Background:Missed clinic appointments negatively impact clinic patient flow and health outcomes of people living with HIV(PLHIV).PLHIV likelihood of missing clinic appointments is associated with direct and indirect e...Background:Missed clinic appointments negatively impact clinic patient flow and health outcomes of people living with HIV(PLHIV).PLHIV likelihood of missing clinic appointments is associated with direct and indirect expenditures made while accessing HIV care.The objective of this study was to examine the relationship between out-of-pocket(OOP)health expenditures and the likelihood of missing appointments.Method:Totally 618 PLHIV older than 18 years attending two HIV care and treatment centres(CTC)in Northern Tanzania were enrolled in the study.Clinic attendance and clinical characteristics were abstracted from medical records.Information on OOP health expenditures,demographics,and socio-economic factors were self-reported by the participants.We used a hurdle model.The first part of the hurdle model assessed the marginal effect of a one Tanzanian Shillings(TZS)increase in OOP health expenditure on the probability of having a missed appointment and the second part assessed the probability of having missed appointments for those who had missed an appointment over the study period.Results:Among these 618 participants,242(39%)had at least one missed clinic appointment in the past year.OOP expenditure was not significantly associated with the number of missed clinic appointments.The median amount of OOP paid was 5100 TZS per visit,about 7%of the median monthly income.Participants who were separated from their partners(adjusted odds ratio[AOR]=1.83,95%confidence interval[CZ]:1.11-8.03)and those aged above 50 years(AOR=2.85,95%CI:1.01-8.03)were significantly associated with missing an appointment.For those who had at least one missed appointment over the study period,the probability of missing a clinic appointment was significantly associated with seeking care in a public CTC(P=0.49,95%CI:0.88-0.09)and aged between>25-35 years(P=0.90,95%CI:0.11-1.69).Conclusion:Interventions focused on improving compliance to clinic appointments should target public CTCs,PLHIV aged between>25-35 years,above 50 years of age and those who are separated from their partners.展开更多
The occurrence of missed appointments from online outpatient bookings significantly hinders the operational efficiency of outpatient services.This study aimed to investigate various factors influencing patients’misse...The occurrence of missed appointments from online outpatient bookings significantly hinders the operational efficiency of outpatient services.This study aimed to investigate various factors influencing patients’missed appointments from online outpatient bookings.Drawing on attribution theory,an empirical analysis was conducted using 382,004 authentic online outpatient appointments.The empirical findings revealed that appointment lead-time,appointment time,weekday appointments,online doctor rating,appointment doctor’s expertise,patient distance,and previous outpatient visit experience significantly influenced patients’missed appointment behaviors from online outpatient bookings.Importantly,previous outpatient experience positively moderated the relationship between the appointment doctor’s expertise and patients’missed-appointment behavior.This study provides insights into the factors influencing patients’missed-appointment behavior from online outpatient bookings.It further offers a theoretical foundation for medical institutions in China to mitigate the likelihood and adverse effects of patients’missed-appointment behavior from online outpatient bookings.展开更多
With the development of information and communication technologies,all public tertiary hospitals in China began to use online outpatient appointment systems.However,the phenomenon of patient no-shows in online outpati...With the development of information and communication technologies,all public tertiary hospitals in China began to use online outpatient appointment systems.However,the phenomenon of patient no-shows in online outpatient appointments is becoming more serious.The objective of this study is to design a prediction model for patient no-shows,thereby assisting hospitals in making relevant decisions,and reducing the probability of patient no-show behavior.We used 382,004 original online outpatient appointment records,and divided the data set into a training set(N_(1)=286,503),and a validation set(N_(2)=95,501).We used machine learning algorithms such as logistic regression,k-nearest neighbor(KNN),boosting,decision tree(DT),random forest(RF)and bagging to design prediction models for patient no-show in online outpatient appointments.The patient no-show rate of online outpatient appointment was 11.1%(N=42,224).From the validation set,bagging had the highest area under the ROC curve and AUC value,which was 0.990,followed by random forest and boosting models,which were 0.987 and 0.976,respectively.In contrast,compared with the previous prediction models,the area under ROC and AUC values of the logistic regression,decision tree,and k-nearest neighbors were lower at 0.597,0.499 and 0.843,respectively.This study demonstrates the possibility of using data from multiple sources to predict patient no-shows.The prediction model results can provide decision basis for hospitals to reduce medical resource waste,develop effective outpatient appointment policies,and optimize operations.展开更多
Objective:Analyze the research hotspots and frontiers of shared outpatient service,and provide a reference for researchers in this field to carry out follow-up research.Methods:Search the Web of Science core collectio...Objective:Analyze the research hotspots and frontiers of shared outpatient service,and provide a reference for researchers in this field to carry out follow-up research.Methods:Search the Web of Science core collection database until 2022 and visually analyzekeywords in this field through CiteSpace5.8.R3 software,Results:A total of 261 iteratures were included.The research focuses mainly on advanced care planning,diabetes care,andgroup prenatal care,The research trend tends to be telemedicine and nursing provided by specialized nurses.Conclusion:Scholars can learn from the research hotspots of foreign shared medical appointments,pay attention to the research trend,expand its application scope in combination with China's national conditions,and further promote thedevelopment of shared medical appointments in China.展开更多
Ubiquitous contamination of the soil environment with volatile organic compounds(VOCs)has raised considerable concerns.However,there is still limited comprehensive surveying of soil VOCs on a national scale.Herein,65 ...Ubiquitous contamination of the soil environment with volatile organic compounds(VOCs)has raised considerable concerns.However,there is still limited comprehensive surveying of soil VOCs on a national scale.Herein,65 species of VOCswere simultaneously determined in surface soil samples collected from 63 chemical industrial parks(CIPs)across China.The results showed that the total VOC concentrations ranged from 7.15 to 1842 ng/g with a mean concentration of 326 ng/g(median:179 ng/g).Benzene homologs and halogenated hydrocarbons were identified as the dominant contaminant groups.Positive correlations between many VOC species indicated that these compounds probably originated from similar sources.Spatially,the hotspots of VOC pollution were located in eastern and southern China.Soils with higher clay content and a higher fraction of total organic carbon(TOC)content were significantly associated with higher soil VOC concentrations.Precipitation reduces the levels of highly water-soluble substances in surface soils.Both positive matrix factorization(PMF)and principal component analysis-multiple linear regression(PCA-MLR)identified a high proportion of industrial sources(PMF:59.2%and PCA-MLR:66.5%)and traffic emission sources(PMF:32.3%and PCA-MLR:33.5%).PMF,which had a higher R^(2) value(0.7892)than PCA-MLR(0.7683),was the preferred model for quantitative source analysis of soil VOCs.The health risk assessment indicated that the non-carcinogenic and carcinogenic risks of VOCs were at acceptable levels.Overall,this study provides valuable data on the occurrence of VOCs in soil from Chinese CIPs,which is essential for a comprehensive understanding of their environmental behavior.展开更多
Background:Telehealth has emerged as a powerful tool for managing chronic diseases and mental health conditions,offering increased access to care and improved patient outcomes.However,inequities in digital connectivit...Background:Telehealth has emerged as a powerful tool for managing chronic diseases and mental health conditions,offering increased access to care and improved patient outcomes.However,inequities in digital connectivity and technological resources have created significant disparities in access to these potentially life-changing services,disproportionately impacting marginalized and minoritized communities across the globe.Methods:Data on 473,716 telehealth encounters occurring between January 1,2022,and June 30,2023 were retrieved from the electronic health records(EHR)system used by University Hospitals.These encounters were classified into three groups:attended,canceled,and no-show.Relative risk was calculated based on age,sex,and race,and a multivariate linear regression was performed with age,sex,and race as inputs,to determine their effect on the encounter outcome.Results:Our analysis identified significant differences in relative risk between demographic groups.Patients 20-39 years of age had a high relative risk of cancellation and no-show,and Black patients demonstrated the highest relative risk for cancellation and no-show.The regression analysis illustrated a statistically significant link between no-shows and patients with a cellular plan with no other internet subscription(p<0.001),smartphone ownership(p<0.001),and not having a computer(p<0.05).Conclusions:This study highlights the clinical repercussions of the digital divide,as patients relying on a mobile phone and data plan to attend telehealth visits were more likely to no-show.Current disparities in digital connectivity for historically marginalized populations heightens the risk of creating a digital underclass.There is evidence this study may be applicable in multiple countries across the world.Further research on the causes of the observed no-shows is necessary to ensure equitable delivery of digital healthcare services.展开更多
In a deeply aging society,the appointed guardianship system,as an important arrangement for the protection of the rights and interests of the elderly,still faces many practical difficulties.Typical examples include:du...In a deeply aging society,the appointed guardianship system,as an important arrangement for the protection of the rights and interests of the elderly,still faces many practical difficulties.Typical examples include:during the decision-making stage of whether to choose appointed guardianship,the lack of professionalism and availability of appointed guardians can easily hinder the elderly from choosing to apply it;during the establishment stage of appointed guardianship,the limited rules related to the appointed guardianship agreement can easily lead to the frustration of the elderly’s subjective will;during the operation stage of appointed guardianship,the insufficient accountability mechanisms for appointed guardians can easily lead to the infringement of the personal or property rights of the elderly.By reflecting on its jurisprudential causes,it can be found that the current law largely ignores the orientation of appointed guardianship as a welfare for the elderly in social law,the concept of substantive equality in the appointed guardianship agreement,and the theoretical attributes of the appointed guardianship as a fiduciary relationship.Therefore,the appointed guardianship system in China should be systematically improved to fully release its institutional potential in the protection of the rights and interests of the elderly based on these jurisprudential principles.In particular,it is possible to consider actively promoting the“trust+appointed guardianship”model and cultivating a team of appointed guardians by the state based on the concept of elderly welfare;strengthening the protection of notarization procedures and the reasonable design of the appointed guardianship agreement based on the concept of substantive equality;and refining the fiduciary standards of appointed guardians and strengthening guardianship supervision based on the nature of fiduciary relationship.展开更多
Background:A better understanding of why HIV-exposed/infected children fail to attend their scheduled follow-up medical appointments for HIV-related care would allow for interventions to enhance the delivery of care.T...Background:A better understanding of why HIV-exposed/infected children fail to attend their scheduled follow-up medical appointments for HIV-related care would allow for interventions to enhance the delivery of care.The aim of this study was to determine characteristics of the caregiver-child dyad(CCD)associated with children’s non-adherence to scheduled follow-up medical appointments in HIV programs in Cameroon.Methods:We conducted a case-control analysis of the usual-care group of CCDs from the MORE CARE trial,in which the effect of mobile phone reminders for HIV-exposed/infected children in attending follow-up appointments was assessed from January to March 2013.For this study,the absence of a child at their appointment was considered a case and the presence of a child at their appointment was defined as a control.We used three multivariate binary logistic regression analyses.The best-fit model was the one which had the smallest chi-square value with the Hosmer-Lemeshow test(HLχ^(2)).Magnitudes of associations were expressed by odds ratio(OR),with a p-value<0.05 considered as statistically significant.Results:We included 30 cases and 31 controls.Our best-fit model which considered the sex of the adults and children separately(HLχ^(2)=3.5)showed that missing scheduled medical appointments was associated with:lack of formal education of the caregiver(OR 29.1,95%CI 1.1-777.0;p=0.044),prolonged time to the next appointment/follow-up(OR[1 week increase]1.4,95%CI 1.03-2.0;p=0.032),and being a female child(OR 5.2,95%CI 1.2-23.1;p=0.032).One model(HLχ^(2)=10.5)revealed that woman-boy pairs adhered less to medical appointments compared to woman-girl pairs(OR 4.9,95%CI 1.05-22.9;p=0.044).Another model(HLχ^(2)=11.1)revealed that man-boy pairs were more likely to attend appointments compared to woman-girl pairs(OR 0.23,95%CI 0.06-0.93;p=0.039).There were no statistical associations for the ages of the children or the caregivers,the study sites,or the HIV status(confirmed vs.suspected)of the children.Conclusion:The profile of children who would not attend follow-up medical appointments in an HIV program was:a female,with a caregiver who has had no formal education,and with a longer follow-up appointment interval.There is a possibility that female children are favored by female caregivers and that male children are favored by male caregivers when they come to medical care.展开更多
Artificial intelligence (AI) is revolutionizing the healthcare sector worldwide. In Morocco, several AI applications are being deployed in public and private healthcare establishments, improving appointment management...Artificial intelligence (AI) is revolutionizing the healthcare sector worldwide. In Morocco, several AI applications are being deployed in public and private healthcare establishments, improving appointment management, surgical operations, diagnostics, patient record tracking, biology and radiology, and OR organization. This article explores the main AI applications used in the Moroccan healthcare sector, their frequency of use, the types of establishments adopting them, as well as the main functionalities of each application and its contribution to the sector. The aim of this study is to analyze the impact of the main AI applications on quality of care and process efficiency in Moroccan healthcare facilities. This research focuses on several fundamental questions: Which AI applications are most frequently used? What types of establishments are adopting these technologies, and for which specific functionalities? What are the benefits and challenges of integrating AI into the Moroccan healthcare system, particularly in terms of territorial distribution and accessibility? The methodology is based on a quantitative analysis of data collected from selected healthcare establishments, combined with studies of reports from public health authorities and a sweep of their websites. The results show that 45% of hospitals use AI systems for appointment scheduling and 30% for medical diagnosis. The use of surgical robots, such as the Da Vinci system, increased by 30% between 2020 and 2024. Comparisons with other emerging countries highlight Morocco’s acceptable advances, while underlining the challenges, particularly in terms of the territorial distribution of these technological infrastructures generally centralized in the country’s major cities.展开更多
To gain a comprehensive understanding of sources and health risks of trace elements in an area of China with high population densities and low PM_(2.5)concentrations,15 trace elements(Al,K,Ca,Ti,V,Cr,Mn,Fe,Ni,Cu,Zn,As...To gain a comprehensive understanding of sources and health risks of trace elements in an area of China with high population densities and low PM_(2.5)concentrations,15 trace elements(Al,K,Ca,Ti,V,Cr,Mn,Fe,Ni,Cu,Zn,As,Sn,Ba,Pb)in PM_(2.5)were monitored from December 2020 to November 2021 in a representative city,Xiamen.The concentrations of trace elements in Xiamen displayed an obvious seasonal variation and were dominated by K,Fe,Al,Ca and Zn.Based on Positive Matrix Factorization analysis,source appointment revealed that the major sources of trace elements in Xiamen were traffic,dust,biomass and firework combustion,industrial manufacture and shipping emission.According to health risk assessment combined with the source appointment results,it indicated that the average noncarcinogenic risk was below the threshold and cancer risk of four hazardous metals(Cr,Ni,As,Pb)exceeded the threshold(10^(-6)).Traffic-related source had almost half amount of contribution to the health risk induced by PM_(2.5)-bound trace elements.During the dust transport period or Spring Festival period,the health risks exceeded an acceptable threshold even an order of magnitude higher,suggesting that the serious health risks still existed in low PM_(2.5)environment at certain times.Health risk assessment reminded that the health risk reduction in PM_(2.5)at southeastern China should prioritize traffic-related hazardous trace elements and highlighted the importance of controlling vehicles emissions in the future.展开更多
We conducted a simultaneous field study of PM_(2.5)-bound particulate polycyclic aromatic hydrocarbons(PAHs)and aromatic acids(AAs)in a polluted city Zhengzhou to explore the concentration,sources and potential conver...We conducted a simultaneous field study of PM_(2.5)-bound particulate polycyclic aromatic hydrocarbons(PAHs)and aromatic acids(AAs)in a polluted city Zhengzhou to explore the concentration,sources and potential conversion pathways between PAHs and AAs in different seasons.The average concentrations of PM_(2.5),28PAHs and 8AAs during the sampling period were 77μg/m^(3),75 ng/m^(3),and 283 ng/m^(3),respectively.The concentration of both28PAHs and 8AAs were highest in winter and lowest in summer with ratios of 6.3 and 2.3,respectively.PAHs with 5-7 rings were the main components of PAHs(52%),followed by 4rings PAHs(30%)and 2-3 rings PAHs(18%).According to the source appointment results obtained by positive matrix factorization,the main sources of PAHs were combustion and vehicle emissions,which account for 37%and 34%,respectively.8AAs were divided into three groups,including four benzene dicarboxylic acids(B2CAs),three benzene tricarboxylic acids(B3CAs)and one benzene tetracarboxylic acid(B4CA).And interspecies correlation analysis with PM_(2.5)source markers were used to investigate potential sources.Phthalic acid(o-Ph)was the most abundant specie of 8AAs(157 ng/m^(3),55%of 8AAs),which was well correlated with sulfate.Meanwhile,B3CAs and B4CA were highly correlated with sulfate and weakly correlated with levoglucosan,suggesting that secondary formation was their main source.As logical oxidation products of PAHs,o-Ph and B3CAs showed good correlations with a number of PAHs,indicating possible photochemical oxidation pathway by PAHs.In addition,O_(3),NO_(2),temperature and relative humidity have positive effects on the secondary formation of B3CAs.展开更多
Objective:To explore the effectiveness of the competency model for nursing managers in the training of newly appointed head nurses.Methods:Eighteen newly appointed head nurses from Yichang Central People’s Hospital,s...Objective:To explore the effectiveness of the competency model for nursing managers in the training of newly appointed head nurses.Methods:Eighteen newly appointed head nurses from Yichang Central People’s Hospital,selected between August 2023 and July 2024,were chosen as the research subjects.Based on the nursing manager competency model,corresponding training programs were developed,and these 18 head nurses were trained accordingly.Results:After the training,all newly appointed head nurses passed the theoretical assessments,with a pass rate of 100.00%.The pass rates for two rounds of assessment were 100.00%and 94.54%,respectively.There was no significant difference in the performance evaluation scores between new and senior head nurses in terms of standardized services,nursing quality,nursing research and teaching,and patient satisfaction(P>0.05).Conclusion:The competency model for nursing managers has a significant effect on the training of newly appointed head nurses.It effectively enhances management awareness,facilitates role transition,and,to some extent,improves the management and leadership capabilities of head nurses.It holds high value for broader implementation.展开更多
Objectives: While the value of glycemic control to minimize adverse health outcomes among patients with diabetes is clear, achieving hemoglobin A1c (A1c) goals remain a challenge. We evaluated the use of financial inc...Objectives: While the value of glycemic control to minimize adverse health outcomes among patients with diabetes is clear, achieving hemoglobin A1c (A1c) goals remain a challenge. We evaluated the use of financial incentives to increase enrollment and improve glycemic control among patients invited to participate in a monthly diabetes group appointment (DGA) as part of their enrollment in DaVita HealthCare Partners, a large southern California managed care organization. Methods: Adult diabetes patients (≥18 years) with a currently uncontrolled hemoglobin A1c level (>8.0% if 9.0% if ≥ 65 years) were randomized to 1) no DGA, 2) DGA with no financial incentives (non-incentive DGA) or 3) DGA with financial incentives (incentive DGA). Results: Nine sites among four regions of the greater Los Angeles area participated. Each site offered one non-incentive DGA and one incentive DGA. Over 1500 patients were identified for recruitment and at the peak of enrollment, 299 patients were enrolled in 18 DGAs. On average, hemoglobin A1c values dropped more for patients participating in the incentive DGA (9.9% to 8.7%, -1.2%) versus non-incentive DGA (9.7% to 9.0%, -0.7%) versus no DGA group (9.1% to 8.7%, -0.4%). Several unexpected implementation challenges arose which complicated evaluation but provide important learning lessons. Conclusions: Management of chronic diseases like diabetes is challenging for patients and the primary care system alike. Continuing to implement and evaluate programs under “real-world” conditions can provide further insight into how best to support patients with diabetes and their primary care teams in order to achieve glycemic control and avoid preventable complications.展开更多
Introduction: Telemedicine has been used as a tool for improving access to health services worldwide. The aim of the present study is thus to evaluate the effectiveness of urological consultation by videoconference, p...Introduction: Telemedicine has been used as a tool for improving access to health services worldwide. The aim of the present study is thus to evaluate the effectiveness of urological consultation by videoconference, perceptions regarding safety on the part of medical teams providing video consultation services and patient satisfaction after a urological appointment. Materials and Methods: A cross-sectional, observational, and analytical study was carried out with 50 volunteers referred from the basic health unit for a urology appointment. All patients were evaluated remotely by videoconference and in person by different urology teams. Results: The study revealed that effectiveness in terms of the degree of match between diagnoses performed by video consultation and those performed in person was 92%. The urology team’s perception regarding safety, measured using an in-house safety questionnaire, was high for both videoconferencing and in-person consultations and there was no statistical difference between the two (overall safety score for video consultation compared to in-person consultation was 9.7 ± 0.8 compared to 9.6 ± 0.8 and the p-value was 0.3 for Student’s t-test). Patient satisfaction with the appointment was similarly high for both groups, averaging 9.72 ± 0.4 among patients who attended a video consultation and 9.82 ± 0.4 among those whose consultation was conducted in person, with a p-value of 0.10478 for Student’s t-test. Conclusion: Video consultation in urology is an effective way to perform diagnoses, with high levels of perceived safety among urologists and high satisfaction rates among patients.展开更多
The COVID-19 pandemic has raised awareness about various environmental issues,includ-ing PM_(2.5) pollution.Here,PM_(2.5) pollution during the COVID-19 lockdown was traced and an-alyzed to clarify the sources and fact...The COVID-19 pandemic has raised awareness about various environmental issues,includ-ing PM_(2.5) pollution.Here,PM_(2.5) pollution during the COVID-19 lockdown was traced and an-alyzed to clarify the sources and factors influencing PM_(2.5) in Guangzhou,with an emphasis on heavy pollution.The lockdown led to large reductions in industrial and traffic emissions,which significantly reduced PM_(2.5) concentrations in Guangzhou.Interestingly,the trend of PM_(2.5) concentrations was not consistent with traffic and industrial emissions,as minimum concentrations were observed in the fourth period(3/01-3/31,22.45 μg/m^(3))of the lockdown.However,the concentrations of other gaseous pollutants,e.g.,SO_(2),NO_(2) and CO,were corre-lated with industrial and traffic emissions,and the lowest values were noticed in the sec-ond period(1/24-2/0_(3))of the lockdown.Meteorological correlation analysis revealed that the decreased PM_(2.5) concentrations during COVID-19 can be mainly attributed to decreased in-dustrial and traffic emissions rather than meteorological conditions.When meteorological factors were included in the PM_(2.5) composition and backward trajectory analyses,we found that long-distance transportation and secondary pollution offset the reduction of primary emissions in the second and third stages of the pandemic.Notably,industrial PM_(2.5) emis-sions from western,southern and southeastern Guangzhou play an important role in the formation of heavy pollution events.Our results not only verify the importance of control-ling traffic and industrial emissions,but also provide targets for further improvements in PM_(2.5) pollution.展开更多
An appointment scheduling problem is studied with the consideration of customer impatience.On the assumption that both the time of leaving queue and the time of service are exponentially distributed,in order to minimi...An appointment scheduling problem is studied with the consideration of customer impatience.On the assumption that both the time of leaving queue and the time of service are exponentially distributed,in order to minimize the joint cost,the optimal appointment schedule of the fixed number of customers is studied.The joint cost function is composed of customers expected delay time and service availability time.The expected delay time of each customer in the queue is recursively computed in terms of customer interarrival time.Furthermore,the effect of impatience on the optimal schedule as well as the total operating cost is studied.The results show that as the impatience rate increases,the optimal interarrival time becomes shorter and the interarrival time of the last few customers gradually approaches that of the customers in the middle.In addition,impatient behaviors can increase the joint cost.展开更多
大多数形容词,具有三种主要用法:作前置定语、后置定语和表语。一般来说,作前置定语的形容词表示限制意义,作后置定语或表语的形容词表示描绘意义,有时同一个形容词在不同的位置上具有不同的词义。本文试结合一些常见的形容词来说明其...大多数形容词,具有三种主要用法:作前置定语、后置定语和表语。一般来说,作前置定语的形容词表示限制意义,作后置定语或表语的形容词表示描绘意义,有时同一个形容词在不同的位置上具有不同的词义。本文试结合一些常见的形容词来说明其位置对意义的影响。 1.alive (1)作前置定语时作“active,fuul of life”展开更多
Prof.James M.Tiedje,University Distinguished Professor and Director of the Center for Microbial Ecology at Michigan State University,Academician of the American Academy of Sciences,has been appointed as an Honorary Ed...Prof.James M.Tiedje,University Distinguished Professor and Director of the Center for Microbial Ecology at Michigan State University,Academician of the American Academy of Sciences,has been appointed as an Honorary Editor-in-Chief of Pedosphere.Prof.展开更多
基金support from the US National Institutes of Health D43 TW009595 and P30 AI064518 programsCharles Muiruri was supported by the National Heart,Lung,And Blood Institute of the National Institutes of Health trader Award U01HL142099.
文摘Background:Missed clinic appointments negatively impact clinic patient flow and health outcomes of people living with HIV(PLHIV).PLHIV likelihood of missing clinic appointments is associated with direct and indirect expenditures made while accessing HIV care.The objective of this study was to examine the relationship between out-of-pocket(OOP)health expenditures and the likelihood of missing appointments.Method:Totally 618 PLHIV older than 18 years attending two HIV care and treatment centres(CTC)in Northern Tanzania were enrolled in the study.Clinic attendance and clinical characteristics were abstracted from medical records.Information on OOP health expenditures,demographics,and socio-economic factors were self-reported by the participants.We used a hurdle model.The first part of the hurdle model assessed the marginal effect of a one Tanzanian Shillings(TZS)increase in OOP health expenditure on the probability of having a missed appointment and the second part assessed the probability of having missed appointments for those who had missed an appointment over the study period.Results:Among these 618 participants,242(39%)had at least one missed clinic appointment in the past year.OOP expenditure was not significantly associated with the number of missed clinic appointments.The median amount of OOP paid was 5100 TZS per visit,about 7%of the median monthly income.Participants who were separated from their partners(adjusted odds ratio[AOR]=1.83,95%confidence interval[CZ]:1.11-8.03)and those aged above 50 years(AOR=2.85,95%CI:1.01-8.03)were significantly associated with missing an appointment.For those who had at least one missed appointment over the study period,the probability of missing a clinic appointment was significantly associated with seeking care in a public CTC(P=0.49,95%CI:0.88-0.09)and aged between>25-35 years(P=0.90,95%CI:0.11-1.69).Conclusion:Interventions focused on improving compliance to clinic appointments should target public CTCs,PLHIV aged between>25-35 years,above 50 years of age and those who are separated from their partners.
文摘The occurrence of missed appointments from online outpatient bookings significantly hinders the operational efficiency of outpatient services.This study aimed to investigate various factors influencing patients’missed appointments from online outpatient bookings.Drawing on attribution theory,an empirical analysis was conducted using 382,004 authentic online outpatient appointments.The empirical findings revealed that appointment lead-time,appointment time,weekday appointments,online doctor rating,appointment doctor’s expertise,patient distance,and previous outpatient visit experience significantly influenced patients’missed appointment behaviors from online outpatient bookings.Importantly,previous outpatient experience positively moderated the relationship between the appointment doctor’s expertise and patients’missed-appointment behavior.This study provides insights into the factors influencing patients’missed-appointment behavior from online outpatient bookings.It further offers a theoretical foundation for medical institutions in China to mitigate the likelihood and adverse effects of patients’missed-appointment behavior from online outpatient bookings.
基金National Natural Science Foundation Program of China[No.71971092],[No.71671073]and[71810107003].
文摘With the development of information and communication technologies,all public tertiary hospitals in China began to use online outpatient appointment systems.However,the phenomenon of patient no-shows in online outpatient appointments is becoming more serious.The objective of this study is to design a prediction model for patient no-shows,thereby assisting hospitals in making relevant decisions,and reducing the probability of patient no-show behavior.We used 382,004 original online outpatient appointment records,and divided the data set into a training set(N_(1)=286,503),and a validation set(N_(2)=95,501).We used machine learning algorithms such as logistic regression,k-nearest neighbor(KNN),boosting,decision tree(DT),random forest(RF)and bagging to design prediction models for patient no-show in online outpatient appointments.The patient no-show rate of online outpatient appointment was 11.1%(N=42,224).From the validation set,bagging had the highest area under the ROC curve and AUC value,which was 0.990,followed by random forest and boosting models,which were 0.987 and 0.976,respectively.In contrast,compared with the previous prediction models,the area under ROC and AUC values of the logistic regression,decision tree,and k-nearest neighbors were lower at 0.597,0.499 and 0.843,respectively.This study demonstrates the possibility of using data from multiple sources to predict patient no-shows.The prediction model results can provide decision basis for hospitals to reduce medical resource waste,develop effective outpatient appointment policies,and optimize operations.
文摘Objective:Analyze the research hotspots and frontiers of shared outpatient service,and provide a reference for researchers in this field to carry out follow-up research.Methods:Search the Web of Science core collection database until 2022 and visually analyzekeywords in this field through CiteSpace5.8.R3 software,Results:A total of 261 iteratures were included.The research focuses mainly on advanced care planning,diabetes care,andgroup prenatal care,The research trend tends to be telemedicine and nursing provided by specialized nurses.Conclusion:Scholars can learn from the research hotspots of foreign shared medical appointments,pay attention to the research trend,expand its application scope in combination with China's national conditions,and further promote thedevelopment of shared medical appointments in China.
基金supported by the Medical and Health Projects in Zhejiang Province(No.2022PY049)the Basic Scientific Research Project of Hangzhou Medical College(No.YS2021006)Key Discipline of Zhejiang Province in Public Health and Preventive Medicine(First Class,Category A),Hangzhou Medical College.
文摘Ubiquitous contamination of the soil environment with volatile organic compounds(VOCs)has raised considerable concerns.However,there is still limited comprehensive surveying of soil VOCs on a national scale.Herein,65 species of VOCswere simultaneously determined in surface soil samples collected from 63 chemical industrial parks(CIPs)across China.The results showed that the total VOC concentrations ranged from 7.15 to 1842 ng/g with a mean concentration of 326 ng/g(median:179 ng/g).Benzene homologs and halogenated hydrocarbons were identified as the dominant contaminant groups.Positive correlations between many VOC species indicated that these compounds probably originated from similar sources.Spatially,the hotspots of VOC pollution were located in eastern and southern China.Soils with higher clay content and a higher fraction of total organic carbon(TOC)content were significantly associated with higher soil VOC concentrations.Precipitation reduces the levels of highly water-soluble substances in surface soils.Both positive matrix factorization(PMF)and principal component analysis-multiple linear regression(PCA-MLR)identified a high proportion of industrial sources(PMF:59.2%and PCA-MLR:66.5%)and traffic emission sources(PMF:32.3%and PCA-MLR:33.5%).PMF,which had a higher R^(2) value(0.7892)than PCA-MLR(0.7683),was the preferred model for quantitative source analysis of soil VOCs.The health risk assessment indicated that the non-carcinogenic and carcinogenic risks of VOCs were at acceptable levels.Overall,this study provides valuable data on the occurrence of VOCs in soil from Chinese CIPs,which is essential for a comprehensive understanding of their environmental behavior.
文摘Background:Telehealth has emerged as a powerful tool for managing chronic diseases and mental health conditions,offering increased access to care and improved patient outcomes.However,inequities in digital connectivity and technological resources have created significant disparities in access to these potentially life-changing services,disproportionately impacting marginalized and minoritized communities across the globe.Methods:Data on 473,716 telehealth encounters occurring between January 1,2022,and June 30,2023 were retrieved from the electronic health records(EHR)system used by University Hospitals.These encounters were classified into three groups:attended,canceled,and no-show.Relative risk was calculated based on age,sex,and race,and a multivariate linear regression was performed with age,sex,and race as inputs,to determine their effect on the encounter outcome.Results:Our analysis identified significant differences in relative risk between demographic groups.Patients 20-39 years of age had a high relative risk of cancellation and no-show,and Black patients demonstrated the highest relative risk for cancellation and no-show.The regression analysis illustrated a statistically significant link between no-shows and patients with a cellular plan with no other internet subscription(p<0.001),smartphone ownership(p<0.001),and not having a computer(p<0.05).Conclusions:This study highlights the clinical repercussions of the digital divide,as patients relying on a mobile phone and data plan to attend telehealth visits were more likely to no-show.Current disparities in digital connectivity for historically marginalized populations heightens the risk of creating a digital underclass.There is evidence this study may be applicable in multiple countries across the world.Further research on the causes of the observed no-shows is necessary to ensure equitable delivery of digital healthcare services.
基金the National Social Science Fund of China Youth Project“Research on the Application Dilemma and Solutions of the Appointed Guardianship Clauses in the Civil Code”(Project Approval Number 20CFX075).
文摘In a deeply aging society,the appointed guardianship system,as an important arrangement for the protection of the rights and interests of the elderly,still faces many practical difficulties.Typical examples include:during the decision-making stage of whether to choose appointed guardianship,the lack of professionalism and availability of appointed guardians can easily hinder the elderly from choosing to apply it;during the establishment stage of appointed guardianship,the limited rules related to the appointed guardianship agreement can easily lead to the frustration of the elderly’s subjective will;during the operation stage of appointed guardianship,the insufficient accountability mechanisms for appointed guardians can easily lead to the infringement of the personal or property rights of the elderly.By reflecting on its jurisprudential causes,it can be found that the current law largely ignores the orientation of appointed guardianship as a welfare for the elderly in social law,the concept of substantive equality in the appointed guardianship agreement,and the theoretical attributes of the appointed guardianship as a fiduciary relationship.Therefore,the appointed guardianship system in China should be systematically improved to fully release its institutional potential in the protection of the rights and interests of the elderly based on these jurisprudential principles.In particular,it is possible to consider actively promoting the“trust+appointed guardianship”model and cultivating a team of appointed guardians by the state based on the concept of elderly welfare;strengthening the protection of notarization procedures and the reasonable design of the appointed guardianship agreement based on the concept of substantive equality;and refining the fiduciary standards of appointed guardians and strengthening guardianship supervision based on the nature of fiduciary relationship.
文摘Background:A better understanding of why HIV-exposed/infected children fail to attend their scheduled follow-up medical appointments for HIV-related care would allow for interventions to enhance the delivery of care.The aim of this study was to determine characteristics of the caregiver-child dyad(CCD)associated with children’s non-adherence to scheduled follow-up medical appointments in HIV programs in Cameroon.Methods:We conducted a case-control analysis of the usual-care group of CCDs from the MORE CARE trial,in which the effect of mobile phone reminders for HIV-exposed/infected children in attending follow-up appointments was assessed from January to March 2013.For this study,the absence of a child at their appointment was considered a case and the presence of a child at their appointment was defined as a control.We used three multivariate binary logistic regression analyses.The best-fit model was the one which had the smallest chi-square value with the Hosmer-Lemeshow test(HLχ^(2)).Magnitudes of associations were expressed by odds ratio(OR),with a p-value<0.05 considered as statistically significant.Results:We included 30 cases and 31 controls.Our best-fit model which considered the sex of the adults and children separately(HLχ^(2)=3.5)showed that missing scheduled medical appointments was associated with:lack of formal education of the caregiver(OR 29.1,95%CI 1.1-777.0;p=0.044),prolonged time to the next appointment/follow-up(OR[1 week increase]1.4,95%CI 1.03-2.0;p=0.032),and being a female child(OR 5.2,95%CI 1.2-23.1;p=0.032).One model(HLχ^(2)=10.5)revealed that woman-boy pairs adhered less to medical appointments compared to woman-girl pairs(OR 4.9,95%CI 1.05-22.9;p=0.044).Another model(HLχ^(2)=11.1)revealed that man-boy pairs were more likely to attend appointments compared to woman-girl pairs(OR 0.23,95%CI 0.06-0.93;p=0.039).There were no statistical associations for the ages of the children or the caregivers,the study sites,or the HIV status(confirmed vs.suspected)of the children.Conclusion:The profile of children who would not attend follow-up medical appointments in an HIV program was:a female,with a caregiver who has had no formal education,and with a longer follow-up appointment interval.There is a possibility that female children are favored by female caregivers and that male children are favored by male caregivers when they come to medical care.
文摘Artificial intelligence (AI) is revolutionizing the healthcare sector worldwide. In Morocco, several AI applications are being deployed in public and private healthcare establishments, improving appointment management, surgical operations, diagnostics, patient record tracking, biology and radiology, and OR organization. This article explores the main AI applications used in the Moroccan healthcare sector, their frequency of use, the types of establishments adopting them, as well as the main functionalities of each application and its contribution to the sector. The aim of this study is to analyze the impact of the main AI applications on quality of care and process efficiency in Moroccan healthcare facilities. This research focuses on several fundamental questions: Which AI applications are most frequently used? What types of establishments are adopting these technologies, and for which specific functionalities? What are the benefits and challenges of integrating AI into the Moroccan healthcare system, particularly in terms of territorial distribution and accessibility? The methodology is based on a quantitative analysis of data collected from selected healthcare establishments, combined with studies of reports from public health authorities and a sweep of their websites. The results show that 45% of hospitals use AI systems for appointment scheduling and 30% for medical diagnosis. The use of surgical robots, such as the Da Vinci system, increased by 30% between 2020 and 2024. Comparisons with other emerging countries highlight Morocco’s acceptable advances, while underlining the challenges, particularly in terms of the territorial distribution of these technological infrastructures generally centralized in the country’s major cities.
基金supported by the National Natural Science Foundation of China(No.U22A20578)the Science and Technology Department of Fujian Province(No.2022L3025)+3 种基金the Center for Excellence in Regional Atmospheric Environment Project(No.E0L1B20201)the Chaozhou Science and Technology Plan Project(No.2018GY03)Xiamen Atmospheric Environment Observation and Research Station of Fujian ProvinceFujian Key Laboratory of Atmospheric Ozone Pollution Prevention(Institute of Urban Environment,Chinese Academy of Sciences)。
文摘To gain a comprehensive understanding of sources and health risks of trace elements in an area of China with high population densities and low PM_(2.5)concentrations,15 trace elements(Al,K,Ca,Ti,V,Cr,Mn,Fe,Ni,Cu,Zn,As,Sn,Ba,Pb)in PM_(2.5)were monitored from December 2020 to November 2021 in a representative city,Xiamen.The concentrations of trace elements in Xiamen displayed an obvious seasonal variation and were dominated by K,Fe,Al,Ca and Zn.Based on Positive Matrix Factorization analysis,source appointment revealed that the major sources of trace elements in Xiamen were traffic,dust,biomass and firework combustion,industrial manufacture and shipping emission.According to health risk assessment combined with the source appointment results,it indicated that the average noncarcinogenic risk was below the threshold and cancer risk of four hazardous metals(Cr,Ni,As,Pb)exceeded the threshold(10^(-6)).Traffic-related source had almost half amount of contribution to the health risk induced by PM_(2.5)-bound trace elements.During the dust transport period or Spring Festival period,the health risks exceeded an acceptable threshold even an order of magnitude higher,suggesting that the serious health risks still existed in low PM_(2.5)environment at certain times.Health risk assessment reminded that the health risk reduction in PM_(2.5)at southeastern China should prioritize traffic-related hazardous trace elements and highlighted the importance of controlling vehicles emissions in the future.
基金supported by the Natural Science Foundation of Henan Province(No.232300421395)the National Key Research and Development Program of China(No.2017YFC0212400)。
文摘We conducted a simultaneous field study of PM_(2.5)-bound particulate polycyclic aromatic hydrocarbons(PAHs)and aromatic acids(AAs)in a polluted city Zhengzhou to explore the concentration,sources and potential conversion pathways between PAHs and AAs in different seasons.The average concentrations of PM_(2.5),28PAHs and 8AAs during the sampling period were 77μg/m^(3),75 ng/m^(3),and 283 ng/m^(3),respectively.The concentration of both28PAHs and 8AAs were highest in winter and lowest in summer with ratios of 6.3 and 2.3,respectively.PAHs with 5-7 rings were the main components of PAHs(52%),followed by 4rings PAHs(30%)and 2-3 rings PAHs(18%).According to the source appointment results obtained by positive matrix factorization,the main sources of PAHs were combustion and vehicle emissions,which account for 37%and 34%,respectively.8AAs were divided into three groups,including four benzene dicarboxylic acids(B2CAs),three benzene tricarboxylic acids(B3CAs)and one benzene tetracarboxylic acid(B4CA).And interspecies correlation analysis with PM_(2.5)source markers were used to investigate potential sources.Phthalic acid(o-Ph)was the most abundant specie of 8AAs(157 ng/m^(3),55%of 8AAs),which was well correlated with sulfate.Meanwhile,B3CAs and B4CA were highly correlated with sulfate and weakly correlated with levoglucosan,suggesting that secondary formation was their main source.As logical oxidation products of PAHs,o-Ph and B3CAs showed good correlations with a number of PAHs,indicating possible photochemical oxidation pathway by PAHs.In addition,O_(3),NO_(2),temperature and relative humidity have positive effects on the secondary formation of B3CAs.
文摘Objective:To explore the effectiveness of the competency model for nursing managers in the training of newly appointed head nurses.Methods:Eighteen newly appointed head nurses from Yichang Central People’s Hospital,selected between August 2023 and July 2024,were chosen as the research subjects.Based on the nursing manager competency model,corresponding training programs were developed,and these 18 head nurses were trained accordingly.Results:After the training,all newly appointed head nurses passed the theoretical assessments,with a pass rate of 100.00%.The pass rates for two rounds of assessment were 100.00%and 94.54%,respectively.There was no significant difference in the performance evaluation scores between new and senior head nurses in terms of standardized services,nursing quality,nursing research and teaching,and patient satisfaction(P>0.05).Conclusion:The competency model for nursing managers has a significant effect on the training of newly appointed head nurses.It effectively enhances management awareness,facilitates role transition,and,to some extent,improves the management and leadership capabilities of head nurses.It holds high value for broader implementation.
文摘Objectives: While the value of glycemic control to minimize adverse health outcomes among patients with diabetes is clear, achieving hemoglobin A1c (A1c) goals remain a challenge. We evaluated the use of financial incentives to increase enrollment and improve glycemic control among patients invited to participate in a monthly diabetes group appointment (DGA) as part of their enrollment in DaVita HealthCare Partners, a large southern California managed care organization. Methods: Adult diabetes patients (≥18 years) with a currently uncontrolled hemoglobin A1c level (>8.0% if 9.0% if ≥ 65 years) were randomized to 1) no DGA, 2) DGA with no financial incentives (non-incentive DGA) or 3) DGA with financial incentives (incentive DGA). Results: Nine sites among four regions of the greater Los Angeles area participated. Each site offered one non-incentive DGA and one incentive DGA. Over 1500 patients were identified for recruitment and at the peak of enrollment, 299 patients were enrolled in 18 DGAs. On average, hemoglobin A1c values dropped more for patients participating in the incentive DGA (9.9% to 8.7%, -1.2%) versus non-incentive DGA (9.7% to 9.0%, -0.7%) versus no DGA group (9.1% to 8.7%, -0.4%). Several unexpected implementation challenges arose which complicated evaluation but provide important learning lessons. Conclusions: Management of chronic diseases like diabetes is challenging for patients and the primary care system alike. Continuing to implement and evaluate programs under “real-world” conditions can provide further insight into how best to support patients with diabetes and their primary care teams in order to achieve glycemic control and avoid preventable complications.
文摘Introduction: Telemedicine has been used as a tool for improving access to health services worldwide. The aim of the present study is thus to evaluate the effectiveness of urological consultation by videoconference, perceptions regarding safety on the part of medical teams providing video consultation services and patient satisfaction after a urological appointment. Materials and Methods: A cross-sectional, observational, and analytical study was carried out with 50 volunteers referred from the basic health unit for a urology appointment. All patients were evaluated remotely by videoconference and in person by different urology teams. Results: The study revealed that effectiveness in terms of the degree of match between diagnoses performed by video consultation and those performed in person was 92%. The urology team’s perception regarding safety, measured using an in-house safety questionnaire, was high for both videoconferencing and in-person consultations and there was no statistical difference between the two (overall safety score for video consultation compared to in-person consultation was 9.7 ± 0.8 compared to 9.6 ± 0.8 and the p-value was 0.3 for Student’s t-test). Patient satisfaction with the appointment was similarly high for both groups, averaging 9.72 ± 0.4 among patients who attended a video consultation and 9.82 ± 0.4 among those whose consultation was conducted in person, with a p-value of 0.10478 for Student’s t-test. Conclusion: Video consultation in urology is an effective way to perform diagnoses, with high levels of perceived safety among urologists and high satisfaction rates among patients.
基金This work was supported by the National Natural Science Foundation of China(Nos.21806025 and 91843301)the Natural Science Foundation of Guangdong Province(No.2019A1515011294)+1 种基金the Science and Technology Planning Project of Guangdong Province(No.2020B1212030008)the National Key Research and Development Project(No.2019YFC1804604).
文摘The COVID-19 pandemic has raised awareness about various environmental issues,includ-ing PM_(2.5) pollution.Here,PM_(2.5) pollution during the COVID-19 lockdown was traced and an-alyzed to clarify the sources and factors influencing PM_(2.5) in Guangzhou,with an emphasis on heavy pollution.The lockdown led to large reductions in industrial and traffic emissions,which significantly reduced PM_(2.5) concentrations in Guangzhou.Interestingly,the trend of PM_(2.5) concentrations was not consistent with traffic and industrial emissions,as minimum concentrations were observed in the fourth period(3/01-3/31,22.45 μg/m^(3))of the lockdown.However,the concentrations of other gaseous pollutants,e.g.,SO_(2),NO_(2) and CO,were corre-lated with industrial and traffic emissions,and the lowest values were noticed in the sec-ond period(1/24-2/0_(3))of the lockdown.Meteorological correlation analysis revealed that the decreased PM_(2.5) concentrations during COVID-19 can be mainly attributed to decreased in-dustrial and traffic emissions rather than meteorological conditions.When meteorological factors were included in the PM_(2.5) composition and backward trajectory analyses,we found that long-distance transportation and secondary pollution offset the reduction of primary emissions in the second and third stages of the pandemic.Notably,industrial PM_(2.5) emis-sions from western,southern and southeastern Guangzhou play an important role in the formation of heavy pollution events.Our results not only verify the importance of control-ling traffic and industrial emissions,but also provide targets for further improvements in PM_(2.5) pollution.
基金The National Natural Science Foundation of China(No.71671036)the Scientific Innovation Research of Graduate Students in Jiangsu Province(No.KYLX_0211)
文摘An appointment scheduling problem is studied with the consideration of customer impatience.On the assumption that both the time of leaving queue and the time of service are exponentially distributed,in order to minimize the joint cost,the optimal appointment schedule of the fixed number of customers is studied.The joint cost function is composed of customers expected delay time and service availability time.The expected delay time of each customer in the queue is recursively computed in terms of customer interarrival time.Furthermore,the effect of impatience on the optimal schedule as well as the total operating cost is studied.The results show that as the impatience rate increases,the optimal interarrival time becomes shorter and the interarrival time of the last few customers gradually approaches that of the customers in the middle.In addition,impatient behaviors can increase the joint cost.
文摘大多数形容词,具有三种主要用法:作前置定语、后置定语和表语。一般来说,作前置定语的形容词表示限制意义,作后置定语或表语的形容词表示描绘意义,有时同一个形容词在不同的位置上具有不同的词义。本文试结合一些常见的形容词来说明其位置对意义的影响。 1.alive (1)作前置定语时作“active,fuul of life”
文摘Prof.James M.Tiedje,University Distinguished Professor and Director of the Center for Microbial Ecology at Michigan State University,Academician of the American Academy of Sciences,has been appointed as an Honorary Editor-in-Chief of Pedosphere.Prof.
