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Primary care physicians (PCPs) play an indispensable role in providing comprehensive care and referring patients for specialty care and other medical services. As the COVID-19 outbreak disrupts patient access to care, understanding the quality of primary care is critical at this unprecedented moment to support patients with complex medical needs in the primary care setting and inform policymakers to redesign our primary care system. The traditional way of collecting information from patient surveys is time-consuming and costly, and novel data collection and analysis methods are needed. In this review paper, we describe the existing algorithms and metrics that use the real-world data to qualify and quantify primary care, including the identification of an individual's likely PCP (identification of plurality provider and major provider), assessment of process quality (for example, appropriate-care-model composite measures), and continuity and regularity of care index (including the interval index, variance index and relative variance index), and highlight the strength and limitation of real world data from electronic health records (EHRs) and claims data in determining the quality of PCP care. The EHR audits facilitate assessing the quality of the workflow process and clinical appropriateness of primary care practices. With extensive and diverse records, administrative claims data can provide reliable information as it assesses primary care quality through coded information from different providers or networks. The use of EHRs and administrative claims data may be a cost-effective analytic strategy for evaluating the quality of primary care.

BackgroundWork-family conflict is common among emergency department physicians. Identifying the factors associated with work-family conflict is key to reducing its negative impact on mental health and work attitudes. However, the work-family conflict of Chinese emergency department physicians and the related factors have been scarcely studied.ObjectiveThis study aimed to investigate the current status and related factors of work-family conflict among Chinese emergency department physicians.MethodsA national cross-sectional study was conducted among emergency department physicians in China from June 2018 to August 2018. A standard questionnaire was used to investigate the demographic characteristics, work-related factors, and work-family conflict of emergency department physicians. The generalized linear regression analysis was used to identify the related factors of work-family conflict.ResultsA total of 10,457 licensed emergency department physicians participated in the study. The average score of work-family conflict among the enrolled emergency department physicians was 19.27 ± 3.94, and the prevalence of high levels of work-family conflict was 69.19%. The multivariable regression analysis showed that emergency physicians who were female (linear regression coefficient, −0.25; SE, 0.08; P = 0.002), older than 40 years (linear regression coefficient,−0.53; SE, 0.14; P < 0.001), and earning more than 4,000 CNY per month (e.g., 4,001~6,000 vs. ≤4,000 CNY: linear regression coefficient, −0.17; SE, 0.09; P = 0.04) had lower work-family conflicts. However, emergency department physicians who were married (linear regression coefficient, 0.37; SE, 0.11; P < 0.001), highly educated (linear regression coefficient, 0.46; SE, 0.10; P < 0.001), had a high technical title (e.g., intermediate vs. junior technical title: linear regression coefficient, 0.61; SE, 0.09; P < 0.001), worked in a high-grade hospital (e.g., tertiary hospital vs. emergency center: linear regression coefficient, 0.38; SE, 0.11; P < 0.001), had a higher frequency of night shifts (e.g., 6~10 night shifts per month vs. 0~5 night shifts per month: linear regression coefficient, 0.43; SE, 0.10; P < 0.001), self-perceived shortage of physicians in the department (linear regression coefficient, 2.22; SE, 0.08; P < 0.001), and experienced verbal abuse (linear regression coefficient, 1.48; SE, 0.10; P < 0.001) and physical violence (linear regression coefficient, 0.84; SE, 0.08; P < 0.001) in the workplace had higher work-family conflict scores.ConclusionMost emergency department physicians in China experience a high-level work-family conflict. Hospital administrations are recommended to develop family-friendly workplace policies, establish a scientific shift system, and keep the number of emergency department physicians to meet the demand to reduce work-family conflict.

Brain function connectivity, derived from functional magnetic resonance imaging (fMRI), has enjoyed high popularity in studies of Autism Spectrum Disorder (ASD) diagnosis. Albeit rapid progress has been made, most studies still suffer from several knotty issues: (1) the hardship of effectively modeling the sophisticated brain neuronal connectivity; (2) the dimensionality explosion resulted from excessive voxels in each fMRI sample; (3) the poor interpretability giving rise to unpersuasive diagnosis. To ameliorate these issues, we propose a GCN-based model, namely ConResNet. Specifically, a convolutional restructuring attention is designed for efficiently ROI-interaction feature extraction. Besides, we embed a salient graph pooling method to sift salient nodes. Extensive experiments conducted on ABIDE dataset demonstrate ConResNet achieves state-of-the-art performance. Moreover, the most salient brain regions predicted by ConResNet are closely consistent with theoretical knowledge in the medical domain, providing potential biomarkers for ASD clinical diagnosis.

The misuse and abuse of opioids has become a serious public health threat in the United States. The state of California has been hit particularly hard by the opioid epidemic, with a noticeable increase in opioid-related fatalities and hospitalizations. This brief report paper aims to contribute to the growing literature by conducting a geospatial analysis of opioid dispensing patterns in California in 2021. The primary objective was to identify areas characterized by high-risk opioid dispending patterns and explore possible contributing factors. This retrospective study analyzed data from over 7 million records of opioid and benzodiazepine prescriptions dispensed by outpatient pharmacies in California in 2021. A series of generalized linear regression models was employed to assess the impact of neighborhood characteristics on opioid recipients and high-risk opioid dispensing. The study defined high-risk opioid dispensing behavior as: (1) multiple provider episodes, (2) overlapping opioid prescriptions for seven or more days, (3) overlapping opioid and benzodiazepine prescriptions for seven or more days, and (4) a high standardized dosage of opioid prescriptions per month. The study identified variables associated with high-risk opioid dispensing behaviors, including age, population density, income, and housing-related variables, as well as marital status and family-related variables. The study uncovered that there are noticeable disparities in opioid dispensing among different racial and ethnic groups within California. The findings indicated a correlation of high-risk dispensing indicators with certain demographic and socioeconomic factors. There was a substantial regional variation in opioid dispensing practices, with certain rural areas having higher rates of opioid prescriptions than urban areas.

Considering the large mined area, wide strata moving range, strong mine pressure occurrence, and difficult roof control for the fully mechanized top coal caving in 20 m ultra-thick coal seams, this study analyzes the strata structure evolution and mine pressure occurrence behavior through field test, numerical simulation, and theoretical analysis. Based on the mine condition of the Tashan Coal Mine in the Datong mining area, mechanical models are established for the compound overlying structures. The following can be demonstrated from this study: (1) The hard strata can form three different compound spatial structures at different positions in the overlying rock strata, including the lower combined cantilever structure I, the middle combined cantilever structure II, and the upper hinged structure. (2) Failure of the higher structure can induce compression on the lower structure, which changed the break span of the lower structure. (3) “Simultaneous and nonsimultaneous structural failures” of the compound spatial structure were caused by the variation of the break span of the multilayered structure. (4) Based on the weighting characteristics, there were three stages during work face weighting, including a gradual pressure increase stage (Stage I), an accelerated pressure increase stage (Stage II), and a fast pressure increase stage (Stage III). (5) The mine pressure occurrence demonstrated a “small to medium and to large” feature. (6) Prefracturing techniques should be additionally incorporated to prevent simultaneous failure of the multilayered structure. Findings of the work can demonstrate the emergence of strong mine pressure in the Datong mining area and have theoretical significance and reference value for maintaining safe mining in similar conditions.

The presence of hard roof poses a significant threat to the safety of underground coal mining. In this study, a mechanical model is established for underground stopes to analyze the overburden structure with the advancing of the mining face. It is indicated that the load-bearing arch structure (LBAS) is formed above the stope for roofs with regular hardness, whereas the reversed-basin bearing structure (RBBS) is formed for hard roofs. Compared with the LBAS, the RBBS can induce an additional pressure at the foot of the bearing structure, and this effect becomes less as the distance between the hard roof and stope increases. The ultra-deep borehole hydro-fracturing technique (UHT) is proposed to weaken the hard roof for pressure release, and the associated equipment and procedures are also presented. The UHT is based on horizontal drilling along the axial direction of the roadway in the roof, and then the receding segmented hydraulic fracturing technique is used to achieve the purpose of fracturing (weakening) of the surrounding rocks. Field tests are carried out in 3022 roadway of Daliangwan coal mine in Yulin to assess the developed technique, equipment, and fracturing procedures. To evaluate the fracturing effect, deep borehole stress-meters are installed at different depths of the fractured and un-fractured zones of the roadway, along with hydraulic support pressure sensors placed at the mining face. The results show that compared with the un-fractured zone, the pressure on the wall and pillar sides is lower than that in the fractured zone, and the associated weighting duration and weighting area ratio of the fractured are reduced by 53.23% and 33.59%, respectively. This indicates that the presented UHT can provide a new solution for the prevention and control of mining disasters induced by hard roof failures in underground coal mining.

BACKGROUND: In stem cell therapy, due to the lack of an effective carrier, a large number of transplanted stem cells are lost and die. Therefore, finding a suitable carrier has become a further direction of stem cell therapy. OBJECTIVE: In research on the co-culture of polycaprolactone (PCL) with 1,1′-Dioctadecyl-3,3,3′,3′- tetramethylindocarbocyanine perchlorate (DiI) labeled bone marrow mesenchymal stem cells (BMSCs), we observe the effect of materials on the growth and proliferation of DiI labeled stem cells, and the effect of DiI labeling on patch preparation, so as to find a kind of biomaterial suitable for the growth and proliferation of BMSCs, and find a suitable cell carrier for stem cell therapy of myocardial infarction and in vivo tracing. METHODS: Clean grade Sprague Dawley rats were selected as experimental objects, BMSCs were isolated and cultured, and the surface markers were identified by flow cytometry. After the BMSCs were cultured for 3 passages, the BMSCs were stained with DiI dye, and the BMSCs DiI and PCL biomaterial film were co-cultured. After 24 hours, the cell growth was observed under fluorescence microscope, and fixed for scanning under electron microscope. The cell proliferation was detected by CCK-8 at 1, 4, 7, 10 days of culture. The measurement data conforming to normal distribution are expressed in the form of mean ± standard deviation (X¯± s). One way ANOVA was used for comparison among groups, LSD analysis was used for pairwise comparison. The difference was statistically significant (P