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Objective Bedding deep cutting slopes containing weak interlayers are commonly found in slope engineering, whose stability is influenced by two key factors: The strength of the sliding zone soil and the reserved thickness of the base (the distance from the base of an excavated slope to the weak interlayer). Methods In this research, taking the K42 cutting slope of the Yang-Xuan Expressway as an example, the evolution process of slope deformation was analyzed, especially the characteristics of basal heave deformation. The properties of the deep sliding zone soil in the slope were revealed by ring shear tests, which are suitable for studying the shear strength of soil that has experienced large shear displacements. Moreover, the residual strength parameters of the saturated sliding zone soil were applied to analyze the reserved thickness of the base. Results The results show that sliding zone soils exhibit obvious strain softening characteristics, which become more evident as the normal stress decreases. As the soil shear strength transitions from peak strength to residual strength, both the cohesion force and internal friction angle decrease, with the cohesion force decreasing to a greater extent than the internal friction angle. The residual cohesion force of sliding zone soil varies slightly with the shear rate, while the relationship between the residual internal friction angle and shear rate varies as a logarithmic function. When the shear rate is less than 2 mm/min, the residual shear strength parameter of sliding zone soil is more sensitive to the shear rate and vice versa. Conclusion Furthermore, according to the regression equations of the critical states of slope stability, the reserved thickness of the base under different slope rates was divided into four zones: A (extremely unstable zone), B (unstable zone), C (basically stable zone) and D (stable zone), and based on this, the criterion and early warning model of the reserved thickness of the base for slope excavation were established.

Abstract Background General practitioner (GP) system is proved to be effective in over 50 countries worldwide. Guangdong province, as a reform pilot in China, initiated its patient-GP contract service reform in 2014. This study is designed to assess the patients’ acceptance of General Practitioners Contract (GPC) reform and explore its influencing factors. Methods This survey interviewed 1010 participants from 16 primary health centers (PHCs) chosen from 4 pilot cities in Guangdong during July and December in 2015. Data were collected through face-to-face interviews. The questionnaire was developed to discover the acceptance of GPC and covered three parts: respondents’ socio-demographic characteristics, health service utilization, and the patients’ assessment of primary health care centers. A binary logistic regression model was used to measure the influencing factors of respondents’ acceptance of GPC policy. Results A total of 611(60.5%) participants accepted GPC policy. Compared to patients visited PHCs over 7 times in the previous year, those visited PHCs fewer times reported lower acceptance of GPC policy (OR:0.68, 95% CI:0.49–0.96 for visits ≤3 times and OR:0.57, 95% CI:0.38–0.84 for visits = 4–6 times). Patients’ satisfaction with medical service coverage was positively associated with patients’ acceptance of GPC (OR: 1.72, 95% CI:1.01–3.98 for the satisfied versus the dissatisfied; OR: 1.38, 95% CI:0.92–3.30 for neutral versus the dissatisfied), and the satisfaction with drug list also positively influenced patients’ acceptance of GPC policy (OR: 1.44, 95% CI:1.26–2.73 for the satisfied versus the dissatisfied; OR:1.61, 95% CI:1.36–2.99 for neutral versus the dissatisfied). Meanwhile, age and education had positive impacts on the acceptance of the GPC policy. Conclusion This study finds out that patients’ satisfaction with medical service coverage and drug list are the influencing factors for the acceptance of GPC policy. Therefore, improvement of medical service accessibility such as better follow-up of patients with chronic diseases and enhanced referral service, as well as the expansion of drug list, will improve patients’ acceptance of GPC policy. It also finds that patients using more primary health service are inclined to accept GPC policy, so more attractive and high-quality service should be provided in PHCs.

In the past few years, deep learning-based electrocardiogram (ECG) compression methods have achieved high-ratio compression by reducing hidden nodes. However, this reduction can result in severe information loss, which will lead to poor quality of the reconstructed signal. To overcome this problem, a novel quality-guaranteed ECG compression method based on a binary convolutional auto-encoder (BCAE) equipped with residual error compensation (REC) was proposed. In traditional compression methods, ECG signals are compressed into floating-point numbers. BCAE directly compresses the ECG signal into binary codes rather than floating-point numbers, whereas binary codes take up fewer bits than floating-point numbers. Compared with the traditional floating-point number compression method, the hidden nodes of the BCAE network can be artificially increased without reducing the compression ratio, and as many hidden nodes as possible can ensure the quality of the reconstructed signal. Furthermore, a novel optimization method named REC was developed. It was used to compensate for the residual between the ECG signal output by BCAE and the original signal. Complemented with the residual error, the restoration of the compression signal was improved, so the reconstructed signal was closer to the original signal. Control experiments were conducted to verify the effectiveness of this novel method. Validated by the MIT-BIH database, the compression ratio was 117.33 and the root mean square difference (PRD) was 7.76%. Furthermore, a portable compression device was designed based on the proposed algorithm using Raspberry Pi. It indicated that this method has attractive prospects in telemedicine and portable ECG monitoring systems.

As one of the important components of electrocardiogram (ECG) signals, QRS signal represents the basic characteristics of ECG signals. The detection of QRS waves is also an essential step for ECG signal analysis. In order to further meet the clinical needs for the accuracy and real-time detection of QRS waves, a simple, fast, reliable, and hardware-friendly algorithm for real-time QRS detection is proposed. The exponential transform (ET) and proportional-derivative (PD) control-based adaptive threshold are designed to detect QRS-complex. The proposed ET can effectively narrow the magnitude difference of QRS peaks, and the PD control-based method can adaptively adjust the current threshold for QRS detection according to thresholds of previous two windows and predefined minimal threshold. The ECG signals from MIT-BIH databases are used to evaluate the performance of the proposed algorithm. The overall sensitivity, positive predictivity, and accuracy for QRS detection are 99.90%, 99.92%, and 99.82%, respectively. It is also implemented on Altera Cyclone V 5CSEMA5F31C6 Field Programmable Gate Array (FPGA). The time consumed for a 30-min ECG record is approximately 1.3 s. It indicates that the proposed algorithm can be used for wearable heart rate monitoring and automatic ECG analysis.

Abstract Background Family doctor contract service is an important service item in China’s primary care reform. This research was designed to evaluate the impact of the provision of family doctor contract services on the patient-perceived quality of primary care, and therefore give evidence-based policy suggestions. Methods This cross-sectional study of family doctor contract service policy was conducted in three pilot cities in the Pearl River Delta, South China, using a multistage stratified sampling method. The validated Primary Care Assessment Tool-Adult Edition (PCAT-AS) was used to measure the quality of primary care services. PCAT-AS assesses each of the unique characteristics of primary care including first contact, continuity, comprehensiveness, coordination, family-centeredness, community orientation, culture orientation. Data was collected through face-to-face interviews held from July to November, 2015. Covariate analysis and multivariate Linear Regression were adopted to explore the effect of contract on the quality of primary care by controlling for the socio-demographic status and health care service utilization factors. Results A total of 828 valid questionnaires were collected. Among the interviewees, 453 patients signed the contract (54.7%) and 375 did not (45.3%). Multivariate linear regression showed that contracted patients reported higher scores in dimensions of PCAT total score (β = − 8.98, P

Background Since the number of chronic disease patients is increasing, relevant prevention and treatment services have become important long-term tasks for primary care institutions. However, problems in the provision of primary care services seriously affect the perception of such services in residents, especially chronic disease patients. Objective To understand chronic disease patients' assessment of the quality of primary care services, providing evidence for improving the quality of chronic disease management services in primary care. Methods A survey was conducted between July and August, 2020 with chronic disease patients (n=630) selected from primary care settings in Guangdong's Chaozhou by use of multistage stratified random sampling. The Primary Care Assessment Tool-Adult Simplified Version (PCAT-AS) (consists of 10 domains, including first contact accessibility, coordination, ongoing, comprehensiveness, community orientation and other 5 domains) was used in the survey for understanding chronic disease patients' assessment of the quality of primary care services. Multiple linear regression was adopted to identify factors potentially associated with the PCAT-AS score. Results Altogether, 553 cases (87.8%) who returned responsive questionnaires were enrolled for analysis. The average total PCAT-AS score for all respondents was (95.88±13.44) . The top three domains ranked in terms of average standardized score were comprehensiveness (services needed) (7.89) , first contact accessibility (7.72) , and first contact utilization (7.58) , and the bottom three-ranked domains were coordination (referrals) (5.61) , community orientation (6.11) and patient and family centeredness (6.40) . Multiple linear regression analysis indicated that higher total PCAT-AS score was associated with living in urban areas in contrast to rural areas〔b (95%CI) =-6.983 (-10.598, -3.368) 〕, senior high school and higher education level instead of junior high school and lower education level〔b (95%CI) =4.046 (0.966, 7.125) 〕, permanent residents without the local hukou in contrast to those with local hukou〔b (95%CI) =-5.360 (-9.517, -1.202) 〕, good self-rated health instead of relatively poor self-rated health〔b (95%CI) =-4.962 (-8.438, -1.486) 〕 or poor self-rated health〔b (95%CI) =-7.787 (-12.789, -2.786) 〕, having a contracted family doctor instead of having no contracted family doctor〔b (95%CI) =4.686 (2.508, 6.865) 〕, first choosing a community health center for treating common diseases instead of a village clinic〔b (95%CI) =-5.865 (-9.951, -1.779) 〕 or a district/county-level hospital or tertiary hospital〔b (95%CI) =-6.061 (-11.330, -0.792) 〕, 4-6 primary care visits instead of 1-3 primary care visits〔b (95%CI) =5.876 (3.367, 8.384) or 7 or more primary care visits instead of 1-3 primary care visits〔b (95%CI) =9.045 (6.512, 11.579) 〕, and high satisfaction with primary care services instead of fair satisfaction〔b (95%CI) =-2.844 (-4.817, -0.870) 〕 or dissatisfaction〔b (95%CI) =-10.418 (-17.050, -3.786) 〕. Conclusion Overall, Chaozhou chronic disease patients reported a sound level of treatment experience in primary care. Specifically, they reported good primary care experience in three domains, including comprehensiveness, first contact accessibility and first contact utilization, but poor experience in community orientation, and coordination (including information systems and referrals) . However, urban patients reported better primary care experience than rural patients. So continued efforts are needed to strengthen primary care performance in rural areas.