal coupling characteristics is constructed with the objective of their day-ahead equivalent carbon emissions that take account of the regulation factor of the operation mode. The sharing of each hydropower plant’s reservoir capacity regulation is realized through aggregating coordinated scheduling of small hydropower. Finally， a small hydropower plant in a county of Zhejiang is used as an example to verify the effectiveness and practicality of the proposed method.

The general medical care quality management system plays an essential and key role in assuring the quality of general medical care and patient safety in primary care settings. There are no unified criteria and methods for assessing the primary general medical care quality, and rare relevant quality improvement research and practical explorations in China.We reviewed the primary general medical care quality management nationwide, and highlighted the problems, then particularly detailed the three-year (2018—2020) implementation status and achievements of Shanghai, in which the primary general medical care quality was managed by Shanghai General Practice Clinical Quality Control Center (hereinafter referred to as Quality Control Center) in an exploratory way. And the management actions taken by the quality control center were as follows: defining the organizational objectives and tasks; developing the organizational framework and allocating workers; establishing municipal-and district-level organizational networks and operational systems for primary general medical care quality control; developing the inspection indicators for assuring primary general medical care quality; conducting an annual investigation of the general medical care in each of the primary care settings in Shanghai, and providing targeted guidance as well as supervision. The actions of the Quality Control Center provide strong support for quality improvement and safety assurance of primary general medical care. And the practical explorations of the Quality Control Center could be a reference for improving primary general medical care quality management nationwide. To improve the primary general medical care quality management at the naitonal level, which is still in its early phase, we put forward four recommendations: improving the development of the organization system, developing a scientific system for assessing the primary general medical care quality, comprehensively and dynamically carrying out quality controlsupervision regarding primary general medical care, and strengthening the quality controlsupervision.

BackgroundStrengtheningclinical quality control and supervision is one of the effective ways to ensure medical quality. Supervising the quality of general medical care in primary care settings in the local region could contribute to the systematical assessment of general medical care quality and identification of relevantproblems in such settings.ObjectiveTo analyze the supervision of quality of general medical care in Shanghai's primary care settings conducted in 2019 and 2020, and based on this, to give targeted, rational recommendations on the identified problems in quality management of general medical care.MethodsThe quality of general medical care in a cluster sample of community health centers (CHCs) of Shanghai was supervised in 2019 and 2020 by relevant experts from Shanghai's municipal and district general practice quality control departments using the Clinical Quality Control and Supervision Standards for General Medical Care in Shanghai's Community Health Centers (hereinafter referred to as CQCSS) developed by Shanghai General Practice Clinical Quality Control Center. In May 2021, the supervision results of the two years were analyzed using descriptive analysis, then compared, and the identified problems were summarized and analyzed.ResultsTwo hundred and forty-three CHCs were involved in the 2019 supervision, and 244 were involved in the 2020 supervision. The average total CQCSS score for 2019 was (87.32±5.97) points, and that for 2020 was (86.67±5.36) points. Compared to the results in 2019, the scores of first-level indicators of basic conditions (99.93% vs 99.80%) , staffing and determining job responsibilities of general practitioners (GPs) (93.44% vs 91.90%) , diagnosis and treatment ability of GPs (85.82% vs 85.72%) , chronic disease management ability of GPs (81.07% vs 80.95%) and scientific research and teaching levels (29.99% vs 28.87%) increased in 2020. The problems mentioned were mainly distributed in five aspects: staffing〔176 (22.03%) 〕, GPs' clinical management ability〔154 (19.27%) 〕, quality of inpatient medical records〔92 (11.51%) 〕, quality of home sickbed patients' medical records〔91 (11.39%) 〕, allocation of facilities〔91 (11.39%) 〕. In terms of the mentioned frequency, the top five problems were: ineligible senior GPs to registered GPs ratio〔84 (10.51%) 〕, poor scientific research〔84 (10.51%) 〕, less than 3.5 GPs per 1 000 residents〔61 (7.63%) 〕, unsatisfactory clinical skills〔40 (5.01%) 〕, and insufficient number of home sickbeds〔36 (4.51%) 〕.ConclusionThese two years of quality control supervision has initially promoted the quality improvementof general medical care in CHCs. To further improve it, it is suggested to take actions to deepen the core essence of general medical care quality management, improve the diagnosis and treatment ability of GPs, as well as their teaching and research ability.

Aim: To elucidate whether mitochondrial biogenesis disorder and damage from oxidative stress promote refractory apical periodontitis (RAP) in rat and human. Methodology: Twenty Enterococcus faecalis‐induced RAPs were established in the maxillary first molars of male Wistar rats. Concurrently, 12 periapical lesion specimens from patients presenting with RAP were obtained by apicoectomy. Radiographic examination and histologic analysis were conducted to evaluate periapical bone tissue destruction and morphological changes. The expression of key regulators of mitochondrial biogenesis, PGC‐1α and Nrf2, were detected by immunohistochemistry and double immunofluorescence staining, Western blot and real‐time PCR were also assayed. Mitochondrial ROS (mtROS) was identified by MitoSOX staining. Mitochondrial function was detected by the quantification of ATP production, mitochondrial DNA (mtDNA) copy number and activities of mitochondrial respiratory chain complexes. Furthermore, mitochondrial oxidative stress was evaluated by the determination of 3‐nitrotyrosine (3‐NT), 4‐hydroxy‐2‐nonenal (4‐HNE) and 8‐hydroxy‐deoxyguanosine (8‐OHdG) expression levels, as well as malondialdehyde (MDA) expression and antioxidant capacity. Student's t‐test was performed to determine significance between the groups; p <.05 was considered significant. Results: In the maxilla, significantly more bone resorption, greater number of periapical apoptotic cells and Tartrate‐resistant acid phosphatase (TRAP)‐positive multinucleated cells were observed in the RAP group compared with the control group (p <.01). PGC‐1α and Nrf2 were significantly reduced in rat and human RAP lesions compared to the control group (p <.01) at both the mRNA and protein levels. Double immunofluorescence analysis of PGC‐1α or Nrf2 with TOMM20 also indicated that mitochondrial biogenesis was impaired in RAP group (p <.01). Additionally, mitochondrial dysfunction was observed in RAP group, as reflected by increased mtROS, decreased ATP production, reduced mtDNA copy number and complexes of the mitochondrial respiratory chain. Finally, the expression levels of mitochondrial oxidative stress markers, 3‐NT, 4‐HNE and 8‐OHdG, were significantly increased in the RAP group (p <.01). Consistent with this, systemic oxidative damage was also present in the progression of RAP, including increased MDA expression and decreased antioxidant activity (p <.01). Conclusions: Mitochondrial biogenesis disorder and damage from oxidative stress contribute to the development of RAP. [ABSTRACT FROM AUTHOR]

The Chinese government encourages rural economic entities to use farmland management rights as collateral for loans, which helps to alleviate multi-level financing needs in rural areas. Based on the panel data of counties in Hubei Province, this paper adopts the Difference-in-Differences (DID) and the intermediary effect model to evaluate the impact of farmland management rights mortgage loans (FMRML) on the agri-food industrial agglomeration (AIA) in China. The study found that the pilot policy has significantly promoted the AIA. Moreover, the regression results remain robust after conducting the placebo test and the Propensity Score Matching Difference-in-Differences (PSM-DID) model, which demonstrates that the improvement effect is stable and long-lasting. From the heterogeneity analysis, it can be seen that the policy of FMRML has a more significant effect on the AIA in mountainous and hilly areas. By further analysis of the mechanism of action, it can be concluded that the pilot policy promotes the AIA by enhancing agricultural specialized production. The main findings can provide information for policymakers in China. The recommendations we have summarized encompass gradually expanding the scope of the pilot policy of FMRML, advancing the institutionalization and legalization of the policy, and promoting agricultural production specialization. [ABSTRACT FROM AUTHOR]

Under the background of carbon neutrality and large‐scale penetration of renewable energy, the integrated local energy system (ILES) has been extensively recognized as an effective way to reduce carbon emissions and improve renewable energy consumption level due to its high energy utilization and multiple energy complementarity. Hence, an optimal low‐carbon scheduling model of ILES considering oxygen‐enriched combustion plant (OECP) and generalized energy storages (GESs) is proposed in this paper to reduce the carbon emissions, improve the renewable energy consumption level and reduce the operating costs of ILES. More specifically, the cooperation mechanism between OECP and power to gas (P2G) is established to maintain a high carbon capture level during peak load periods; the GESs under the background of ILES is modelled, which can make full use of the multiple energy complementarity to improve the renewable energy consumption level of ILES. Case studies are performed on an IES that consists of an IEEE 33‐bus distribution network, a 44‐node district heating network and a 20‐node natural gas network to verify the effectiveness and advantages of the proposed model. [ABSTRACT FROM AUTHOR]