Floods often cause significant crop loss in the United States. Timely and objective information on flood-related crop loss, such as flooded acreage and degree of crop damage, is very important for crop monitoring and ...Floods often cause significant crop loss in the United States. Timely and objective information on flood-related crop loss, such as flooded acreage and degree of crop damage, is very important for crop monitoring and risk management in ag- ricultural and disaster-related decision-making at many concerned agencies. Currently concerned agencies mostly rely on field surveys to obtain crop loss information and compensate farmers＇ loss claim. Such methods are expensive, labor intensive, and time consumptive, especially for a large flood that affects a large geographic area. The results from such methods suffer from inaccuracy, subjectiveness, untimeliness, and lack of reproducibility. Recent studies have demonstrated that Earth observation （EO） data could be used in post-flood crop loss assessment for a large geographic area objectively, timely, accurately, and cost effectively. However, there is no operational decision support system, which employs such EO-based data and algorithms for operational flood-related crop decision-making. This paper describes the development of an EO-based flood crop loss assessment cyber-service system, RF-CLASS, for supporting flood-related crop statistics and insurance decision-making. Based on the service-orientated architecture, RF-CLASS has been implemented with open interoperability specifications to facilitate the interoperability with EO data systems, particularly the National Aeronautics and Space Administration （NASA） Earth Observing System Data and Information System （EOSDIS）, for automatically fetching the input data from the data systems. Validated EO algorithms have been implemented as web services in the system to operationally produce a set of flood-related products from EO data, such as flood frequency, flooded acreage, and degree of crop damage, for supporting decision-making in flood statistics and flood crop insurance policy. The system leverages recent advances in the remote sensing-based flood monitoring and assessment, the near-real-time availability of EO data, the service-oriented architecture, geospatial interoperability standards, and the standard-based geospatial web service technology. The prototypical system has automatically generated the flood crop loss products and demonstrated the feasibility of using such products to improve the agricultural decision-making. Evaluation of system by the end-user agencies indicates that significant improvement on flood-related crop decision-making has been achieved with the system.展开更多
With the increasing complexity of industrial automation,planetary gearboxes play a vital role in largescale equipment transmission systems,directly impacting operational efficiency and safety.Traditional maintenance s...With the increasing complexity of industrial automation,planetary gearboxes play a vital role in largescale equipment transmission systems,directly impacting operational efficiency and safety.Traditional maintenance strategies often struggle to accurately predict the degradation process of equipment,leading to excessive maintenance costs or potential failure risks.However,existing prediction methods based on statistical models are difficult to adapt to nonlinear degradation processes.To address these challenges,this study proposes a novel condition-based maintenance framework for planetary gearboxes.A comprehensive full-lifecycle degradation experiment was conducted to collect raw vibration signals,which were then processed using a temporal convolutional network autoencoder with multi-scale perception capability to extract deep temporal degradation features,enabling the collaborative extraction of longperiod meshing frequencies and short-term impact features from the vibration signals.Kernel principal component analysis was employed to fuse and normalize these features,enhancing the characterization of degradation progression.A nonlinear Wiener process was used to model the degradation trajectory,with a threshold decay function introduced to dynamically adjust maintenance strategies,and model parameters optimized through maximum likelihood estimation.Meanwhile,the maintenance strategy was optimized to minimize costs per unit time,determining the optimal maintenance timing and preventive maintenance threshold.The comprehensive indicator of degradation trends extracted by this method reaches 0.756,which is 41.2%higher than that of traditional time-domain features;the dynamic threshold strategy reduces the maintenance cost per unit time to 55.56,which is 8.9%better than that of the static threshold optimization.Experimental results demonstrate significant reductions in maintenance costs while enhancing system reliability and safety.This study realizes the organic integration of deep learning and reliability theory in the maintenance of planetary gearboxes,provides an interpretable solution for the predictive maintenance of complex mechanical systems,and promotes the development of condition-based maintenance strategies for planetary gearboxes.展开更多
The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a pati...The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a patient's health status directly from their perspective,encompassing various domains such as symptom severity,functional status,and overall quality of life.By integrating PROMs into routine clinical practice and research,healthcare providers can achieve a more nuanced understanding of patient experiences and tailor treatments accordingly.The deployment of PROMs supports dynamic patient-provider interactions,fostering better patient engagement and adherence to tre-atment plans.Moreover,PROMs are pivotal in clinical settings for monitoring disease progression and treatment efficacy,particularly in chronic and mental health conditions.However,challenges in implementing PROMs include data collection and management,integration into existing health systems,and acceptance by patients and providers.Overcoming these barriers necessitates technological advancements,policy development,and continuous education to enhance the acceptability and effectiveness of PROMs.The paper concludes with recommendations for future research and policy-making aimed at optimizing the use and impact of PROMs across healthcare settings.展开更多
To solve problems of poor security guarantee and insufficient training efficiency in the conventional reinforcement learning methods for decision-making,this study proposes a hybrid framework to combine deep reinforce...To solve problems of poor security guarantee and insufficient training efficiency in the conventional reinforcement learning methods for decision-making,this study proposes a hybrid framework to combine deep reinforcement learning with rule-based decision-making methods.A risk assessment model for lane-change maneuvers considering uncertain predictions of surrounding vehicles is established as a safety filter to improve learning efficiency while correcting dangerous actions for safety enhancement.On this basis,a Risk-fused DDQN is constructed utilizing the model-based risk assessment and supervision mechanism.The proposed reinforcement learning algorithm sets up a separate experience buffer for dangerous trials and punishes such actions,which is shown to improve the sampling efficiency and training outcomes.Compared with conventional DDQN methods,the proposed algorithm improves the convergence value of cumulated reward by 7.6%and 2.2%in the two constructed scenarios in the simulation study and reduces the number of training episodes by 52.2%and 66.8%respectively.The success rate of lane change is improved by 57.3%while the time headway is increased at least by 16.5%in real vehicle tests,which confirms the higher training efficiency,scenario adaptability,and security of the proposed Risk-fused DDQN.展开更多
Due to the numerous variables to take into account as well as the inherent ambiguity and uncertainty,evaluating educational institutions can be difficult.The concept of a possibility Pythagorean fuzzy hypersoft set(pP...Due to the numerous variables to take into account as well as the inherent ambiguity and uncertainty,evaluating educational institutions can be difficult.The concept of a possibility Pythagorean fuzzy hypersoft set(pPyFHSS)is more flexible in this regard than other theoretical fuzzy set-like models,even though some attempts have been made in the literature to address such uncertainties.This study investigates the elementary notions of pPyFHSS including its set-theoretic operations union,intersection,complement,OR-and AND-operations.Some results related to these operations are also modified for pPyFHSS.Additionally,the similarity measures between pPyFHSSs are formulated with the assistance of numerical examples and results.Lastly,an intelligent decision-assisted mechanism is developed with the proposal of a robust algorithm based on similarity measures for solving multi-attribute decision-making(MADM)problems.A case study that helps the decision-makers assess the best educational institution is discussed to validate the suggested system.The algorithmic results are compared with the most pertinent model to evaluate the adaptability of pPyFHSS,as it generalizes the classical possibility fuzzy set-like theoretical models.Similarly,while considering significant evaluating factors,the flexibility of pPyFHSS is observed through structural comparison.展开更多
Accurate medical diagnosis,which involves identifying diseases based on patient symptoms,is often hindered by uncertainties in data interpretation and retrieval.Advanced fuzzy set theories have emerged as effective to...Accurate medical diagnosis,which involves identifying diseases based on patient symptoms,is often hindered by uncertainties in data interpretation and retrieval.Advanced fuzzy set theories have emerged as effective tools to address these challenges.In this paper,new mathematical approaches for handling uncertainty in medical diagnosis are introduced using q-rung orthopair fuzzy sets(q-ROFS)and interval-valued q-rung orthopair fuzzy sets(IVq-ROFS).Three aggregation operators are proposed in our methodologies:the q-ROF weighted averaging(q-ROFWA),the q-ROF weighted geometric(q-ROFWG),and the q-ROF weighted neutrality averaging(qROFWNA),which enhance decision-making under uncertainty.These operators are paired with ranking methods such as the similarity measure,score function,and inverse score function to improve the accuracy of disease identification.Additionally,the impact of varying q-rung values is explored through a sensitivity analysis,extending the analysis beyond the typical maximum value of 3.The Basic Uncertain Information(BUI)method is employed to simulate expert opinions,and aggregation operators are used to combine these opinions in a group decisionmaking context.Our results provide a comprehensive comparison of methodologies,highlighting their strengths and limitations in diagnosing diseases based on uncertain patient data.展开更多
China’s healthcare system faces increasing challenges,including surging medical costs,resource allocation imbalances favoring large hospitals,and ineffective referral mechanisms.The lack of a unified strategy integra...China’s healthcare system faces increasing challenges,including surging medical costs,resource allocation imbalances favoring large hospitals,and ineffective referral mechanisms.The lack of a unified strategy integrating standardized coverage with personalized payment compounds these issues.To this end,this study proposes a risk-sharing reform strategy that combines equal coverage for the same disease(ECSD)with an individualized out-of-pocket(I-OOP)model.Specifically,the study employs a Markov model to capture patient transitions across health states and care levels.The findings show that ECSD and I-OOP enhance equity by standardizing disease coverage while tailoring costs to patient income and facility type.This approach alleviates demand on high-tier hospitals,promoting primary care utilization and enabling balanced resource distribution.The study’s findings provide a reference for policymakers and healthcare administrators by presenting a scalable framework that is aligned with China’s development goals with the aim of fostering an efficient,sustainable healthcare system that is adaptable to regional needs.展开更多
BACKGROUND Understanding a patient's clinical status and setting priorities for their care are two aspects of the constantly changing process of clinical decision-making.One analytical technique that can be helpfu...BACKGROUND Understanding a patient's clinical status and setting priorities for their care are two aspects of the constantly changing process of clinical decision-making.One analytical technique that can be helpful in uncertain situations is clinical judgment.Clinicians must deal with contradictory information,lack of time to make decisions,and long-term factors when emergencies occur.AIM To examine the ethical issues healthcare professionals faced during the coronavirus disease 2019(COVID-19)pandemic and the factors affecting clinical decision-making.METHODS This pilot study,which means it was a preliminary investigation to gather information and test the feasibility of a larger investigation was conducted over 6 months and we invited responses from clinicians worldwide who managed patients with COVID-19.The survey focused on topics related to their professional roles and personal relationships.We examined five core areas influencing critical care decision-making:Patients'personal factors,family-related factors,informed consent,communication and media,and hospital administrative policies on clinical decision-making.The collected data were analyzed using the χ^(2) test for categorical variables.RESULTS A total of 102 clinicians from 23 specialties and 17 countries responded to the survey.Age was a significant factor in treatment planning(n=88)and ventilator access(n=78).Sex had no bearing on how decisions were made.Most doctors reported maintaining patient confidentiality regarding privacy and informed consent.Approximately 50%of clinicians reported a moderate influence of clinical work,with many citing it as one of the most important factors affecting their health and relationships.Clinicians from developing countries had a significantly higher score for considering a patient's financial status when creating a treatment plan than their counterparts from developed countries.Regarding personal experiences,some respondents noted that treatment plans and preferences changed from wave to wave,and that there was a rapid turnover of studies and evidence.Hospital and government policies also played a role in critical decision-making.Rather than assessing the appropriateness of treatment,some doctors observed that hospital policies regarding medications were driven by patient demand.CONCLUSION Factors other than medical considerations frequently affect management choices.The disparity in treatment choices,became more apparent during the pandemic.We highlight the difficulties and contradictions between moral standards and the realities physicians encountered during this medical emergency.False information,large patient populations,and limited resources caused problems for clinicians.These factors impacted decision-making,which,in turn,affected patient care and healthcare staff well-being.展开更多
The COVID-19 pandemic,as a global public health crisis,has had profound and lasting effects on the world economy and social operating models,fundamentally changing individuals',enterprises',and governments'...The COVID-19 pandemic,as a global public health crisis,has had profound and lasting effects on the world economy and social operating models,fundamentally changing individuals',enterprises',and governments'perceptions of risk and risk management paradigms.The Chinese insurance industry has experienced short-term pain due to the impact of the pandemic,but in the long term,the pandemic has served as a"catalyst"and"accelerator"for the industry's development,greatly enhancing societal awareness of risk protection and,with unprecedented strength,promoting the industry's digital revolution and supply-side structural reform.This article aims to conduct a comprehensive and systematic analysis of the macro environment,technological background,and demand changes faced by the Chinese insurance industry in the post-pandemic era,and to deeply explore the historical opportunities inherent in key areas such as health insurance,pension insurance,digital transformation,and green insurance.Additionally,this article will objectively examine the severe challenges the industry faces in the sustainability of profit models,structural mismatches in supply and demand,rebuilding trust systems,new risk management,and regulatory adaptation.Lastly,based on the above analysis,this article will propose strategic pathways and policy recommendations from three levels:national policy,industry regulation,and corporate strategy to promote the high-quality and sustainable development of the Chinese insurance industry,better serving the needs of national governance modernization and the well-being of the people.展开更多
As a city-customized supplementary medical insurance bridging basic medical insurance and commercial health insurance,Huimin Insurance has expanded to 30 provinces and served 168 million people within four years,emerg...As a city-customized supplementary medical insurance bridging basic medical insurance and commercial health insurance,Huimin Insurance has expanded to 30 provinces and served 168 million people within four years,emerging as a phenomenal success in China's inclusive insurance landscape.This paper examines its evolution,operational mechanisms,and effectiveness,identifying core challenges including declining participation and renewal rates,adverse selection,uneven benefit compensation,and insufficient information disclosure.It proposes sustainable development pathways across five dimensions:government role,financing and payment,product stratification,service value-added,and technology empowerment.The study demonstrates that the future of Huimin Insurance will likely evolve towards a model characterized by provincial-level co-ordination,stratified benefit design,dynamic pricing,and integrated health management.Its success or failure will ultimately determine the integration depth of China's multi-tiered medical security system and significantly impact the realization of common prosperity goals.展开更多
In this article,we comment on the work put forth by Wu et al regarding the investigation of oesophageal cancer-specific mortality for a cohort of patients from Chongqing University Cancer Hospital.We specifically focu...In this article,we comment on the work put forth by Wu et al regarding the investigation of oesophageal cancer-specific mortality for a cohort of patients from Chongqing University Cancer Hospital.We specifically focused on the implications of public health plans such as Urban Employee Basic Medical Insurance(UEBMI)and Urban Resident Basic Medical Insurance as well as out-of-pocket ratios on patient treatment plans regarding whether they pursue surgical interventions or therapeutic treatments such as chemotherapy.While Wu et al put forth potential explanations for why patients with the UEBMI plan surprisingly had a 23.30%increased risk of oesophageal cancer-specific death,more analysis is needed to alleviate cancer burden within this group.Although it is likely that patients covered by Urban Resident Basic Medical Insurance and higher out-ofpocket ratios have stronger self-recovery awareness,more work must be done to improve outcomes for people with the UEBMI plan while simultaneously implementing international and domestic initiatives to better emphasize cancer prevention and early detection.Lastly,future research must explore the relationship between Serious Illness Medical Insurance as well as the New Rural Cooperative Medical System on the mortality rate of oesophageal cancer patients in rural China,where disease burden is significantly higher than urban areas.By unifying these public health insurance schemes,officials can significantly alleviate economic burden of treatment and better prognosis for patients with oesophageal cancer.展开更多
With the rapid development of China's insurance market,the high-quality development of the insurance market is faced with many different challenges and various problems.This paper aims to deeply analyze the actual...With the rapid development of China's insurance market,the high-quality development of the insurance market is faced with many different challenges and various problems.This paper aims to deeply analyze the actual problems in China's insurance market and put forward supporting countermeasures.First,by understanding the background of highquality insurance development,we can explain the research significance of this paper in combination with the existing national policies.Secondly,by summarizing the current situation of high-quality insurance development,the paper puts forward the shortage of insurance talents in the expansion of insurance scale,the continuous improvement of insurance density and depth,and the growth of insurance compensation in the development of high-quality insurance.Finally,from the perspective of differentiated customized insurance products,training professionals,and providing financial subsidies,we will put forward the corresponding suggestions for the problem and look forward to the future development prospects.展开更多
Marxist and social science methodologies provide scientific conceptual tools and analytical perspectives for research across various disciplines.Among these,the methodology of quantitative and qualitative changes reve...Marxist and social science methodologies provide scientific conceptual tools and analytical perspectives for research across various disciplines.Among these,the methodology of quantitative and qualitative changes reveals the fundamental laws governing the development of things,offering significant guidance for exploring the relationship between Huimin Insurance and basic medical insurance,and for promoting the sustainable development of the medical security system.Based on this methodology and the practical context of the medical security field,this paper provides an in-depth analysis of the impact of Huimin Insurance on the sustainable development of basic medical insurance.展开更多
The purpose of this paper is to study the influencing factors of flexible employment personnel's participation in urban-rural residents'pension insurance.After reading a large number of literature and research...The purpose of this paper is to study the influencing factors of flexible employment personnel's participation in urban-rural residents'pension insurance.After reading a large number of literature and research results on flexible employment personnel and analyzing and interpreting the urban-rural residents'pension insurance policy of Zhuhai,we take the flexible employment personnel of Zhuhai City as the object of the study,combined with questionnaire survey method,and analyze the difficulties of the flexible employment personnel's participation in the insurance by analyzing the collected data,and find out that Zhuhai's flexibly employed people have cognitive bias towards urban and rural residents'pension insurance,the government's business personnel have a vague understanding of the insurance,and some of the flexibly employed people think that the subsidy is low,etc.The government of Zhuhai City has provided the suggestions of expanding the scope of the publicity of the urban and rural residents'pension insurance,increasing publicity efforts,and providing regular training for the counterpart service personnel in order to increase the rate of the flexibly employed people's participation in the insurance,and improve the inherent bad impression of the insurance by the flexibly employed people.personnel's inherent bad impression of insurance,and further improve China's insurance system.展开更多
This article investigates the development process and current status of policy-based agricultural insurance in Chongqing.Based on recent data-including premium income,compensation amounts,the number of insured househo...This article investigates the development process and current status of policy-based agricultural insurance in Chongqing.Based on recent data-including premium income,compensation amounts,the number of insured households,and insurance penetration,the article analyzes the primary challenges faced in the system's operation and proposes recommendations from two dimensions:institutional optimization and practical interventions.These recommendations include establishing a differentiated participation incentive mechanism,optimizing the composition of insurance products,enhancing risk diversification and reinsurance systems,creating an agricultural disaster risk reserve fund,developing a dynamic fiscal subsidy distribution mechanism based on risk and performance,improving information-sharing platforms,strengthening the rural grassroots power grid infrastructure,and accelerating the adoption of modern technologies in underwriting and claims settlement processes.The findings suggest that the coordinated advancement of institutional optimization and technological empowerment can substantially enhance the inclusiveness,sustainability,and operational efficiency of policy-based agricultural insurance in Chongqing,thereby providing substantial support for agricultural modernization and the Rural Revitalization Strategy.展开更多
BACKGROUND Oesophageal cancer is a significant health concern worldwide,with high inci-dence and mortality rates.In China,the disease burden is particularly high,accounting for a substantial proportion of oesophageal ...BACKGROUND Oesophageal cancer is a significant health concern worldwide,with high inci-dence and mortality rates.In China,the disease burden is particularly high,accounting for a substantial proportion of oesophageal cancer cases and related deaths worldwide.AIM To explore the relationship between the mortality rate of oesophageal cancer patients and insurance type,out-of-pocket ratio,and the joint effects of insurance type and out-of-pocket ratio.METHODS The χ^(2) test was used to analyze patients’demographic and clinical characteristics.Multivariate logistic regression,the Cox proportional hazard model,and the competitive risk model were used to calculate the cumulative hazard ratios(HRs)of all-cause death and oesophageal cancer-specific death among patients with different types of insurance and out-of-pocket ratios.RESULTS Compared with patients covered by basic medical insurance for urban and rural residents,patients covered by urban employee basic medical insurance for urban workers(UEBMI)had a 23.30%increased risk of oesophageal cancer-specific death[HR=1.233,95%confidence interval(CI):1.093-1.391,P<0.005].Compared with patients in the low out-of-pocket ratio group,patients in the high out-of-pocket ratio group had a 25.80%reduction in the risk of oesophageal cancer-specific death(HR=0.742,95%CI:0.6555-0.84,P<0.005).With each 10%increase in the out-of-pocket ratio,the risk of oesophageal cancer-specific death decreased by 10.10%in patients covered by UEBMI.However,the risk of oesophageal cancer-specific death increased by 26.90%in patients in the high out-of-pocket ratio group.CONCLUSION This study reveals the relationships of the specific mortality rate of patients with oesophageal cancer with the out-of-pocket ratio and medical insurance types as well as their combined effects.This study provides practical suggestions and guidance for the formulation of relevant policies in this area.展开更多
Objectives This study aimed to clarify the relationship between the content of proxy decision-making made by families of patients with malignant brain tumors regarding treatment policies and daily care and the cues le...Objectives This study aimed to clarify the relationship between the content of proxy decision-making made by families of patients with malignant brain tumors regarding treatment policies and daily care and the cues leading to those decisions.Methods Semi-structured personal interviews were used to collect data.Seven family members of patients with malignant brain tumors were selected to participate in the study by purposive sampling method from June to August 2022 in the Patient Family Association of Japan.Responses were content analyzed to explore the relationship between the content of decisions regarding“treatment policies”and“daily care”and the cues influencing those decisions.Semi-structured interviews were analyzed by using thematic analysis.Results The contents of proxy decisions regarding“treatment policies”included implementation,interruption,and termination of initial treatments,free medical treatments,use of respirators,and end-of-life sedation and included six cues:treatment policies suggested by the primary physician,information and knowledge about the disease and treatment obtained by the family from limited resources,perceived life threat from symptom worsening,words and reactions from the patient regarding treatment,patient’s personality and way of life inferred from their treatment preferences,family’s thoughts and values hoping for better treatment for the patient.Decisions for“daily care”included meal content and methods,excretion,mobility,maintaining cleanliness,rehabilitation,continuation or resignation from work,treatment settings(outpatient or inpatient),and ways to spend time outside and included seven cues:words and thoughts from the patient about their way of life,patient’s reactions and life history inferred from their preferred way of living,things the patient can do to maintain daily life and roles,awareness of the increasing inability to do things in daily life,family’s underlying thoughts and values about how to spend the remaining time,approval from family members regarding the care setting,advice from medical professionals on living at home.Conclusions For“treatment policies,”guidelines from medical professionals were a key cue,while for“daily care,”the small signs from the patients in their daily lives served as cues for proxy decision-making.This may be due to the lack of information available to families and the limited time available for discussion with the patient.Families of patients with malignant brain tumors repeatedly use multiple cues to make proxy decision-making under high uncertainty.Therefore,nurses supporting proxy decision-making should assess the family’s situation and provide cues that facilitate informed and confident decisions.展开更多
Group living is widespread across diverse taxa,and the mechanisms underlying collective decision-making in contexts of variable role division are critical for understanding the dynamics of group stability.While studie...Group living is widespread across diverse taxa,and the mechanisms underlying collective decision-making in contexts of variable role division are critical for understanding the dynamics of group stability.While studies on collective behavior in small animals such as fish and insects are well-established,similar research on large wild animals remains challenging due to the limited availability of sufficient and systematic field data.Here,we aimed to explore the collective decision-making pattern and its sexual difference for the dimorphic Tibetan antelopes Pantholops hodgsonii(chiru)in Xizang Autonomous Region,China,by analyzing individual leadership distribution,as well as the joining process,considering factors such as calving stages and joining ranks.The distinct correlations of decision participants’ratio with group size and decision duration underscore the trade-off between accuracy and speed in decision-making.Male antelopes display a more democratic decision-making pattern,while females exhibit more prompt responses after calving at an early stage.This study uncovers a partially shared decision-making strategy among Tibetan antelopes,suggesting flexible self-organization in group decision processes aligned with animal life cycle progression.展开更多
The article by Wu et al highlights the growing incidence of esophageal tumor patients,particularly in China,where the high frequency and death rate are significant problems.The article also examined the impact of heal...The article by Wu et al highlights the growing incidence of esophageal tumor patients,particularly in China,where the high frequency and death rate are significant problems.The article also examined the impact of health insurance on treatment availability and patient outcomes,demonstrating that the type of insurance can affect the financial burden on patients.This study investigates the effects of different types of health care coverage,namely Urban Employee Basic Medical Insurance vs Urban-Rural Resident Basic Medical Insurance,and the personal spending ratio on treatment decisions and survival outcomes.The database used is derived from esophageal tumor patient continuation from Chongqing University Hospital in China.A total of 2543 patients were included in the study,allowing for the formation of research cohorts.Patient information included demographic characteristics.The study followed various processes to maintain consistency,including data sources,inclusion and exclusion criteria,follow-up duration,health insurance,and statistical analysis.The average age at diagnosis ranged from 57-74 years,and predominantly included men,married people,and those of Han ethnic background,comprising 2088 and 2519 individuals,respectively.Upon controlling for age,sex,relationship status,country of origin,pathological evaluation,tumor stage,and biochemical indicators,individuals who had Urban Employee Basic Medical Insurance exhibited a higher propensity to opt for radiotherapy,chemotherapy,immunotherapy,and targeted therapy compared to those covered by the Urban-Rural Resident Basic Medical Insurance.During the follow-up phase of the study,a total of 1438 deaths were documented,with 1106 ascribed to esophageal cancer.Additionally,individuals with Urban-Rural Resident Basic Medical Insurance had a significantly elevated risk of esophageal cancer,particularly mortality,compared to those without Urban-Rural Resident Basic Medical Insurance.展开更多
Accurately determining when and what to remanufacture is essential for maximizing the lifecycle value of industrial equipment.However,existing approaches face three significant limitations:(1)reliance on predefined ma...Accurately determining when and what to remanufacture is essential for maximizing the lifecycle value of industrial equipment.However,existing approaches face three significant limitations:(1)reliance on predefined mathematical models that often fail to capture equipment-specific degradation,(2)offline optimization methods that assume access to future data,and(3)the absence of component-level guidance.To address these challenges,we propose a data-driven framework for component-level decision-making.The framework leverages streaming sensor data to predict the remaining useful life(RUL)without relying on mathematical models,employs an online optimization algorithm suitable for practical settings,and,through remanufacturing simulations,provides guidance on which components should be replaced.In a case study on gas-insulated switchgear,the proposed framework achieved RUL prediction performance comparable to an oracle model in an online setting without relying on predefined mathematical models.Furthermore,by employing online optimization,it determined a remanufacturing timing close to the global optimum using only past and current data.In addition,unlike previous studies,the framework enables component-level decision-making,allowing for more detailed and actionable remanufacturing guidance in practical applications.展开更多
基金supported by grants from the National Aeronautics and Space Administration Applied Science Program,USA (NNX12AQ31G,NNX14AP91G,PI:Dr.Liping Di)
文摘Floods often cause significant crop loss in the United States. Timely and objective information on flood-related crop loss, such as flooded acreage and degree of crop damage, is very important for crop monitoring and risk management in ag- ricultural and disaster-related decision-making at many concerned agencies. Currently concerned agencies mostly rely on field surveys to obtain crop loss information and compensate farmers＇ loss claim. Such methods are expensive, labor intensive, and time consumptive, especially for a large flood that affects a large geographic area. The results from such methods suffer from inaccuracy, subjectiveness, untimeliness, and lack of reproducibility. Recent studies have demonstrated that Earth observation （EO） data could be used in post-flood crop loss assessment for a large geographic area objectively, timely, accurately, and cost effectively. However, there is no operational decision support system, which employs such EO-based data and algorithms for operational flood-related crop decision-making. This paper describes the development of an EO-based flood crop loss assessment cyber-service system, RF-CLASS, for supporting flood-related crop statistics and insurance decision-making. Based on the service-orientated architecture, RF-CLASS has been implemented with open interoperability specifications to facilitate the interoperability with EO data systems, particularly the National Aeronautics and Space Administration （NASA） Earth Observing System Data and Information System （EOSDIS）, for automatically fetching the input data from the data systems. Validated EO algorithms have been implemented as web services in the system to operationally produce a set of flood-related products from EO data, such as flood frequency, flooded acreage, and degree of crop damage, for supporting decision-making in flood statistics and flood crop insurance policy. The system leverages recent advances in the remote sensing-based flood monitoring and assessment, the near-real-time availability of EO data, the service-oriented architecture, geospatial interoperability standards, and the standard-based geospatial web service technology. The prototypical system has automatically generated the flood crop loss products and demonstrated the feasibility of using such products to improve the agricultural decision-making. Evaluation of system by the end-user agencies indicates that significant improvement on flood-related crop decision-making has been achieved with the system.
基金funded by scientific research projects under Grant JY2024B011.
文摘With the increasing complexity of industrial automation,planetary gearboxes play a vital role in largescale equipment transmission systems,directly impacting operational efficiency and safety.Traditional maintenance strategies often struggle to accurately predict the degradation process of equipment,leading to excessive maintenance costs or potential failure risks.However,existing prediction methods based on statistical models are difficult to adapt to nonlinear degradation processes.To address these challenges,this study proposes a novel condition-based maintenance framework for planetary gearboxes.A comprehensive full-lifecycle degradation experiment was conducted to collect raw vibration signals,which were then processed using a temporal convolutional network autoencoder with multi-scale perception capability to extract deep temporal degradation features,enabling the collaborative extraction of longperiod meshing frequencies and short-term impact features from the vibration signals.Kernel principal component analysis was employed to fuse and normalize these features,enhancing the characterization of degradation progression.A nonlinear Wiener process was used to model the degradation trajectory,with a threshold decay function introduced to dynamically adjust maintenance strategies,and model parameters optimized through maximum likelihood estimation.Meanwhile,the maintenance strategy was optimized to minimize costs per unit time,determining the optimal maintenance timing and preventive maintenance threshold.The comprehensive indicator of degradation trends extracted by this method reaches 0.756,which is 41.2%higher than that of traditional time-domain features;the dynamic threshold strategy reduces the maintenance cost per unit time to 55.56,which is 8.9%better than that of the static threshold optimization.Experimental results demonstrate significant reductions in maintenance costs while enhancing system reliability and safety.This study realizes the organic integration of deep learning and reliability theory in the maintenance of planetary gearboxes,provides an interpretable solution for the predictive maintenance of complex mechanical systems,and promotes the development of condition-based maintenance strategies for planetary gearboxes.
文摘The critical role of patient-reported outcome measures(PROMs)in enhancing clinical decision-making and promoting patient-centered care has gained a profound significance in scientific research.PROMs encapsulate a patient's health status directly from their perspective,encompassing various domains such as symptom severity,functional status,and overall quality of life.By integrating PROMs into routine clinical practice and research,healthcare providers can achieve a more nuanced understanding of patient experiences and tailor treatments accordingly.The deployment of PROMs supports dynamic patient-provider interactions,fostering better patient engagement and adherence to tre-atment plans.Moreover,PROMs are pivotal in clinical settings for monitoring disease progression and treatment efficacy,particularly in chronic and mental health conditions.However,challenges in implementing PROMs include data collection and management,integration into existing health systems,and acceptance by patients and providers.Overcoming these barriers necessitates technological advancements,policy development,and continuous education to enhance the acceptability and effectiveness of PROMs.The paper concludes with recommendations for future research and policy-making aimed at optimizing the use and impact of PROMs across healthcare settings.
基金Supported by National Key Research and Development Program of China(Grant No.2022YFE0117100)National Science Foundation of China(Grant No.52102468,52325212)Fundamental Research Funds for the Central Universities。
文摘To solve problems of poor security guarantee and insufficient training efficiency in the conventional reinforcement learning methods for decision-making,this study proposes a hybrid framework to combine deep reinforcement learning with rule-based decision-making methods.A risk assessment model for lane-change maneuvers considering uncertain predictions of surrounding vehicles is established as a safety filter to improve learning efficiency while correcting dangerous actions for safety enhancement.On this basis,a Risk-fused DDQN is constructed utilizing the model-based risk assessment and supervision mechanism.The proposed reinforcement learning algorithm sets up a separate experience buffer for dangerous trials and punishes such actions,which is shown to improve the sampling efficiency and training outcomes.Compared with conventional DDQN methods,the proposed algorithm improves the convergence value of cumulated reward by 7.6%and 2.2%in the two constructed scenarios in the simulation study and reduces the number of training episodes by 52.2%and 66.8%respectively.The success rate of lane change is improved by 57.3%while the time headway is increased at least by 16.5%in real vehicle tests,which confirms the higher training efficiency,scenario adaptability,and security of the proposed Risk-fused DDQN.
基金supported by the Deanship of Graduate Studies and Scientific Research at Qassim University(QU-APC-2024-9/1).
文摘Due to the numerous variables to take into account as well as the inherent ambiguity and uncertainty,evaluating educational institutions can be difficult.The concept of a possibility Pythagorean fuzzy hypersoft set(pPyFHSS)is more flexible in this regard than other theoretical fuzzy set-like models,even though some attempts have been made in the literature to address such uncertainties.This study investigates the elementary notions of pPyFHSS including its set-theoretic operations union,intersection,complement,OR-and AND-operations.Some results related to these operations are also modified for pPyFHSS.Additionally,the similarity measures between pPyFHSSs are formulated with the assistance of numerical examples and results.Lastly,an intelligent decision-assisted mechanism is developed with the proposal of a robust algorithm based on similarity measures for solving multi-attribute decision-making(MADM)problems.A case study that helps the decision-makers assess the best educational institution is discussed to validate the suggested system.The algorithmic results are compared with the most pertinent model to evaluate the adaptability of pPyFHSS,as it generalizes the classical possibility fuzzy set-like theoretical models.Similarly,while considering significant evaluating factors,the flexibility of pPyFHSS is observed through structural comparison.
文摘Accurate medical diagnosis,which involves identifying diseases based on patient symptoms,is often hindered by uncertainties in data interpretation and retrieval.Advanced fuzzy set theories have emerged as effective tools to address these challenges.In this paper,new mathematical approaches for handling uncertainty in medical diagnosis are introduced using q-rung orthopair fuzzy sets(q-ROFS)and interval-valued q-rung orthopair fuzzy sets(IVq-ROFS).Three aggregation operators are proposed in our methodologies:the q-ROF weighted averaging(q-ROFWA),the q-ROF weighted geometric(q-ROFWG),and the q-ROF weighted neutrality averaging(qROFWNA),which enhance decision-making under uncertainty.These operators are paired with ranking methods such as the similarity measure,score function,and inverse score function to improve the accuracy of disease identification.Additionally,the impact of varying q-rung values is explored through a sensitivity analysis,extending the analysis beyond the typical maximum value of 3.The Basic Uncertain Information(BUI)method is employed to simulate expert opinions,and aggregation operators are used to combine these opinions in a group decisionmaking context.Our results provide a comprehensive comparison of methodologies,highlighting their strengths and limitations in diagnosing diseases based on uncertain patient data.
基金The National Natural Science Foundation of China(No.72071042)。
文摘China’s healthcare system faces increasing challenges,including surging medical costs,resource allocation imbalances favoring large hospitals,and ineffective referral mechanisms.The lack of a unified strategy integrating standardized coverage with personalized payment compounds these issues.To this end,this study proposes a risk-sharing reform strategy that combines equal coverage for the same disease(ECSD)with an individualized out-of-pocket(I-OOP)model.Specifically,the study employs a Markov model to capture patient transitions across health states and care levels.The findings show that ECSD and I-OOP enhance equity by standardizing disease coverage while tailoring costs to patient income and facility type.This approach alleviates demand on high-tier hospitals,promoting primary care utilization and enabling balanced resource distribution.The study’s findings provide a reference for policymakers and healthcare administrators by presenting a scalable framework that is aligned with China’s development goals with the aim of fostering an efficient,sustainable healthcare system that is adaptable to regional needs.
文摘BACKGROUND Understanding a patient's clinical status and setting priorities for their care are two aspects of the constantly changing process of clinical decision-making.One analytical technique that can be helpful in uncertain situations is clinical judgment.Clinicians must deal with contradictory information,lack of time to make decisions,and long-term factors when emergencies occur.AIM To examine the ethical issues healthcare professionals faced during the coronavirus disease 2019(COVID-19)pandemic and the factors affecting clinical decision-making.METHODS This pilot study,which means it was a preliminary investigation to gather information and test the feasibility of a larger investigation was conducted over 6 months and we invited responses from clinicians worldwide who managed patients with COVID-19.The survey focused on topics related to their professional roles and personal relationships.We examined five core areas influencing critical care decision-making:Patients'personal factors,family-related factors,informed consent,communication and media,and hospital administrative policies on clinical decision-making.The collected data were analyzed using the χ^(2) test for categorical variables.RESULTS A total of 102 clinicians from 23 specialties and 17 countries responded to the survey.Age was a significant factor in treatment planning(n=88)and ventilator access(n=78).Sex had no bearing on how decisions were made.Most doctors reported maintaining patient confidentiality regarding privacy and informed consent.Approximately 50%of clinicians reported a moderate influence of clinical work,with many citing it as one of the most important factors affecting their health and relationships.Clinicians from developing countries had a significantly higher score for considering a patient's financial status when creating a treatment plan than their counterparts from developed countries.Regarding personal experiences,some respondents noted that treatment plans and preferences changed from wave to wave,and that there was a rapid turnover of studies and evidence.Hospital and government policies also played a role in critical decision-making.Rather than assessing the appropriateness of treatment,some doctors observed that hospital policies regarding medications were driven by patient demand.CONCLUSION Factors other than medical considerations frequently affect management choices.The disparity in treatment choices,became more apparent during the pandemic.We highlight the difficulties and contradictions between moral standards and the realities physicians encountered during this medical emergency.False information,large patient populations,and limited resources caused problems for clinicians.These factors impacted decision-making,which,in turn,affected patient care and healthcare staff well-being.
文摘The COVID-19 pandemic,as a global public health crisis,has had profound and lasting effects on the world economy and social operating models,fundamentally changing individuals',enterprises',and governments'perceptions of risk and risk management paradigms.The Chinese insurance industry has experienced short-term pain due to the impact of the pandemic,but in the long term,the pandemic has served as a"catalyst"and"accelerator"for the industry's development,greatly enhancing societal awareness of risk protection and,with unprecedented strength,promoting the industry's digital revolution and supply-side structural reform.This article aims to conduct a comprehensive and systematic analysis of the macro environment,technological background,and demand changes faced by the Chinese insurance industry in the post-pandemic era,and to deeply explore the historical opportunities inherent in key areas such as health insurance,pension insurance,digital transformation,and green insurance.Additionally,this article will objectively examine the severe challenges the industry faces in the sustainability of profit models,structural mismatches in supply and demand,rebuilding trust systems,new risk management,and regulatory adaptation.Lastly,based on the above analysis,this article will propose strategic pathways and policy recommendations from three levels:national policy,industry regulation,and corporate strategy to promote the high-quality and sustainable development of the Chinese insurance industry,better serving the needs of national governance modernization and the well-being of the people.
文摘As a city-customized supplementary medical insurance bridging basic medical insurance and commercial health insurance,Huimin Insurance has expanded to 30 provinces and served 168 million people within four years,emerging as a phenomenal success in China's inclusive insurance landscape.This paper examines its evolution,operational mechanisms,and effectiveness,identifying core challenges including declining participation and renewal rates,adverse selection,uneven benefit compensation,and insufficient information disclosure.It proposes sustainable development pathways across five dimensions:government role,financing and payment,product stratification,service value-added,and technology empowerment.The study demonstrates that the future of Huimin Insurance will likely evolve towards a model characterized by provincial-level co-ordination,stratified benefit design,dynamic pricing,and integrated health management.Its success or failure will ultimately determine the integration depth of China's multi-tiered medical security system and significantly impact the realization of common prosperity goals.
文摘In this article,we comment on the work put forth by Wu et al regarding the investigation of oesophageal cancer-specific mortality for a cohort of patients from Chongqing University Cancer Hospital.We specifically focused on the implications of public health plans such as Urban Employee Basic Medical Insurance(UEBMI)and Urban Resident Basic Medical Insurance as well as out-of-pocket ratios on patient treatment plans regarding whether they pursue surgical interventions or therapeutic treatments such as chemotherapy.While Wu et al put forth potential explanations for why patients with the UEBMI plan surprisingly had a 23.30%increased risk of oesophageal cancer-specific death,more analysis is needed to alleviate cancer burden within this group.Although it is likely that patients covered by Urban Resident Basic Medical Insurance and higher out-ofpocket ratios have stronger self-recovery awareness,more work must be done to improve outcomes for people with the UEBMI plan while simultaneously implementing international and domestic initiatives to better emphasize cancer prevention and early detection.Lastly,future research must explore the relationship between Serious Illness Medical Insurance as well as the New Rural Cooperative Medical System on the mortality rate of oesophageal cancer patients in rural China,where disease burden is significantly higher than urban areas.By unifying these public health insurance schemes,officials can significantly alleviate economic burden of treatment and better prognosis for patients with oesophageal cancer.
文摘With the rapid development of China's insurance market,the high-quality development of the insurance market is faced with many different challenges and various problems.This paper aims to deeply analyze the actual problems in China's insurance market and put forward supporting countermeasures.First,by understanding the background of highquality insurance development,we can explain the research significance of this paper in combination with the existing national policies.Secondly,by summarizing the current situation of high-quality insurance development,the paper puts forward the shortage of insurance talents in the expansion of insurance scale,the continuous improvement of insurance density and depth,and the growth of insurance compensation in the development of high-quality insurance.Finally,from the perspective of differentiated customized insurance products,training professionals,and providing financial subsidies,we will put forward the corresponding suggestions for the problem and look forward to the future development prospects.
文摘Marxist and social science methodologies provide scientific conceptual tools and analytical perspectives for research across various disciplines.Among these,the methodology of quantitative and qualitative changes reveals the fundamental laws governing the development of things,offering significant guidance for exploring the relationship between Huimin Insurance and basic medical insurance,and for promoting the sustainable development of the medical security system.Based on this methodology and the practical context of the medical security field,this paper provides an in-depth analysis of the impact of Huimin Insurance on the sustainable development of basic medical insurance.
文摘The purpose of this paper is to study the influencing factors of flexible employment personnel's participation in urban-rural residents'pension insurance.After reading a large number of literature and research results on flexible employment personnel and analyzing and interpreting the urban-rural residents'pension insurance policy of Zhuhai,we take the flexible employment personnel of Zhuhai City as the object of the study,combined with questionnaire survey method,and analyze the difficulties of the flexible employment personnel's participation in the insurance by analyzing the collected data,and find out that Zhuhai's flexibly employed people have cognitive bias towards urban and rural residents'pension insurance,the government's business personnel have a vague understanding of the insurance,and some of the flexibly employed people think that the subsidy is low,etc.The government of Zhuhai City has provided the suggestions of expanding the scope of the publicity of the urban and rural residents'pension insurance,increasing publicity efforts,and providing regular training for the counterpart service personnel in order to increase the rate of the flexibly employed people's participation in the insurance,and improve the inherent bad impression of the insurance by the flexibly employed people.personnel's inherent bad impression of insurance,and further improve China's insurance system.
基金Supported by Chongqing Social Science Planning Project(Doctoral Project)"Research Support on the Impact of Policy-based Agricultural Insurance on the Production Behavior of Chinese Farmers"(2020BS39).
文摘This article investigates the development process and current status of policy-based agricultural insurance in Chongqing.Based on recent data-including premium income,compensation amounts,the number of insured households,and insurance penetration,the article analyzes the primary challenges faced in the system's operation and proposes recommendations from two dimensions:institutional optimization and practical interventions.These recommendations include establishing a differentiated participation incentive mechanism,optimizing the composition of insurance products,enhancing risk diversification and reinsurance systems,creating an agricultural disaster risk reserve fund,developing a dynamic fiscal subsidy distribution mechanism based on risk and performance,improving information-sharing platforms,strengthening the rural grassroots power grid infrastructure,and accelerating the adoption of modern technologies in underwriting and claims settlement processes.The findings suggest that the coordinated advancement of institutional optimization and technological empowerment can substantially enhance the inclusiveness,sustainability,and operational efficiency of policy-based agricultural insurance in Chongqing,thereby providing substantial support for agricultural modernization and the Rural Revitalization Strategy.
基金Supported by the Chongqing Science and Health Joint Medical Research Project,No.2024MSXM065.
文摘BACKGROUND Oesophageal cancer is a significant health concern worldwide,with high inci-dence and mortality rates.In China,the disease burden is particularly high,accounting for a substantial proportion of oesophageal cancer cases and related deaths worldwide.AIM To explore the relationship between the mortality rate of oesophageal cancer patients and insurance type,out-of-pocket ratio,and the joint effects of insurance type and out-of-pocket ratio.METHODS The χ^(2) test was used to analyze patients’demographic and clinical characteristics.Multivariate logistic regression,the Cox proportional hazard model,and the competitive risk model were used to calculate the cumulative hazard ratios(HRs)of all-cause death and oesophageal cancer-specific death among patients with different types of insurance and out-of-pocket ratios.RESULTS Compared with patients covered by basic medical insurance for urban and rural residents,patients covered by urban employee basic medical insurance for urban workers(UEBMI)had a 23.30%increased risk of oesophageal cancer-specific death[HR=1.233,95%confidence interval(CI):1.093-1.391,P<0.005].Compared with patients in the low out-of-pocket ratio group,patients in the high out-of-pocket ratio group had a 25.80%reduction in the risk of oesophageal cancer-specific death(HR=0.742,95%CI:0.6555-0.84,P<0.005).With each 10%increase in the out-of-pocket ratio,the risk of oesophageal cancer-specific death decreased by 10.10%in patients covered by UEBMI.However,the risk of oesophageal cancer-specific death increased by 26.90%in patients in the high out-of-pocket ratio group.CONCLUSION This study reveals the relationships of the specific mortality rate of patients with oesophageal cancer with the out-of-pocket ratio and medical insurance types as well as their combined effects.This study provides practical suggestions and guidance for the formulation of relevant policies in this area.
文摘Objectives This study aimed to clarify the relationship between the content of proxy decision-making made by families of patients with malignant brain tumors regarding treatment policies and daily care and the cues leading to those decisions.Methods Semi-structured personal interviews were used to collect data.Seven family members of patients with malignant brain tumors were selected to participate in the study by purposive sampling method from June to August 2022 in the Patient Family Association of Japan.Responses were content analyzed to explore the relationship between the content of decisions regarding“treatment policies”and“daily care”and the cues influencing those decisions.Semi-structured interviews were analyzed by using thematic analysis.Results The contents of proxy decisions regarding“treatment policies”included implementation,interruption,and termination of initial treatments,free medical treatments,use of respirators,and end-of-life sedation and included six cues:treatment policies suggested by the primary physician,information and knowledge about the disease and treatment obtained by the family from limited resources,perceived life threat from symptom worsening,words and reactions from the patient regarding treatment,patient’s personality and way of life inferred from their treatment preferences,family’s thoughts and values hoping for better treatment for the patient.Decisions for“daily care”included meal content and methods,excretion,mobility,maintaining cleanliness,rehabilitation,continuation or resignation from work,treatment settings(outpatient or inpatient),and ways to spend time outside and included seven cues:words and thoughts from the patient about their way of life,patient’s reactions and life history inferred from their preferred way of living,things the patient can do to maintain daily life and roles,awareness of the increasing inability to do things in daily life,family’s underlying thoughts and values about how to spend the remaining time,approval from family members regarding the care setting,advice from medical professionals on living at home.Conclusions For“treatment policies,”guidelines from medical professionals were a key cue,while for“daily care,”the small signs from the patients in their daily lives served as cues for proxy decision-making.This may be due to the lack of information available to families and the limited time available for discussion with the patient.Families of patients with malignant brain tumors repeatedly use multiple cues to make proxy decision-making under high uncertainty.Therefore,nurses supporting proxy decision-making should assess the family’s situation and provide cues that facilitate informed and confident decisions.
基金supported by the National Natural Science Foundation of China(Grant no.32101237)the China Postdoctoral Science Foundation(Grant no.2021M691522)+1 种基金the National Key Research and Development Program(Grant no.2022YFC3202104)the Tibet Major Science and Technology Project(Grant no.XZ201901-GA-06).
文摘Group living is widespread across diverse taxa,and the mechanisms underlying collective decision-making in contexts of variable role division are critical for understanding the dynamics of group stability.While studies on collective behavior in small animals such as fish and insects are well-established,similar research on large wild animals remains challenging due to the limited availability of sufficient and systematic field data.Here,we aimed to explore the collective decision-making pattern and its sexual difference for the dimorphic Tibetan antelopes Pantholops hodgsonii(chiru)in Xizang Autonomous Region,China,by analyzing individual leadership distribution,as well as the joining process,considering factors such as calving stages and joining ranks.The distinct correlations of decision participants’ratio with group size and decision duration underscore the trade-off between accuracy and speed in decision-making.Male antelopes display a more democratic decision-making pattern,while females exhibit more prompt responses after calving at an early stage.This study uncovers a partially shared decision-making strategy among Tibetan antelopes,suggesting flexible self-organization in group decision processes aligned with animal life cycle progression.
文摘The article by Wu et al highlights the growing incidence of esophageal tumor patients,particularly in China,where the high frequency and death rate are significant problems.The article also examined the impact of health insurance on treatment availability and patient outcomes,demonstrating that the type of insurance can affect the financial burden on patients.This study investigates the effects of different types of health care coverage,namely Urban Employee Basic Medical Insurance vs Urban-Rural Resident Basic Medical Insurance,and the personal spending ratio on treatment decisions and survival outcomes.The database used is derived from esophageal tumor patient continuation from Chongqing University Hospital in China.A total of 2543 patients were included in the study,allowing for the formation of research cohorts.Patient information included demographic characteristics.The study followed various processes to maintain consistency,including data sources,inclusion and exclusion criteria,follow-up duration,health insurance,and statistical analysis.The average age at diagnosis ranged from 57-74 years,and predominantly included men,married people,and those of Han ethnic background,comprising 2088 and 2519 individuals,respectively.Upon controlling for age,sex,relationship status,country of origin,pathological evaluation,tumor stage,and biochemical indicators,individuals who had Urban Employee Basic Medical Insurance exhibited a higher propensity to opt for radiotherapy,chemotherapy,immunotherapy,and targeted therapy compared to those covered by the Urban-Rural Resident Basic Medical Insurance.During the follow-up phase of the study,a total of 1438 deaths were documented,with 1106 ascribed to esophageal cancer.Additionally,individuals with Urban-Rural Resident Basic Medical Insurance had a significantly elevated risk of esophageal cancer,particularly mortality,compared to those without Urban-Rural Resident Basic Medical Insurance.
基金supported by the Human Resources Development of the Korea Institute of Energy Technology Evaluation and Planning(KETEP)grant funded by the Korea government Ministry of Knowledge Economy(No.RS-2023-00244330)the National Research Foundation of Korea(NRF)grant funded by the Korea government(MSIT)(No.NRF RS-2023-00219052RS-2024-00352587)。
文摘Accurately determining when and what to remanufacture is essential for maximizing the lifecycle value of industrial equipment.However,existing approaches face three significant limitations:(1)reliance on predefined mathematical models that often fail to capture equipment-specific degradation,(2)offline optimization methods that assume access to future data,and(3)the absence of component-level guidance.To address these challenges,we propose a data-driven framework for component-level decision-making.The framework leverages streaming sensor data to predict the remaining useful life(RUL)without relying on mathematical models,employs an online optimization algorithm suitable for practical settings,and,through remanufacturing simulations,provides guidance on which components should be replaced.In a case study on gas-insulated switchgear,the proposed framework achieved RUL prediction performance comparable to an oracle model in an online setting without relying on predefined mathematical models.Furthermore,by employing online optimization,it determined a remanufacturing timing close to the global optimum using only past and current data.In addition,unlike previous studies,the framework enables component-level decision-making,allowing for more detailed and actionable remanufacturing guidance in practical applications.
