Objective: To evaluate the organizational model of a perinatal network and its relevance in a resource-limited country. Methodology: This was a mixed prospective qualitative and quantitative study conducted over a 2-y...Objective: To evaluate the organizational model of a perinatal network and its relevance in a resource-limited country. Methodology: This was a mixed prospective qualitative and quantitative study conducted over a 2-year period, from January 1, 2022, to December 31, 2023. This study took place in Senegal, a country with limited resources and a weakness of hyperspecialized medical technical resources. There was no policy for the management of fetal malformations. The qualitative part was carried out through overt participant observation. The human resources and the organization of the perinatal network were described. For the quantitative part, all fetuses managed during the study period were included. The studied parameters related to neonatal care and outcomes. Qualitative variables were described using dispersion parameters, and quantitative variables were described using proportions. Results: The perinatal network includes several specialists across six hospitals. Of these hospitals, only one provided emergency pediatric surgery. The network included highly specialized human resources in prenatal diagnosis, congenital heart defects, pediatric surgery, anesthesia, and other medical specialties in perinatology. Advanced ultrasound was centralized by an obstetrician. The team decided on the follow-up methods, timing, and mode of delivery. The newborn was immediately transferred to the appropriate specialty. Over the 2-year period, 201 fetuses were managed. The rate of cesarean delivery was 76.3%. Neonatal mortality was 51.4%. Discussion: Centralizing care improves the quality of prenatal diagnosis and management of congenital defects. Mortality remains high when emergency surgery is not well available. This mortality is also due to the lack of a single center offering all perinatal care and so, the transfer of newborns. The cesarean rate increases due to underlying conditions and organizational factors. Conclusion: Public policies should prioritize the centralization of care for congenital disorders to reduce the costs of disability and mortality.展开更多
To explore the impact of partial centralization on supply chain performance,this study constructs a two-period game model of a closed-loop supply chain involving a manufacturer and an online retail platform participat...To explore the impact of partial centralization on supply chain performance,this study constructs a two-period game model of a closed-loop supply chain involving a manufacturer and an online retail platform participating in the trade-in strategy.Through mathematical modeling and numerical simulation methods,the optimal decisions were analyzed under conditions where the manufacturer partially owns the retail platform’s partial equity.This study finds that partial centralization yields the highest profits,followed by full centralization,with decentralized decisions yielding the lowest profits.Moderate centralization enhances overall profits by optimizing incentive mechanisms,whereas excessive ownership concentration reduces the flexibility of the retail platform,leading to a decline in profits.Additionally,product durability and trade-in subsidy significantly influence supply chain profitability:high-durability products reduce renewal frequency,while trade-in subsidy effectively stimulates consumer demand and increase overall profits.This study provides theoretical support and practical guidance for companies implementing the trade-in strategy.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)remains a significant public health concern in South Korea even though the incidence rates are declining.While medical travel for cancer treatment is common,its patterns and inf...BACKGROUND Hepatocellular carcinoma(HCC)remains a significant public health concern in South Korea even though the incidence rates are declining.While medical travel for cancer treatment is common,its patterns and influencing factors for patients with HCC are unknown.AIM To assess medical travel patterns and determinants and their policy implications among patients with newly diagnosed HCC in South Korea.METHODS This retrospective cohort study used the National Health Insurance Service database to identify patients with newly diagnosed HCC from 2013 to 2021.Medical travel was defined as receiving initial treatment outside one’s residential region.Patient characteristics and regional trends were analyzed,and factors influencing medical travel were identified using logistic regression analysis.RESULTS Among 64808 patients 52.4%received treatment in the capital.This proportion increased to 67.4%when including the surrounding metropolitan area.Medical travel was significantly more common among younger and wealthier patients.Patients with greater comorbidity burden or liver cirrhosis were less likely to travel.While geographic distance influenced travel patterns,high-volume academic centers in the capital attracted patients nationwide regardless of proximity.CONCLUSION This nationwide study highlighted the centralization of HCC care in the capital.This observation indicates that regional cancer hubs should be strengthened and promoted for equitable healthcare access.展开更多
Efficient reconstruction of severe cutaneous wounds necessitates the orchestration of effective cell-mediated matrix remodeling and robust protection against microbial invasion.Herein,we engineered a near-infrared lig...Efficient reconstruction of severe cutaneous wounds necessitates the orchestration of effective cell-mediated matrix remodeling and robust protection against microbial invasion.Herein,we engineered a near-infrared light(NIR)-stimulated,thermo-responsive bilayer system based on a drug-loaded hydrogel with a thermal-responsive temperature of~42℃ as the matrix layer and an antibacterial nanofibrous mat as the top layer.The matrix layer integrates basic fibroblast growth factor(bFGF)-loaded thermosensitive gelatin(Gel)hydrogel with polydopamine-Cu^(2+)coated short nanofibers(P@SF).Upon NIR exposure,P@SF elicits a photothermal effect,causing a rapid increase in temperature by 13.4℃ within 1 min at a power density of 0.75 W/cm^(2),which triggers the gel-sol transition of Gel and controls the release of bFGF.This,in turn,enhances fibroblast and endothelial cells ingrowth into the hydrogel,fostering cell functionalization and matrix remodeling.The top layer consists of poly(L-lactide-co-caprolactone)nanofibers functionalized with lysine-doped polydopamine and poly-l-lysine.It possesses antibacterial efficacy by isolating,controlling(76.23%for E.coli and 89.16%for S.aureus),and eliminating bacteria upon NIR activation.In rat skin wound models,this NIR-responsive smart bilayer system prevents S.aureus-mediated bacterial infection(indicative of reduced IL-6 expression),regulates CD31-positive neovascularization,and facilitates collagen remodeling for skin regeneration.In summary,this study introduces a novel strategy,inspired by the centralization of authority,for developing a smart thermo-responsive system with promising potential for the effective reconstruction of severe cutaneous wounds.展开更多
The blockchain technology has been parenting Bitcoins and many other cryptocurrencies that have strived to be traded on the global markets.It has been only within the last two decades that eventually the concept of bl...The blockchain technology has been parenting Bitcoins and many other cryptocurrencies that have strived to be traded on the global markets.It has been only within the last two decades that eventually the concept of blockchain technology was flourished through evolution of IoT,or Internet of Things,and the first well defined cryptocurrency,namely Bitcoin,as a main biproduct of it was evolved to what we know as blockchain technology.Unlike what most people recognize cryptocurrency,as a main concept of its parenting blockchain technology,the cryptos are not just the main or everything about blockchain.Blockchain technology,is rather much more powerfully designed to interconnect and facilitate trade among many businesses in commerce,including insurance,banking,healthcare industry,etc.,through an amazing cryptocurrency,a non-fiat currency and medium of exchange.Bitcoin’s extension into the 21st century’s monetary system was and will continue to be registered as a historical turning point of the medium of exchange,store of value,and unit of account,among other desirable properties of money.We dare to have concluded that the blockchain technology is another revolution inside the capitalistic ecosystem for enforcing its powerful potential in the conversion of centralized businesses into somewhat more decentralized,where competition and efficiency would be more practically fostered than ever before.There will be more reliable and verifiable information,permanently stored on electronic ledgers,connected to enormous other nodes merged with those already accessible through the blockchain platform,operated by entrepreneurs,such as“Your First Venture Companion,”just as a tentative example.展开更多
Objective:Limited evidence is available regarding the associations of centralization with gastric cancer patients’quality of care in high surgical volume settings.The current study aimed to explore the effects of hos...Objective:Limited evidence is available regarding the associations of centralization with gastric cancer patients’quality of care in high surgical volume settings.The current study aimed to explore the effects of hospital volume and the Herfindahl-Hirschman index(HHI)on in-hospital mortality,total cost,and length of stay for Chinese gastrectomy patients in a nationwide database.Methods:We extracted data on gastrectomy for gastric cancer from the Hospital Quality Monitoring System Database between 2013 and 2018.Hospital volume was divided into 4 quartiles:low(1-83 cases per year),medium(84-238 cases),high(239-579 cases),and very high(580-1,193 cases).The HHI was divided into 3 categories:highly concentrated(>2,500),moderately concentrated(1,500-2,500),and unconcentrated(<1,500).We used mixed-effects models to analyze the data while accounting for data clustering.Results:We analyzed 125,683 patients in 515 institutions.In the multivariable analyses,hospital volume was significantly associated with in-hospital mortality[medium vs.low:odds ratio(OR)=0.61,95%confidence interval(95%CI)=0.43-0.84,P=0.003;high:OR=0.57,95%CI=0.38-0.87,P=0.009;and very high:OR=0.33,95%CI=0.18-0.61,P<0.001)and length of stay(high vs.low:β=-0.036,95%CI=-0.071--0.002,P=0.039)but not with total cost.Hospitals located in unconcentrated provinces had higher in-hospital mortality(OR=1.52,95%CI=1.03-2.26,P=0.036)and longer lengths of stay(β=0.024,95%CI=0.001-0.047,P=0.041)than hospitals located in highly concentrated provinces.Conclusions:Centralization of gastrectomy,measured by hospital volume and the HHI,was associated with decreased in-hospital mortality and shortened length of stay without increasing total cost.These results support the strategy of centralizing gastrectomy in high-volume settings.展开更多
This white paper discusses the Ecuadorian healthcare system specifically the lack of proper anesthesia and post-operative pain medication and touches base with centralized hospitals. This paper articulates the specifi...This white paper discusses the Ecuadorian healthcare system specifically the lack of proper anesthesia and post-operative pain medication and touches base with centralized hospitals. This paper articulates the specific problems inhibiting the usage of these proper medications, specifically looking at a hospital in Quito, Ecuador. Present day tribal situations are also discussed as they are a significant part of the population that is affected by the shortages of pain medication and anesthesia. Solutions are presented to solve the problems the country faces and how it is relevant today.展开更多
Telemedicine＇s greatest problem is not found in software and hardware. Many can make software and hardware work. It has for long been clear that telemedicine has diffusion problems. Focus should be shifted over to th...Telemedicine＇s greatest problem is not found in software and hardware. Many can make software and hardware work. It has for long been clear that telemedicine has diffusion problems. Focus should be shifted over to the humanware. Telemedicine means work is done by virtual organizations. For the future of telemedicine, organizational issues will represent a challenge. Organizations consist of humans in interaction. In Norwegian telemedicine projects, organizational problems were identified and solutions to the problems were designed. More than 40 publications show numerous organizational consequences and numerous types of organizational consequences. When it comes to the solving telemedicine＇s organizational problems, learning from the experience others have is important. It is not necessary for all to invent what the organizational problems are. Organizing health care around the physical telecommunication networks is associated with the concept of network organization. The electronic networks become an infrastructure around which single health care providers are distributed. Such network organization means a formation of alliances between organizations. Centralization and decentralization are important terms for all organizing. Telemedicine makes the question of centralization or decentralization relevant. Telemedicine requires collaboration between participating parties. Obtaining the benefits of telemedicine is dependent on implementing the right measures for good collaboration. We know there are problems with telemedicine virtual organizations, but solutions to these problems exist. For the future of telemedicine, doing work with organization is important. Skilled managers have an important role to play.展开更多
Amharic folk literature is a time-honoured tradition dating back to the imperial songs of the 14th and 15th centuries. One of these subgenres is Amharic folk poetry which is permeated with the political, social, econo...Amharic folk literature is a time-honoured tradition dating back to the imperial songs of the 14th and 15th centuries. One of these subgenres is Amharic folk poetry which is permeated with the political, social, economic, and cultural legacies of successive Ethiopian governments that rise and demise. The image of these governments was determined by their integrity, vision, and responsiveness to the aspirations of the populace. This study was designed to determine the popular image of the imperial governments of Menelik II and Haile Selasse I as reflected in Amharic folk poetry. Without prejudice to some odes which invariably idealise the vision of these monarchs, the politically-inspired Amharic folk poetry is found to be critical of the feudal status quo thus perpetuating its negative images. This underpins the partial unpopularity of Menilik and Haile Selasse. However, these critical gestures would by no means undermine their monumental contributions to the reunification, modernization, and survival of Ethiopia. Thus, the contemporary Amharic folk-poetry is neither iconoclastic nor idealistic but an impassioned allegory of the nation-state.展开更多
Congenital radial club hand (CRCH) is a terminal deficiency characterized by the radial deviation of the hand, marked shortening of the forearm, and generalized underdevelopment of the extremity with an incidence rate...Congenital radial club hand (CRCH) is a terminal deficiency characterized by the radial deviation of the hand, marked shortening of the forearm, and generalized underdevelopment of the extremity with an incidence rate of 1 per 100,000 live births. Both sexes are nearly or equally affected. Challenges that the disease poses to the patient are multifaceted, ranging from medical, social, cosmetic and functional issues which also are the multidimensional treatment modalities. We report a case of a 2-month-old baby with the severe case of bilateral CRCH. The patient had the centralization of the left ulna with Kwire stabilization. About 160d of correction was achieved. He did well and was discharged after two weeks at the orthopedic clinic for follow-up. Congenital radial club hand though uncommon may be amenable to surgery. Centralization is still the treatment of choice in severe cases and early intervention will offer a better outcome.展开更多
The As-level topology is a hotspot of the recent reseaches. We can understand the centralization of the network clearly by researching the evolvement trend of the Internet macroscopic topology. The massive data we use...The As-level topology is a hotspot of the recent reseaches. We can understand the centralization of the network clearly by researching the evolvement trend of the Internet macroscopic topology. The massive data we use in this paper is from CAIDA (The Cooperative Association for Internet Data Analysis) Skitter project. And the time span of the data is from July, 2001 to January, 2008. This paper introduces the background of the AS-level topology at first, then carries out the evolvement of degree, core and layer. It is believed that the influence of the top-degree nodes on the other nodes decreases and the centralization of network is going to fall off with the decrease of the core. And the nucleus status of network declines.展开更多
The numeral trait of aquiferous zones in flowage studies and estimations is under most parts of nation. In this study Karaj aquiferous zone in Alborz province was surveyed from the view point of form, the agglomeratio...The numeral trait of aquiferous zones in flowage studies and estimations is under most parts of nation. In this study Karaj aquiferous zone in Alborz province was surveyed from the view point of form, the agglomeration of drainage net length of channel and space. The orientation of hillside was specified as the affective factor on creating and streaming the flowage. A flow aggregating hydrological model for the studied zone was prepared and amount of the flow is mostly in which parts of the zone the delay and centralization time in the zone was evaluated and the related diagrams were derived. Finally, the zone was divided into 4 main subzones and their drainage nets were ranked and by 4 factors namely, space, length of canal, drainage aggregation and branch ratio affecting on performance of the zone from the view of from and appearance was surveyed. The factors interfering in SPSS software and their correlations were specified and specific coefficients stand in their related charts. By considering in the zone width and charts it is specified which of the sub zones has the most flowage potential from the view of the zones physical and numeral qualifications. All plots were prepared using GIS and WMS software and the studied zone’s hydrograph was depicted.展开更多
An important guiding thought that ran through the laws of the Ming Dynasty was ＂governing the country according to the corpus juries＂. The founding emperor of Ming Dynasty Zhu Yuanzhang found that the laws of the fo...An important guiding thought that ran through the laws of the Ming Dynasty was ＂governing the country according to the corpus juries＂. The founding emperor of Ming Dynasty Zhu Yuanzhang found that the laws of the former Yuan Dynasty could not suit the demands of the development of the new situations, so he developed the new statutes. The laws of the Ming Dynasty absorbed the lessons that the Yuan government law and discipline ceased to be binding or become lax, and put forward that the laws must be strict, and abolished the system of the prime minister, showing a high degree of centralization. The laws of the Ming Dynasty had the important influence on the political thoughts in the late feudal society, so the researches on the legal systems in the Ming dynasty have practical significance. This paper briefly expounds the legal privileges of the Ming Dynasty for reference.展开更多
To ensure the quality and marketability of products, the field of regulatory affairs (RA) serves as an intermediary between regulatory bodies, the industry, and consumers. The primary objective of pharmaceutical regis...To ensure the quality and marketability of products, the field of regulatory affairs (RA) serves as an intermediary between regulatory bodies, the industry, and consumers. The primary objective of pharmaceutical registration is centered on the marketing process. The World Health Organization (WHO), Pan American Health Organization (PAHO), World Trade Organization (WTO), International Conference on Harmonization (ICH), and World Intellectual Property Organization (WIPO) play crucial roles in the process. Drug registration and commercialization are overseen by national regulatory authorities initially, following the guidelines of the key organizations. The phenomenon of digital disruption is widespread and has significant effects on several domains of work. This influence has been further intensified by the COVID-19 epidemic, as well as the rapid advancements in the complexity and capabilities of machine learning and artificial intelligence algorithms. The future of this profession is influenced by various trends, including the swift progress in scientific comprehension of diseases, which has resulted in the emergence of novel therapeutic approaches for the treatment and potential eradication of some ailments. The importance of strategic collaborations, alignment, and integration among national regulatory agencies has been heightened by recent global regulatory reforms. This trend is expected to persist. The impact of these elements on regulatory professionals, medication development, and medical practice in the future is a subject of considerable attention. The enhancement of skills and the adoption of a growth mindset are crucial for regulatory affairs professionals to implement the necessary adjustments. This emerging paradigm promotes the cultivation of personal responsibility in individuals’ professional development, fostering adaptability and emphasizing the significance of lifelong learning. Through their actions, these specialists could exert influence on the process of product development, contributing to the improvement of their society.展开更多
Using simple statistical analysis of count-level budgetary data from across all of China＇s counties, the present paper examines whether the post-1994 fiscal decentralization has affected redistribution at the count-l...Using simple statistical analysis of count-level budgetary data from across all of China＇s counties, the present paper examines whether the post-1994 fiscal decentralization has affected redistribution at the count-level. The new fiscal system has been less able to narrow inter-county dispersion in ftscal imbalances than the old one, even after taking intergovernmental transfer payments into account. Although with the post-1994 system there has been a modest increase in per capita welfare spending in all counties on average, much of the new-found fiscal resources have been spent on salary and administrative expenses rather than spending on public goods. Therefore, it is imperative that the reform of China＇s tax system is intensified.展开更多
Industrial symbiosis is the quintessential characteristic of an eco-industrial park. To divide parks into different types, previous studies mostly focused on qualitative judgments, and failed to use metrics to conduct...Industrial symbiosis is the quintessential characteristic of an eco-industrial park. To divide parks into different types, previous studies mostly focused on qualitative judgments, and failed to use metrics to conduct quantitative research on the intemal structural or functional characteristics of a park. To analyze a park＇s structural attributes, a range of metrics from network analysis have been applied, but few researchers have compared two or more symbioses using multiple metrics. In this study, we used two metrics （density and network degree centraliza- tion） to compare the degrees of completeness and dependence of eight diverse but representative industrial symbiosis networks. Through the combination of the two metrics, we divided the networks into three types： weak completeness, and two forms of strong completeness, namely ＂anchor tenant＂ mutualism and ＂equality-oriented＂ mutualism. The results showed that the networks with a weak degree of completeness were sparse and had few connections among nodes; for ＂anchor tenant＂ mutualism, the degree of completeness was relatively high, but the affiliated members were too dependent on core members; and the members in ＂equality-oriented＂ mutualism had equal roles, with diverse and flexible symbiotic paths. These results revealed some of the systems＇ internal structure and how different structures influenced the exchanges of materials, energy, and knowledge among members of a system, thereby providing insights into threats that may destabilize the network. Based on this analysis, we provide examples of the advantages and effectiveness of recent improvement projects in a typical Chinese eco-industrial park （Shandong Lubei）.展开更多
By far, the researches on how to distribute blood products among different departments in hospital have not been further studied, though the problem of blood shortage and wastage that caused by improper blood allocati...By far, the researches on how to distribute blood products among different departments in hospital have not been further studied, though the problem of blood shortage and wastage that caused by improper blood allocation is severe, which may endanger patient＇s lives and impose considerable costs on hospitals. In order to solve this problem, this paper mainly studies on how to distribute the blood items among different departments within a hospital and investigates the allocation approach with the novel management method by centralizing the inventory of several different departments. By integrating the blood inventory requirements of some departments, the hospital could reduce the rate of blood shortage and wastage effectively, release the pressure of the occupancy of resources and reduce the bullwhip effect of blood products. This paper illustrates the centralization principle in hospital and formulates the mixed integer programming model to work out the optimal allocation network scheme and the optimal inventory setting for every department. And the results of the numerical example demonstrate that this centralization method could considerably reduce blood shortage and wastage in hospital by about 72% and 90% respectively. Furthermore, it could decrease the total cost by about 108,540 RMB a month on blood supply chain management in the hospital and improve the effect of some certain surgeries by transfusing the fresh blood to patients.展开更多
文摘Objective: To evaluate the organizational model of a perinatal network and its relevance in a resource-limited country. Methodology: This was a mixed prospective qualitative and quantitative study conducted over a 2-year period, from January 1, 2022, to December 31, 2023. This study took place in Senegal, a country with limited resources and a weakness of hyperspecialized medical technical resources. There was no policy for the management of fetal malformations. The qualitative part was carried out through overt participant observation. The human resources and the organization of the perinatal network were described. For the quantitative part, all fetuses managed during the study period were included. The studied parameters related to neonatal care and outcomes. Qualitative variables were described using dispersion parameters, and quantitative variables were described using proportions. Results: The perinatal network includes several specialists across six hospitals. Of these hospitals, only one provided emergency pediatric surgery. The network included highly specialized human resources in prenatal diagnosis, congenital heart defects, pediatric surgery, anesthesia, and other medical specialties in perinatology. Advanced ultrasound was centralized by an obstetrician. The team decided on the follow-up methods, timing, and mode of delivery. The newborn was immediately transferred to the appropriate specialty. Over the 2-year period, 201 fetuses were managed. The rate of cesarean delivery was 76.3%. Neonatal mortality was 51.4%. Discussion: Centralizing care improves the quality of prenatal diagnosis and management of congenital defects. Mortality remains high when emergency surgery is not well available. This mortality is also due to the lack of a single center offering all perinatal care and so, the transfer of newborns. The cesarean rate increases due to underlying conditions and organizational factors. Conclusion: Public policies should prioritize the centralization of care for congenital disorders to reduce the costs of disability and mortality.
文摘To explore the impact of partial centralization on supply chain performance,this study constructs a two-period game model of a closed-loop supply chain involving a manufacturer and an online retail platform participating in the trade-in strategy.Through mathematical modeling and numerical simulation methods,the optimal decisions were analyzed under conditions where the manufacturer partially owns the retail platform’s partial equity.This study finds that partial centralization yields the highest profits,followed by full centralization,with decentralized decisions yielding the lowest profits.Moderate centralization enhances overall profits by optimizing incentive mechanisms,whereas excessive ownership concentration reduces the flexibility of the retail platform,leading to a decline in profits.Additionally,product durability and trade-in subsidy significantly influence supply chain profitability:high-durability products reduce renewal frequency,while trade-in subsidy effectively stimulates consumer demand and increase overall profits.This study provides theoretical support and practical guidance for companies implementing the trade-in strategy.
基金Supported by Dong-A University Research Fund,No.20230598.
文摘BACKGROUND Hepatocellular carcinoma(HCC)remains a significant public health concern in South Korea even though the incidence rates are declining.While medical travel for cancer treatment is common,its patterns and influencing factors for patients with HCC are unknown.AIM To assess medical travel patterns and determinants and their policy implications among patients with newly diagnosed HCC in South Korea.METHODS This retrospective cohort study used the National Health Insurance Service database to identify patients with newly diagnosed HCC from 2013 to 2021.Medical travel was defined as receiving initial treatment outside one’s residential region.Patient characteristics and regional trends were analyzed,and factors influencing medical travel were identified using logistic regression analysis.RESULTS Among 64808 patients 52.4%received treatment in the capital.This proportion increased to 67.4%when including the surrounding metropolitan area.Medical travel was significantly more common among younger and wealthier patients.Patients with greater comorbidity burden or liver cirrhosis were less likely to travel.While geographic distance influenced travel patterns,high-volume academic centers in the capital attracted patients nationwide regardless of proximity.CONCLUSION This nationwide study highlighted the centralization of HCC care in the capital.This observation indicates that regional cancer hubs should be strengthened and promoted for equitable healthcare access.
基金support by Shandong Provincial Natural Science Foundation(Grant No ZR2024QH150,ZR2024YQ068)Taishan Scholars Program of Shandong Province(Grant No tsqn202306272)+5 种基金National Natural Science Foundation of China(Grant No 82302388)National Key Research and Development Project of China(Grant No 2023YFFO715101)Qingdao Natural Science Foundation(Grant No 23-2-1-132-zyyd-jch)the Leading Project of Science and Technology of Yantai Development Zone(Grant No 2021RC016)National Key RD Program of China(2021YFF1201100)Hubei Key Laboratory of Biomass Fibers&Eco-Dyeing&Finishing(Wuhan Textile University,Grant No STRZ202322).
文摘Efficient reconstruction of severe cutaneous wounds necessitates the orchestration of effective cell-mediated matrix remodeling and robust protection against microbial invasion.Herein,we engineered a near-infrared light(NIR)-stimulated,thermo-responsive bilayer system based on a drug-loaded hydrogel with a thermal-responsive temperature of~42℃ as the matrix layer and an antibacterial nanofibrous mat as the top layer.The matrix layer integrates basic fibroblast growth factor(bFGF)-loaded thermosensitive gelatin(Gel)hydrogel with polydopamine-Cu^(2+)coated short nanofibers(P@SF).Upon NIR exposure,P@SF elicits a photothermal effect,causing a rapid increase in temperature by 13.4℃ within 1 min at a power density of 0.75 W/cm^(2),which triggers the gel-sol transition of Gel and controls the release of bFGF.This,in turn,enhances fibroblast and endothelial cells ingrowth into the hydrogel,fostering cell functionalization and matrix remodeling.The top layer consists of poly(L-lactide-co-caprolactone)nanofibers functionalized with lysine-doped polydopamine and poly-l-lysine.It possesses antibacterial efficacy by isolating,controlling(76.23%for E.coli and 89.16%for S.aureus),and eliminating bacteria upon NIR activation.In rat skin wound models,this NIR-responsive smart bilayer system prevents S.aureus-mediated bacterial infection(indicative of reduced IL-6 expression),regulates CD31-positive neovascularization,and facilitates collagen remodeling for skin regeneration.In summary,this study introduces a novel strategy,inspired by the centralization of authority,for developing a smart thermo-responsive system with promising potential for the effective reconstruction of severe cutaneous wounds.
文摘The blockchain technology has been parenting Bitcoins and many other cryptocurrencies that have strived to be traded on the global markets.It has been only within the last two decades that eventually the concept of blockchain technology was flourished through evolution of IoT,or Internet of Things,and the first well defined cryptocurrency,namely Bitcoin,as a main biproduct of it was evolved to what we know as blockchain technology.Unlike what most people recognize cryptocurrency,as a main concept of its parenting blockchain technology,the cryptos are not just the main or everything about blockchain.Blockchain technology,is rather much more powerfully designed to interconnect and facilitate trade among many businesses in commerce,including insurance,banking,healthcare industry,etc.,through an amazing cryptocurrency,a non-fiat currency and medium of exchange.Bitcoin’s extension into the 21st century’s monetary system was and will continue to be registered as a historical turning point of the medium of exchange,store of value,and unit of account,among other desirable properties of money.We dare to have concluded that the blockchain technology is another revolution inside the capitalistic ecosystem for enforcing its powerful potential in the conversion of centralized businesses into somewhat more decentralized,where competition and efficiency would be more practically fostered than ever before.There will be more reliable and verifiable information,permanently stored on electronic ledgers,connected to enormous other nodes merged with those already accessible through the blockchain platform,operated by entrepreneurs,such as“Your First Venture Companion,”just as a tentative example.
基金supported by Beijing Scholar Project 20182024(No.B00033)。
文摘Objective:Limited evidence is available regarding the associations of centralization with gastric cancer patients’quality of care in high surgical volume settings.The current study aimed to explore the effects of hospital volume and the Herfindahl-Hirschman index(HHI)on in-hospital mortality,total cost,and length of stay for Chinese gastrectomy patients in a nationwide database.Methods:We extracted data on gastrectomy for gastric cancer from the Hospital Quality Monitoring System Database between 2013 and 2018.Hospital volume was divided into 4 quartiles:low(1-83 cases per year),medium(84-238 cases),high(239-579 cases),and very high(580-1,193 cases).The HHI was divided into 3 categories:highly concentrated(>2,500),moderately concentrated(1,500-2,500),and unconcentrated(<1,500).We used mixed-effects models to analyze the data while accounting for data clustering.Results:We analyzed 125,683 patients in 515 institutions.In the multivariable analyses,hospital volume was significantly associated with in-hospital mortality[medium vs.low:odds ratio(OR)=0.61,95%confidence interval(95%CI)=0.43-0.84,P=0.003;high:OR=0.57,95%CI=0.38-0.87,P=0.009;and very high:OR=0.33,95%CI=0.18-0.61,P<0.001)and length of stay(high vs.low:β=-0.036,95%CI=-0.071--0.002,P=0.039)but not with total cost.Hospitals located in unconcentrated provinces had higher in-hospital mortality(OR=1.52,95%CI=1.03-2.26,P=0.036)and longer lengths of stay(β=0.024,95%CI=0.001-0.047,P=0.041)than hospitals located in highly concentrated provinces.Conclusions:Centralization of gastrectomy,measured by hospital volume and the HHI,was associated with decreased in-hospital mortality and shortened length of stay without increasing total cost.These results support the strategy of centralizing gastrectomy in high-volume settings.
文摘This white paper discusses the Ecuadorian healthcare system specifically the lack of proper anesthesia and post-operative pain medication and touches base with centralized hospitals. This paper articulates the specific problems inhibiting the usage of these proper medications, specifically looking at a hospital in Quito, Ecuador. Present day tribal situations are also discussed as they are a significant part of the population that is affected by the shortages of pain medication and anesthesia. Solutions are presented to solve the problems the country faces and how it is relevant today.
文摘Telemedicine＇s greatest problem is not found in software and hardware. Many can make software and hardware work. It has for long been clear that telemedicine has diffusion problems. Focus should be shifted over to the humanware. Telemedicine means work is done by virtual organizations. For the future of telemedicine, organizational issues will represent a challenge. Organizations consist of humans in interaction. In Norwegian telemedicine projects, organizational problems were identified and solutions to the problems were designed. More than 40 publications show numerous organizational consequences and numerous types of organizational consequences. When it comes to the solving telemedicine＇s organizational problems, learning from the experience others have is important. It is not necessary for all to invent what the organizational problems are. Organizing health care around the physical telecommunication networks is associated with the concept of network organization. The electronic networks become an infrastructure around which single health care providers are distributed. Such network organization means a formation of alliances between organizations. Centralization and decentralization are important terms for all organizing. Telemedicine makes the question of centralization or decentralization relevant. Telemedicine requires collaboration between participating parties. Obtaining the benefits of telemedicine is dependent on implementing the right measures for good collaboration. We know there are problems with telemedicine virtual organizations, but solutions to these problems exist. For the future of telemedicine, doing work with organization is important. Skilled managers have an important role to play.
文摘Amharic folk literature is a time-honoured tradition dating back to the imperial songs of the 14th and 15th centuries. One of these subgenres is Amharic folk poetry which is permeated with the political, social, economic, and cultural legacies of successive Ethiopian governments that rise and demise. The image of these governments was determined by their integrity, vision, and responsiveness to the aspirations of the populace. This study was designed to determine the popular image of the imperial governments of Menelik II and Haile Selasse I as reflected in Amharic folk poetry. Without prejudice to some odes which invariably idealise the vision of these monarchs, the politically-inspired Amharic folk poetry is found to be critical of the feudal status quo thus perpetuating its negative images. This underpins the partial unpopularity of Menilik and Haile Selasse. However, these critical gestures would by no means undermine their monumental contributions to the reunification, modernization, and survival of Ethiopia. Thus, the contemporary Amharic folk-poetry is neither iconoclastic nor idealistic but an impassioned allegory of the nation-state.
文摘Congenital radial club hand (CRCH) is a terminal deficiency characterized by the radial deviation of the hand, marked shortening of the forearm, and generalized underdevelopment of the extremity with an incidence rate of 1 per 100,000 live births. Both sexes are nearly or equally affected. Challenges that the disease poses to the patient are multifaceted, ranging from medical, social, cosmetic and functional issues which also are the multidimensional treatment modalities. We report a case of a 2-month-old baby with the severe case of bilateral CRCH. The patient had the centralization of the left ulna with Kwire stabilization. About 160d of correction was achieved. He did well and was discharged after two weeks at the orthopedic clinic for follow-up. Congenital radial club hand though uncommon may be amenable to surgery. Centralization is still the treatment of choice in severe cases and early intervention will offer a better outcome.
文摘The As-level topology is a hotspot of the recent reseaches. We can understand the centralization of the network clearly by researching the evolvement trend of the Internet macroscopic topology. The massive data we use in this paper is from CAIDA (The Cooperative Association for Internet Data Analysis) Skitter project. And the time span of the data is from July, 2001 to January, 2008. This paper introduces the background of the AS-level topology at first, then carries out the evolvement of degree, core and layer. It is believed that the influence of the top-degree nodes on the other nodes decreases and the centralization of network is going to fall off with the decrease of the core. And the nucleus status of network declines.
文摘The numeral trait of aquiferous zones in flowage studies and estimations is under most parts of nation. In this study Karaj aquiferous zone in Alborz province was surveyed from the view point of form, the agglomeration of drainage net length of channel and space. The orientation of hillside was specified as the affective factor on creating and streaming the flowage. A flow aggregating hydrological model for the studied zone was prepared and amount of the flow is mostly in which parts of the zone the delay and centralization time in the zone was evaluated and the related diagrams were derived. Finally, the zone was divided into 4 main subzones and their drainage nets were ranked and by 4 factors namely, space, length of canal, drainage aggregation and branch ratio affecting on performance of the zone from the view of from and appearance was surveyed. The factors interfering in SPSS software and their correlations were specified and specific coefficients stand in their related charts. By considering in the zone width and charts it is specified which of the sub zones has the most flowage potential from the view of the zones physical and numeral qualifications. All plots were prepared using GIS and WMS software and the studied zone’s hydrograph was depicted.
文摘An important guiding thought that ran through the laws of the Ming Dynasty was ＂governing the country according to the corpus juries＂. The founding emperor of Ming Dynasty Zhu Yuanzhang found that the laws of the former Yuan Dynasty could not suit the demands of the development of the new situations, so he developed the new statutes. The laws of the Ming Dynasty absorbed the lessons that the Yuan government law and discipline ceased to be binding or become lax, and put forward that the laws must be strict, and abolished the system of the prime minister, showing a high degree of centralization. The laws of the Ming Dynasty had the important influence on the political thoughts in the late feudal society, so the researches on the legal systems in the Ming dynasty have practical significance. This paper briefly expounds the legal privileges of the Ming Dynasty for reference.
文摘To ensure the quality and marketability of products, the field of regulatory affairs (RA) serves as an intermediary between regulatory bodies, the industry, and consumers. The primary objective of pharmaceutical registration is centered on the marketing process. The World Health Organization (WHO), Pan American Health Organization (PAHO), World Trade Organization (WTO), International Conference on Harmonization (ICH), and World Intellectual Property Organization (WIPO) play crucial roles in the process. Drug registration and commercialization are overseen by national regulatory authorities initially, following the guidelines of the key organizations. The phenomenon of digital disruption is widespread and has significant effects on several domains of work. This influence has been further intensified by the COVID-19 epidemic, as well as the rapid advancements in the complexity and capabilities of machine learning and artificial intelligence algorithms. The future of this profession is influenced by various trends, including the swift progress in scientific comprehension of diseases, which has resulted in the emergence of novel therapeutic approaches for the treatment and potential eradication of some ailments. The importance of strategic collaborations, alignment, and integration among national regulatory agencies has been heightened by recent global regulatory reforms. This trend is expected to persist. The impact of these elements on regulatory professionals, medication development, and medical practice in the future is a subject of considerable attention. The enhancement of skills and the adoption of a growth mindset are crucial for regulatory affairs professionals to implement the necessary adjustments. This emerging paradigm promotes the cultivation of personal responsibility in individuals’ professional development, fostering adaptability and emphasizing the significance of lifelong learning. Through their actions, these specialists could exert influence on the process of product development, contributing to the improvement of their society.
文摘Using simple statistical analysis of count-level budgetary data from across all of China＇s counties, the present paper examines whether the post-1994 fiscal decentralization has affected redistribution at the count-level. The new fiscal system has been less able to narrow inter-county dispersion in ftscal imbalances than the old one, even after taking intergovernmental transfer payments into account. Although with the post-1994 system there has been a modest increase in per capita welfare spending in all counties on average, much of the new-found fiscal resources have been spent on salary and administrative expenses rather than spending on public goods. Therefore, it is imperative that the reform of China＇s tax system is intensified.
基金This work was supported by the Fund for Innovative Research Group of the National Natural Science Foundation of China （No. 51421065）, by the Program for New Century Excellent Talents in University （No. NCET-12-0059）, and by the National Natural Science Foundation of China （Grant No. 41171068）, and by the Fundamental Research Funds for the Central Universities （2015KJJCA09）.
文摘Industrial symbiosis is the quintessential characteristic of an eco-industrial park. To divide parks into different types, previous studies mostly focused on qualitative judgments, and failed to use metrics to conduct quantitative research on the intemal structural or functional characteristics of a park. To analyze a park＇s structural attributes, a range of metrics from network analysis have been applied, but few researchers have compared two or more symbioses using multiple metrics. In this study, we used two metrics （density and network degree centraliza- tion） to compare the degrees of completeness and dependence of eight diverse but representative industrial symbiosis networks. Through the combination of the two metrics, we divided the networks into three types： weak completeness, and two forms of strong completeness, namely ＂anchor tenant＂ mutualism and ＂equality-oriented＂ mutualism. The results showed that the networks with a weak degree of completeness were sparse and had few connections among nodes; for ＂anchor tenant＂ mutualism, the degree of completeness was relatively high, but the affiliated members were too dependent on core members; and the members in ＂equality-oriented＂ mutualism had equal roles, with diverse and flexible symbiotic paths. These results revealed some of the systems＇ internal structure and how different structures influenced the exchanges of materials, energy, and knowledge among members of a system, thereby providing insights into threats that may destabilize the network. Based on this analysis, we provide examples of the advantages and effectiveness of recent improvement projects in a typical Chinese eco-industrial park （Shandong Lubei）.
文摘By far, the researches on how to distribute blood products among different departments in hospital have not been further studied, though the problem of blood shortage and wastage that caused by improper blood allocation is severe, which may endanger patient＇s lives and impose considerable costs on hospitals. In order to solve this problem, this paper mainly studies on how to distribute the blood items among different departments within a hospital and investigates the allocation approach with the novel management method by centralizing the inventory of several different departments. By integrating the blood inventory requirements of some departments, the hospital could reduce the rate of blood shortage and wastage effectively, release the pressure of the occupancy of resources and reduce the bullwhip effect of blood products. This paper illustrates the centralization principle in hospital and formulates the mixed integer programming model to work out the optimal allocation network scheme and the optimal inventory setting for every department. And the results of the numerical example demonstrate that this centralization method could considerably reduce blood shortage and wastage in hospital by about 72% and 90% respectively. Furthermore, it could decrease the total cost by about 108,540 RMB a month on blood supply chain management in the hospital and improve the effect of some certain surgeries by transfusing the fresh blood to patients.
