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The ability of a system to tolerate disruptions and mitigate against malicious attacks is crucial in many applications, especially when a failure of the system can have huge economic and social consequences. The concept of system resilience has drawn increasing research and practical interest, and in this article, we propose a framework to define system resilience based on modelling of fortification strategies in the context of network interdiction problems. Specifically, we consider fortification strategies that address disruptions in two ways: immunization, where a certain disruption is not permitted to take place, and mitigation, where the disruption occurs, but is unable to impair significantly the system performance. We then propose the resilience optimization problem (RES-OPT) to maximize the capability of a system in fortifying against disruptions through immunization and mitigation strategies. The flexibility of this approach lies in that instead of assuming a fixed set of disruption scenarios, we fortify the system against as powerful an attacker as possible. In addition, we propose a cutting plane methodology to effectively solve the resulting optimization problem, and apply it to a network flow with transmission-links fortification and an electricity transmission network problem in Southern China. The results show that RES-OPT yields good quality solutions in terms of both resilience and average costs, compared to other benchmark approaches. [ABSTRACT FROM AUTHOR]

The aim of this paper was to examine the validity and reliability of age band 1 of the Movement Assessment Battery for Children-Second Edition (MABC-2) in preparation for its standardization in mainland China. Interrater and test-retest reliability of the MABC-2 was estimated using Intraclass Correlation Coefficient (ICC). Cronbach's alpha for each item and Item-total correlation were used to determine internal consistency. The content validity was determined by the Item-level content validity index (I-CVI). Confirmatory factor analysis was used to examine the factorial validity of the MABC-2 test. The correlation coefficients between the MABC-2 and the Peabody Developmental Motor Scales-2 (PDMS-2) were used to assess the criteria-related validity. The Cronbach's alpha values of all eight items together were moderate but acceptable. The correlation coefficients between each test item and the total score were moderate except for two items. The ICC of interrater and test-retest reliability for each test items was good. The I-CVI of each item was excellent (each above 0.78). The result of confirmatory factor analysis showed that the goodness-of-fit indices of the adjusted model were good (each above 0.9), indicating a satisfactory fit of the data to the model. The total score on MABC-2 and PDMS-2 was correlated well (r = 0.631). It is concluded that the reliability and validity of age band 1 of MABC-2 were fair in this study based on a large sample. However, there was a need to adjust part of items to improve the test's psychometric properties when it is used in Chinese children. (Contains 3 figures and 4 tables.)

Introduction In China, the number of women giving birth at a health-care facility is used as a target indicator for measuring progress towards improved maternal health. (1) The proportion of [...], Objective To investigate changes in the expenditure of giving birth in health-care facilities in rural China during 1998-2007, to examine the financial burden on households, particularly poor ones, and to identify factors associated with out-of-pocket expenditure. Methods Cross-sectional data on births between 1998 and 2007 were obtained from national household surveys conducted in 2003 and 2008. Descriptive statistics and Iog-linear models were used to identify factors associated with out-of-pocket expenditure on delivery. Findings During 1998-2007, the proportion of facility-based deliveries increased from 55% to 90%. In 2007, 60% of births occurred at county-level or higher-level facilities. The Caesarean delivery rate increased from 6% to 26%. Total expenditure on a facility-based delivery increased by 152%, with a marked rise from 2002 onwards with the introduction of the New Cooperative Medical Scheme. In 2007, out-of-pocket expenditure on a facility-based delivery equalled 13% of the mean annual household income for low-income households. This proportion had decreased from 18% in 2002 and differences between income groups had narrowed. Regression models showed that Caesarean delivery and delivery at a higher-level facility were associated with higher expenditure in 2007. The New Cooperative Medical Scheme was associated with lower out-of-pocket expenditure on Caesarean delivery but not on vaginal delivery. Conclusion Expenditure on facility-based delivery greatly increased in rural China over 1998-2007 because of greater use of higher-level facilities, more Caesarean deliveries and the introduction of the New Cooperative Medical Scheme. The financial burden on the rural poor remained high. Objectif Etudier I'evolution des depenses liees a la naissance dans les etablissement de soins de sante en Chine rurale durant les annees 19982007, analyser la charge financiere afferente sur les menages, en particulier les plus pauvres, et identifier les facteurs associes aux paiements directs. Methodes Des donnees croisees sur les naissances entre 1998 et 2007 ont ete obtenues a partir d'enquetes nationales sur les menages realisees en 2003 et en 2008. Des statistiques descriptives et des modeles par regression (Iog-lineaires) ont ete utilises pour identifier les facteurs associes aux paiements directs relatifs aux naissances. Resultats Pendant les annees 1998-2007, la proportion d'accouchements en maternite s'est accrue de 55 a 90%. En 2007, 60% des naissances ont eu lieu dans des centres de comte eu dans des etablissements plus importants. Le taux d'accouchements par cesarienne est passe de 6 a 26%. Les depenses totales pour accouchement en etablissement medical ont augmente de 152%, avec une augmentation marquee depuis 2002, suite a I'introduction du nouveau systeme d'assurance-maladie facultatif (New Cooperative Medical Scheme). En 2007, les paiements directs pour un accouchement dans un etablissement medical comptaient pour 13% ales revenus annuels moyens des menages a faible revenu. Cette proportion a diminue de 18% en 2002 et les differences entre les tranches de revenu se sont estompees. Les modeles par regression montrent que I'accouchement par cesarienne et I'accouchement dans un etablissement de plus haut niveau s'accompagnaient de depenses plus elevees en 2007. Le nouveau systeme d'assurance-maladie facultatif etait, quant a lui, associe a des paiements directs moindres pour I'accouchement par cesarienne, mais non pour I'accouchement par voie basse. Conclusion Les depenses afferentes a I'accouchement en etablissement de soins de sante ont beaucoup augmente dans la Chine rurale entre 1998 et 2007 du fait du recours plus frequent a ales etablissements de plus haut niveau, du nombre accru d'accouchements par cesarienne et de I'introduction du nouveau systeme medical d'assurance-maladie. La charge financiere sur les familles rurales pauvres est restee eleve. Objetivo Investigar los cambios que ha experimentado el gasto correspondiente al alumbramiento en los centros sanitarios de las zonas rurales de China entre 1998 y 2007, con el fin de examinar la carga economica que supone para las familias, especialmente para las mas desfavorecidas, y para identificar los factores asociados a los desembolsos efectuados. Metodos Se obtuvieron los datos de una muestra aleatoria y representativa de les nacimientos que tuvieron lugar entre 1998 y 2007 a traves de las encuestas Ilevadas a cabo en hogares entre 2003 y 2008. Se emplearon estadisticas descriptivas y modelos logaritmicos lineales para identificar los factores asociados con los desembolsos efectuados para la asistencia al parto. Resultados Durante el periodo comprendido entre 1998 y 2007, la proporcion de partos en centros sanitarios aumento de un 55% a un 90%. En 2007, el 60% de los nacimientos tuvieron lugar en centros sanitarios dei condado o de un ambito territorial mas elevado. EI porcentaje de partos por cesarea aumento de un 6% a un 26%. EI gasto total en partos asistidos en un centro sanitario aumento en un 152%, registrando un marcado aumento desde 2002 en adelante con la introduccion dei Nuevo Sistema de Asistencia Medica Cooperativa. En 2007, los desembolsos efectuados para un parto asistido en un centro sanitario equivalieron al 13% de los ingresos anuales medios de un hogar de bajos ingresos. Esta proporcion supuso un descenso desde el 18% registrado en 2002 y las diferencias entre grupos de ingresos se redujeron. Los modelos de regresion mostraron que los partos por cesarea y los partos en los centros sanitarios de un nivel superior estuvieron asociados a un mayor gasto en 2007. EI Nuevo Sistema de Asistencia Medica Cooperativa se asocio a un menor desembolso efectuado en los partos por cesarea, pero no en los partos vaginales. Conclusion EI gasto en partos asistidos en centros sanitarios ha aumentado significativamente en China entre 1998 y 2007 debido a un mayor uso de las instalaciones de un nivel mas elevado, a un mayor numero de partos por cesarea y a la introduccion dei Nuevo Sistema de Asistencia Medica Cooperativa. La carga economica para las familias mas desfavorecidas dei entorno rural siguio siendo elevada.

Abstract Background A community-based randomized control prenatal care trial was performed in a rural county of China during 2000-2003. The purpose of this paper is to describe the trial implementation and the impact of the trial on the utilization of prenatal care and perinatal outcomes. Materials and methods In the study county, 10 townships (from a total of 55) were each paired with a control (20 study townships in total), with the criteria for pairing being the township's socioeconomic development, perinatal health, and maternal care utilization and provision. One of each township pair was randomly allocated to the intervention or control groups. The trial interventions were: 1) training township hospital midwives and instructing them in how to provide systematic maternal care, 2) informing women in the community of the importance of prenatal care, 3) if needed, providing basic medical instruments to the hospitals. A variety of data sources were used to describe the trial implementation (observations, group discussions, field notes, survey to women). The data on pregnancy and perinatal outcomes were from the original hand-written work-records in the village family planning centers of the study townships. Results Implementation of the intervention was deficient. The factors hindering the trial implementation included poor coordination between midwives and family planning officers, broader policy changes implemented by the provincial government during the trial, the decentralization of county governance, and the lack of government funding for maternal care. There was only little difference in the use of maternal care, in women's opinions related to maternal care or content of prenatal care, and no difference in the perinatal outcomes between the intervention and control townships. Conclusions A community based randomized controlled trial could not be fully carried out in rural China as planned due to the changing political landscape, the complexity of the socio-economic situation and a lengthy planning stage. The study could not answer if perinatal outcomes could be improved by increased use of prenatal care. Trial registration NCT 01054235

Abstract Background Studies on prenatal care in China have focused on the timing and frequency of prenatal care and relatively little information can be found on how maternal care has been organized and funded or on the actual content of the visits, especially in the less developed rural areas. This study explored maternal care in a rural county from Anhui province in terms of care organization, provision and utilization. Methods A total of 699 mothers of infants under one year of age were interviewed with structured questionnaires; the county health bureau officials and managers of township hospitals (n = 10) and county level hospitals (n = 2) were interviewed; the process of the maternal care services was observed by the researchers. In addition, statistics from the local government were used. Results The county level hospitals were well staffed and equipped and served as a referral centre for women with a high-risk pregnancy. Township hospitals had, on average, 1.7 midwives serving an average population of 15,000 people. Only 10–20% of the current costs in county level hospitals and township hospitals were funded by the local government, and women paid for delivery care. There was no systematic organized prenatal care and referrals were not mandatory. About half of the women had their first prenatal visit before the 13th gestational week, 36% had fewer than 5 prenatal visits, and about 9% had no prenatal visits. A major reason for not having prenatal care visits was that women considered it unnecessary. Most women (87%) gave birth in public health facilities, and the rest in a private clinic or at home. A total of 8% of births were delivered by caesarean section. Very few women had any postnatal visits. About half of the women received the recommended number of prenatal blood pressure and haemoglobin measurements. Conclusion Delivery care was better provided than both prenatal and postnatal care in the study area. Reliance on user fees gave the hospitals an incentive to put more emphasis on revenue generating activities such as delivery care instead of prenatal and postnatal care.

Abstract Background China has a national policy regulating the number of children that a woman is allowed to have. The central concept at the individual level application is "illegal pregnancy". The purpose of this article is to describe and problematicize the concept of illegal pregnancy and its use in practice. Methods Original texts and previous published and unpublished reports and statistics were used. Results By 1979 the Chinese population policy was clearly a policy of controlling population growth. For a pregnancy to be legal, it has to be defined as such according to the family-level eligibility rules, and in some places it has to be within the local quota. Enforcement of the policy has been pursued via the State Family Planning (FP) Commission and the Communist Party (CP), both of which have a functioning vertical structure down to the lowest administrative units. There are various incentives and disincentives for families to follow the policy. An extensive system has been created to keep the contraceptive use and pregnancy status of all married women at reproductive age under constant surveillance. In the early 1990s FP and CP officials were made personally responsible for meeting population targets. Since 1979, abortion has been available on request, and the ratio of legal abortions to birth increased in the 1980s and declined in the 1990s. Similar to what happens in other Asian countries with low fertility rates and higher esteem for boys, both national- and local-level data show that an unnaturally greater number of boys than girls are registered as having been born. Conclusion Defining a pregnancy as "illegal" and carrying out the surveillance of individual women are phenomena unique in China, but this does not apply to other features of the policy. The moral judgment concerning the policy depends on the basic question of whether reproduction should be considered as an individual or social decision.