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Background China is making efforts to promote the equalization of National Essential Public Health Services (NEPHS) for internal migrants. Studies have demonstrated that the impacts of social capital on health services are different among subgroups of people. Clarifying these differences will help China accurately promote the equalization of NEPHS for the internal migrants and provide reference for other countries. Methods Data from the China Migrant Dynamic Survey of 2017, involving 130,642 migrants in 31 provinces were used to clarify the complex relationship between social capital and the utilization of NEPHS. Social capital was divided into regional cognitive social capital (RCSC), regional structural social capital (RSSC), individual cognitive social capital (ICSC), and individual structural social capital (ISSC). Then, multi-level logistic regression was conducted to analyze their impacts on the utilization of NEPHS of the migrants, and whether such impacts are moderated by sex and education. Results (1) There are significant differences in the levels of CSC, SSC, and NEPHS utilization between different sexs and educational subgroups of the migrants, among which the educational difference is more prominent. (2) An interaction exists between the levels and dimensions of social capital and NEPHS projects. Also, the impact of SSC on NEPHS is always greater than that of CSC at the same level. (3) The effects of RCSC, RSSC, ICSC, and ISSC on NEPHS utilization by migrants are not moderated by sex. However, a high education could weaken the relationship between RCSC and health education, ISSC and health education, and RSSC and health records but strengthen the correlation between RSSC and health education. Conclusion Social capital plays an important role in the access of migrants to NEPHS. Governments should vigorously promote the construction of regional social capital, encourage migrants to actively participate in community activities, especially pay attention to the enhancement of the migrants with low SES to the destination identity.

Background Injuries are of growing public health concern in China, and the trends of urban-rural injury mortality disparity for the last decade are still being explored. This study aims to analyze trends in injury mortality disparity between urban and rural areas of China by region, sex, and age from 2010 to 2016. Methods Using data from the Disease Surveillance Points system (DSPs) collected by the Chinese Center for Disease Control and Prevention (CDC) from 2010 to 2016, injury age-standardized mortality rates (ASMRs) and rate ratios (RRs) were calculated for different groups. Chi-square tests were used to compare differences in rates between urban and rural residents. The time trends of injury ASMRs were assessed via the annual percentage change (APC), and RRs were used to analyze urban-rural mortality disparity. Results The crude injury mortality rate of rural areas was 1.5 times higher than that of urban areas. The urban-rural RR of injury ASMR decreased from 1.8 to 1.5 (APC = 5.0%) over time, from 2.0 to 1.7 (APC = 4.7%) for eastern regions, from 1.9 to 1.5 (APC = 5.4%) and from 1.6 to 1.3 (APC = 4.5%) among males and females, respectively. Further decreases were from 2.0 to 1.4 (APC = 7.8%), from 1.9 to 1.6 (APC = 6.4%), and from 1.8 to 1.2 (APC = 5.7%) in the 5–14, 45–64, and 65+ year age groups, respectively. The urban-rural RRs of ASMRs for fall, drowning and suicide decreased from 1.3 to 1.2 (APC = − 3.0%), from 2.3 to 1.6 (APC = − 13.8%) and from 2.1 to 1.6 (APC = − 9.9%,), respectively. Conclusions The urban-rural injury mortality disparity was large, but showed a significant decreasing trend in China. Residents of eastern regions, males/females, 5–14/45+ year age groups in the urban-rural injury mortality disparity all decreased gradually during the investigated period.

IntroductionTelemedicine and blood pressure (BP) self-monitoring conduces to management of hypertension. Recent hypertension guidelines highly recommended single pill combination (SPC) for the initial treatment of essential hypertension. Based on this fact, an SPC-based telemedicine titration regimen with BP self-monitoring could be a better way in managing hypertension. This trial aims to elucidate whether telemedicine combined with BP self-monitoring is superior to self-monitoring alone during hypertension management.Methods and analysisThis study will be a multicentred, open-labelled, randomised controlled trial. A minimum sample of 358 hypertensive patients with uncontrolled BP from four centres will be included. The intervention group will include BP self-monitoring and tele-monitoring plus a free SPC-based telemedicine titration therapy for 6 months, they will be recommended to take BP measurements at least once every 7 days, in the meantime, researchers will call to give a consultation on lifestyle or titration advice once a fortnight. The control group will be required to self-monitor BP at the same time interval as intervention group, without any therapy change. Primary outcome of the trial will be the difference in systolic blood pressure at 6-month follow-up between intervention and control group, adjusted for baseline variables. Secondary outcomes such as BP control rate, major adverse cardiovascular events, medication adherence, quality of life will be investigated.Ethics and disseminationEthics approval was granted by Ethical Committee of Shanghai Tenth People’s Hospital (SHSY-IEC-4.1/20-194/01). The results will be disseminated in peer-reviewed literature, and to policy-makers and healthcare partners.Trial registration numberChiCTR2000037217.

Background China is promoting the equalization of National Essential Public Health Services (NEPHS) for the internal migrants (IMs). Studies have analyzed the impact of migration range (MR) and regional economic development level (REDL) on the IMs' NEPHS utilization (NEPHSU), but no studies have explored the interaction of MR and REDL on it. Methods Data from the China Migrant Dynamic Survey of 2017, involving 122656 IMs. Per capita GDP was set as the indicator for REDL, and 28 provinces were divided into three groups according to REDL: affluent, medium and poor. The MR was divided into inter-province and intra-province, and social capital (SC) was distinguished into cognitive (CSC) and structural social capital (SSC). Awareness of NEPHS (ANEPHS) and establishment of health record (EHR) were selected as indexes of NEPHSU. Multiple line charts and hierarchical logistic regression were used to investigate the interaction of MR, REDL and SC on NEPHSU. Results (1) The socioeconomic status (SES) and social capital (SC) of inter-provincial IMs were significantly lower than those of intra-provincial IMs, and the gap was most prominent in affluent areas. (2) From low to high, the NEPHSU of inter-provincial IMs was ranked as affluent, medium and poor, while the corresponding order of intra-provincial IMs was medium, poor and affluent areas, and the gap of NEPHSU between inter-provincial and intra-provincial IMs was the largest in affluent areas. (3) SC could significantly promote the IMs' NEPHSU, but there was a gap between inter-provincial and intra-provincial IMs, and the gap was the largest in affluent areas. Conclution: REDL can significantly affect the gaps of SES and SC among subgroups of IMs with different MR. Inter-provincial migrants in affluent areas have relatively lower SES and SC, which may be a major barrier to their access to NEPHS, and the government should pay special attention to this vulnerable group when promoting equalization of NEPHS for IMs.

Background It has been a risk of the internal migrants' (IMs') health that their utilization of National Essential Public Health Services (NEPHS) was inadequate. Studies have analyzed the impact of migration range (MR) or regional economic development level (REDL) on the IMs' utilization of NEPHS, but no studies have explored the interaction of MR and REDL on it. Methods Data from the China Migrant Dynamic Survey of 2017, involving 122656 IMs. Per capita GDP was set as the indicator for REDL, and all provinces were divided into three groups according to REDL: affluent, medium and poor. The MR was divided into inter-province and intra-province, and social capital (SC) was distinguished into cognitive (CSC) and structural social capital (SSC). Awareness of NEPHS (ANEPHS) and establishment of health record (EHR) were selected as indexes of NEPHS utilization. Then we used multiple line charts and hierarchical logistic regression to investigate the interaction of MR, REDL and SC on NEPHS utilization. Results (1) The socioeconomic status (SES) and social capital (SC) of the inter-provincial IMs were significantly lower than those of the intra-provincial IMs, and the gap was most prominent in the affluent areas. (2) From low to high, the NEPHS utilization of inter-provincial IMs was ranked as affluent, medium and poor, while the corresponding order of intra-provincial IMs was medium, poor and affluent areas. (3) SC could significantly promote the IMs' utilization of NEPHS, but there was a gap between the inter-provincial and intra-provincial IMs, and the gap was the largest in the affluent areas. Conclution: The IMs' SES, SC and NEPHS utilization were influenced by MR and REDL. The gaps of SES, SC and NEPHS utilization between the inter-provincial and the intra-provincial IMs in affluent areas were much larger than that in medium and poor areas. The government should pay more attention to the inter-provincial IMs in affluent areas.

Background: China is making every effort to promote equal access to public health services(PHS) for the internal migrants. Studies have demonstrated that the impact of social capital on PHS is different among subgroups of people. Clarifying these differences will help China accurately promote the equalization of PHS for the internal migrants and provide reference for other developing countries.Methods: Data from the China Migrant Dynamic Survey of 2017, involving 130642 migrants in 31 provinces were used to clarify the complex relationship between social capital and the utilization of National Essential Public Health Services (NEPHS). Social capital was divided into regional cognitive social capital (RCSC), regional structural social capital (RSSC), individual cognitive social capital (ICSC), and individual structural social capital (ISSC). Then, multi-level logistic regression was conducted to analyze their impacts on the utilization of NEPHS of the migrants, and whether such effects are moderated by gender and education. Results: The results suggest: (1) There are significant differences in the levels of CSC, SSC, and NEPHS utilization between different genders and educational subgroups of the migrants, among which the educational difference is more prominent. (2) An interaction exists between the levels and dimensions of social capital and NEPHS projects. Also, the impact of SSC on NEPHS is always greater than that of CSC at the same level. (3) The effects of RCSC, RSSC, ICSC, and ISSC on NEPHS utilization by migrants are not moderated by gender. However, education could weaken the relationship between RCSC and health education, ISSC and health education, and RSSC and health records but strengthen the correlation between RSSC and health education. Conclution: This study demonstrated complex interactions between the dimensions and levels of social capital, NEPHS projects, and the population characteristics of migrants. As the government strives towards the equalization of NEPHS, these interactions should be fully considered.

Background: China has about 240 million internal migrants(IMs), and they face lots of mental health risks. The government is actively promoting mental health education for IMs. Previous studies have focused more on the relation between social capital and mental health, but ignored the impact of social capital on the accessibility to mental health services.Methods: Data from the China Migrant Dynamic Survey of 2017, involving 138939 IMs in 31 provinces were used to explore the interaction of social capital, life stress index and gender on acceptance of mental health education(AMHE). Social capital was divided into cognitive(CSC) and structural social capital (SSC). Multiple line charts and multi-level logistic regression were conducted to analyze their impacts on AMHE, and whether such impacts were moderated by gender and life stress index(LSI). Results: The results suggest: (1) The SSC ranking of IMs with different LSI levels was "moderate (3.62 ± 1.736), mild(3.53 ± 1.755), severe(3.53 ± 1.755)", SSC was positively correlated with AMHE(OR=1.320, 95%CI 1.305 to 1.336), but the correlation would decrease with the increase of LSI(OR=0.969, 95%CI 0.953 to 0.985; OR=0.949, 95%CI 0.934 to 0.964); (2) Males’ SSC(3.67 ± 1.780) was significantly higher than that of females(3.36 ± 1.614), but its influence on AMHE of females was higher(OR=1.050, 95%CI 1.036 to 1.064); (3) The CSC ranking of IMs with different LSI levels was "mild(3.71 ± 2.096), moderate(3.71 ± 2.076), severe(3.42 ± 2.024)", there was no significant gender difference in CSC, and CSC was positively correlated with AMHE(OR=1.087, 95%CI 1.076 to 1.098), but gender and LSI had no significant moderating effect on it.Conclution: Gender and LSI were associated with social capital, but only the relationship between SSC and AMHE was moderated by them. SSC had both a main effect and a buffering effect, while CSC only showed a main effect. The government should pay attention to enhancing their positive identity to the city and at the same time improve their civic participation and social participation.

Additional file 1. The ICD-10 codes for types of injury.

Additional file 2. Map of China with geographical divisions. Red: eastern region; blue: central region; white: western region. Source: Zhang L, Li Z, Li X, et al. Study on the trend and disease burden of injury deaths in Chinese population, 2004–2010. PLoS One. 2014;9(1):e85319. doi:https://doi.org/10.1371/journal.pone.0085319. This original figure is under a Creative Commons Attribution License.

At Tongji University School of Medicine we established affiliation relationships with community health centers (CHCs) in Shanghai, which was unprecedented in China. During the process, we assisted CHCs in strengthening their portfolio through the improvement of public trust, working environment

There has been much debate on how prophylactic ankle supports (PASs) may influence the vertical ground reaction force (vGRF) during landing. Therefore, the primary aims of this meta-analysis were to systematically review and synthesize the effect of PASs on vGRF, and to understand how PASs affect vGRF peaks (F1, F2) and the time from initial contact to peak loading (T1, T2) during landing. Several key databases, including Scopus, Cochrane, Embase, PubMed, ProQuest, Medline, Ovid, Web of Science, and the Physical Activity Index, were used for identifying relevant studies published in English since inception to April 1, 2015. The computerized literature search and cross-referencing the citation list of the articles yielded 3,993 articles. Criteria for inclusion required that 1) the study was conducted on healthy adults; 2) the subject number and trial number were known; 3) the subjects performed landing with and without PAS; 4) the landing movement was in the sagittal plane; 5) the comparable vGRF parameters were reported; and 6) the F1 and F2 must be normalized to the subject’s body weight. After the removal of duplicates and irrelevant articles, 6, 6, 15 and 11 studies were respectively pooled for outcomes of F1, T1, F2 and T2. This study found a significantly increased F2 (.03 BW, 95% CI: .001, .05) and decreased T1 (-1.24 ms, 95% CI: -1.77, -.71) and T2 (-3.74 ms, 95% CI: -4.83, -2.65) with the use of a PAS. F1 was not significantly influenced by the PAS. Heterogeneity was present in some results, but there was no evidence of publication bias for any outcome. These changes represented deterioration in the buffering characteristics of the joint. An ideal PAS design should limit the excessive joint motion of ankle inversion, while allowing a normal range of motion, especially in the sagittal plane.

Objective. Existing research shows a serious scarcity of EBPH practice in China and other developing regions; as an exploratory study, this study aimed to assess the current EBPH implementation status in Shanghai of China qualitatively.Methods. Using semistructured key informant interviews, we examined the status of and impediments to the lagging EBPH in China. Data were analyzed based on the Consolidated Framework for Implementation Research (CFIR).Results. Chinese public health practitioners knew more about evidence-based medicine but less about EBPH. The situation was worse in community healthcare centers. Participants perceived that evidence sources were limited and the quality of evidence was low. Concerning the inner setting factors, the structural characteristics, networks and communications, implementation climate, and leadership engagement were confronted with many problems. Among the outer setting factors, external government policies and incentives and low patient compliance were the key problems. Additionally, public health practitioners in Shanghai lacked sufficient awareness of EBPH. Furthermore, the current project-based EBPH lacks a systematic implementation system.Conclusions. Existing practical perspectives on EBPH indicate a lag in the advocacy of this new ideology in China. It would be advisable for healthcare institutions to take the initiative to explore feasible and multiple methods of EBPH promotion.

The objective of this study was to investigate the effect of dropping height on the forces of joints and muscles in lower extremities during landing. A total of 10 adult subjects were required to landing from three different heights (32 cm, 52 cm, and 72 cm), and the ground reaction force and kinematics of lower extremities were measured. Then, the experimental data were input into the AnyBody Modeling System, in which software the musculoskeletal system of each subject was modeled. The reverse dynamic analysis was done to calculate the joint and muscle forces for each landing trial, and the effect of dropping-landing on the results was evaluated. The computational simulation showed that, with increasing of dropping height, the vertical forces of all the hip, knee, and ankle joints, and the forces of rectus femoris, gluteus maximus, gluteus medius, vastii, biceps femoris and adductor magnus were all significantly increased. The increased dropping height also resulted in earlier activation of the iliopsoas, rectus femoris, gluteus medius, gluteus minimus, and soleus, but latter activation of the tibialis anterior. The quantitative joint and muscle forces can be used as loading conditions in finite element analysis to calculate stress and strain and energy absorption processes in various tissues of the lower limbs.

Recent developments in the treatment of HIV-1 have improved the disease prognosis from a terminal disease to a chronic disease. The number of HIV-1-infected patients who require surgery has become more common. The main threat to HIV-1-infected patients following surgery is the development of sepsis. In this study, we collected a large number of clinical recordings of HIV-1-infected patients from two hospitals in China, specializing in HIV-1 treatment in order to summarize the risk indicators of sepsis in HIV-1-infected patients. We compared the significant risk indicators between the sepsis and non-sepsis groups. Using logistic regression based on the indicators of four separate surgery-based diseases, we generally found that low CD4 and hypoalbuminemia counts prior to surgery were the significant risk factors for developing sepsis. The morbidity of sepsis in trauma patients was approximately 10 times higher than the dysfunction group, whereas the tumor and the infection groups were approximately 1.5 and 2 times higher, respectively. Based on the comparison between the sepsis and non-sepsis groups for each surgery-based disease, we found that the severity of trauma is a critical risk factor for trauma patients; therefore, limiting the size of the wound during surgery is crucial. HIV-1-infected patients often develop postoperative sepsis due to immunodeficiency and complications due to the surgery. We hope that this study can help to reduce the risk of developing sepsis due to surgery and improve the survival rate of HIV-1-infected patients.

An accurate estimation of a casualty rate is critical in response to earthquake disasters, and could allow an increase in the survival rate. Building damage is considered to be a major cause of earthquake casualties in developing countries. High-resolution satellite imagery (HRSI) can be used to detect the building damage in a period of a short time. This makes it possible to use a model to estimate earthquake casualties immediately after the occurrence of an earthquake. With respect to the capability of HRSI, this study built a new model for estimating the casualty rate in an earthquake disaster based on remote sensing and a geographical information system. Three groups of earthquake data, the 2003 Bam earthquake, the 2008 Wenchuan earthquake, and the 2010 Yushu earthquake, were used to evaluate this model. The results indicated that our new model significantly improved the accuracy in predicting the casualty rate. The parameters used in the model vary between developed and developing countries. This study could provide valuable information for a more efficient rescue operation in response to earthquakes.

(1) To systematically review peak vertical ground reaction force (PvGRF) during two-leg drop landing from specific drop height (DH), (2) to construct a mathematical model describing correlations between PvGRF and DH, and (3) to analyze the effects of some factors on the pooled PvGRF regardless of DH.A computerized bibliographical search was conducted to extract PvGRF data on a single foot when participants landed with both feet from various DHs. An innovative mathematical model was constructed to analyze effects of gender, landing type, shoes, ankle stabilizers, surface stiffness and sample frequency on PvGRF based on the pooled data.Pooled PvGRF and DH data of 26 articles showed that the square root function fits their relationship well. An experimental validation was also done on the regression equation for the medicum frequency. The PvGRF was not significantly affected by surface stiffness, but was significantly higher in men than women, the platform than suspended landing, the barefoot than shod condition, and ankle stabilizer than control condition, and higher than lower frequencies.The PvGRF and root DH showed a linear relationship. The mathematical modeling method with systematic review is helpful to analyze the influence factors during landing movement without considering DH.

Injuries are a growing public health concern in China, accounting for more than 30% of all Person Years of Life Lost (PYLL) due to premature mortality. This study analyzes the trend and disease burden of injury deaths in Chinese population from 2004 to 2010, using data from the National Disease Surveillance Points (DSPs) system, as injury deaths are classified based on the International Classification of Disease-10(th) Revision (ICD-10). We observed that injury death accounted for nearly 10% of all deaths in China throughout the period 2004-2010, and the injury mortality rates were higher in males than those in females, and higher in rural areas than in urban areas. Traffic crashes (33.79-38.47% of all injury deaths) and suicides (16.20-22.01%) were the two leading causes of injury deaths. Alarmingly, suicide surpassed traffic crashes as the leading cause of injury mortality in rural females, yet adults aged 65 and older suffered the greatest number of fatal falls (20,701 deaths, 2004-2010). The burden of injury among men (72.11%) was about three times more than that of women's (28.89%). This study provides indispensible evidence that China Authority needs to improve the surveillance and deterrence of three major types of injuries: Traffic-related injury deaths should be targeted for injury prevention activities in all population, people aged 65+ should be encouraged to take individual fall precautions, and prevention of suicidal behavior in rural females should be another key priority for the government of China.

BACKGROUND: Primary health care and patient triage are two basic functions of rural hospitals. As a routine test, the diagnostic radiology is still unavailable in some rural hospitals in China. Therefore, high-level hospitals are often the first choice of rural residents when they feel unwell. It brings serious social problems. This study was designed to propose an on-the-job drilling schema with integration of practical medical recordings and experienced radiological doctors as tutors to improve skills in diagnostic radiology of rural physicians. METHODS: The information technology was used to help the contact between rural doctors and tutors. In a longitudinal pre/post-test control study design, a cohort of 20 young physicians, each of whom was working in a rural hospital and had a work experience less than two years, were established as the trial group over one year. Another 20 similar counterparts were established as the control group. Participants' performances were evaluated in four categories at five-time point (TP). RESULTS: The trial group significantly outscored the control group on the style of writing at the second TP (d = 2.28); on the accuracy of the image description at final TP (d = 1.11); on the accuracy of the diagnosis at the fourth TP (d = 3.62); and on the correct treatment selection at the third TP (d = 6.45). The aspects with the most improvement were the accuracies of the diagnosis and the treatment selection. CONCLUSION: This study provided the detailed evidences that applying the on-the-job drilling schema has a significant effect on the skills improvement in diagnostic radiology of rural physicians. It was also concluded that the educational intervention based on practical cases was better than that only based on didactic slides presentation.

Reaction of [Pt2(μ-S)2(PPh3)4] (1) with a mixture containing [Re2(CO)10], Me3NO·2H2O and MeOH at room temperature affords an oxidative methoxylation complex, [Pt2Re2(μ-OMe)2(μ3-S)2(PPh3)4(CO)6] (2), and a PtRe heterometallic salt, [Pt2Re(μ3-S)2(PPh3)4(CO)3]+[Re3(μ3-OMe)(μ-OMe)3(CO)9]− (3a). The core of the cation of 3a comprises a {Pt2ReS2} trigonal bipyramidal ‘cluster’ with weak PtRe bonding interactions and an apparently unsaturated Re(I) atom. The [BF4]− salt of this cation, 3b, can be prepared by the reaction of 1 with [Re(CO)5(H2O)][BF4], and the Mn analogue, [Pt2Mn(μ3-S)2(PPh3)4(CO)3][BF4] (4), can be similarly synthesised using [Mn(FBF3)(CO)5]. Addition of 1 to [M(I)2(CO)3(NCMe)2] (M=Mo, W) is accompanied by iodide migration to give the salts [Pt2M(μ3-S)2I(PPh3)4(CO)4][M(I)3(CO)4] (M=Mo, 5; W, 6a). With [Mo(CO)4(NCMe)2], 1 undergoes reductive carbonylation and desulfurization to give [Pt2(μ-S)(PPh3)3(CO)] (7). The above reactions represent the first examples of 1 as a metalloligand towards carbonyl complexes of the less electron-rich transition metals, and demonstrate that addition reactions of 1 can be complicated by ligand dissociation, ligand migration, or reductive desulphurization. The crystal structures of compounds 3a and 3b were determined.

Negative-ion electrospray mass spectrometry has been used to investigate the reactions of the dinuclear rhenium aggregates [Re2(μ-OH)3(CO)6]−1 and [Re2(μ-OMe)3(CO)6]−2 with a range of thiols, benzeneselenol, and some other sulfur-, phosphorus- and nitrogen-based ligands. Typically up to three of the hydroxo ligands are replaced by simple thiolates, giving the series of species [Re2(OH)2(SR)(CO)6]−, [Re2(OH)(SR)2(CO)6]−, and [Re2(SR)3(CO)6]−. Similarly, reaction of 1 with H2S gives the species [Re2(μ-SH)3(CO)6]−, which undergoes an analogous fragmentation process to [Re2(μ-OH)3(CO)6]−, at high cone voltages, by loss of H2S and formation of [Re2(S)(SH)(CO)6]−. With ligands which are good chelating agents (such as dithiocarbamates R2NCS2−, and thiosalicylic acid, HSC6H4CO2H) initial substitution of one or two OH groups readily occurs, but on standing the dimer is cleaved giving [Re(S2CNR2)2(CO)3]− and [Re(SC6H4CO2)(CO)3]−. The different reactivities of the dithiol reagents benzene-1,2- and benzene-1,4-dimethanethiol towards 1 are also described. Complex 1 also reacts with aniline, and with primary (but not secondary) amides RC(O)NH2, giving monosubstituted species [Re2(OH)2(NHPh)(CO)6]− and [Re2(OH)2{NHC(O)R}(CO)6]− respectively. The reactions with adenine and thymine, and with the inorganic anions thiocyanate and thiosulfate, are also described.

The rhenium hydroxy and methoxy carbonyl complexes [Re2(μ-OR)3(CO)6]− (R = H or Me) have been studied by negative-ion electrospray mass spectrometry (ESMS). The complexes undergo facile exchange reactions with protic compounds, including alcohols and phenols. With dimethyl malonate, ester hydrolysis occurs giving carboxylate-containing complexes, and with H2O2 or ButOOH, oxidation to ReO4− occurs. The feasibility and extent of these reactions can conveniently, rapidly, and unambiguously be determined by electrospray mass spectrometry, and is dependent on the acidity and steric bulk of the protic compound. The results also suggest that the complexes can be used as versatile starting materials for the synthesis of a wide range of analogous [Re2(μ-OR)3(CO)6]− complexes by simple reaction with an excess of the appropriate alcohol. By varying the applied cone voltage the fragmentation pathways have been investigated; the hydroxy complex undergoes dehydration followed by CO loss, whereas for the methoxy complex β-hydride elimination (and CO loss) is observed, with confirmation provided by deuterium labelling studies. Under ESMS conditions, the neutral complexes [Re2(μ-OR)2(μ-dppf)(CO)6] [R = H or Me; dppf = 1,1′-bis(diphenylphosphino)ferrocene] undergo substantial solvolysis and hydrolysis to give mainly mononuclear species; simple parent ions (e.g. [M + H]+) are not formed in appreciable abundance, probably due to the lack of an efficient ionisation pathway.

Reaction of the activated mixture of Re2(CO)10, Me3NO and MeOH with a 1:1 mixture of rac (d/l)- and meso-1,1,4,7,10,10-hexaphenyl-1,4,7,10-tetraphosphadecane (hptpd) yields a mixture of (d/l)- and meso-[{Re2(μ-OMe)2(CO)6}2(μ,μ′-hptpd)] 1. The diastereomers can be easily separated by selective dissolution of d/l-1 in benzene, and give clearly distinguishable 1H- and 31P-NMR spectra. The fluxional behavior of d/l-1 in solution has been studied by variable-temperature 1H- and 31P-{1H}-NMR spectroscopy. The crystal structures of both d/l- and meso-1 have been determined. Both molecules consist of two {Re2(μ-OMe)2(CO)6} moieties which are bridged by the two PCH2CH2P moieties of the hptpd ligand. Whilst the molecules of meso-1 possess crystallographic i-symmetry, those of d/l-1 do not have any crystallographic symmetry. These diastereomers therefore give clearly distinguishable Raman spectra in the solid state. Reaction of tris[2-(diphenylphosphino)ethyl]phosphine (tdppep) with the activated mixture affords the complex [{Re2(μ-OMe)2(CO)6}(μ,η2-tdppep)] 2, and the analogous reaction involving bis[2-diphenylphospinoethyl)phenylphosphine (triphos) gives [{Re2(μ-OMe)2(CO)6}(μ,μ′,η3-triphos){Re2(CO)9}] 3 and [{Re2(μ-OMe)2(CO)6}(μ,η2-triphos)] 4.

Oxidative decarbonylation of Re 2 (CO) 10 by Me 3 NO in a mixture of THF and phenol resulted in Re 3 (CO) 14 ( μ -H), 1 , and [Me 3 NH] + [Re 2 (CO) 6 ( μ -OPh) 3 ] − , 2 , in 30 and 17% yields respectively. In the analogous reaction in THF-MeOH mixture, a trinuclear complex, [Me 3 NH] + [Re 3 (CO) 9 ( μ -OH) 2 ( μ -OMe)( μ 3 -OMe)] − , 3 , was isolated instead. The structure of 3 was determined by single-crystal X-ray diffraction analysis: orthorhombic, space group Ama 2, a = 14.022(2), b = 18.003(5), c = 9.601(2) A, final R = 0.031 for 958 reflections. The anion contains a Re 3 triangle edge-bridged by one methoxy and two hydroxy ligands and capped by a methoxy group. No formal Re-Re bond (Re ⋯ Re 3.423 and 3.439 A is envisaged. Possible mechanisms for the formation of 1, 2 and 3 are proposed.

A good knowledge of midfoot biomechanics is important in understanding the biomechanics of the entire foot, but it has never been investigated thoroughly in the literature. This study carried out in vitro experiments and finite element analysis to investigate the midfoot biomechanics. A foot-ankle finite element model simulating the mid-stance phase of the normal gait was developed and the model validated in in vitro experimental tests. Experiments used seven in vitro samples of fresh human cadavers. The simulation found that the first principal stress peaks of all midfoot bones occurred at the navicular bone and that the tensile force of the spring ligament was greater than that of any other ligament. The experiments showed that the longitudinal strain acting on the medial cuneiform bone was -26.2±10.8 μ-strain, and the navicular strain was -240.0±169.1 μ-strain along the longitudinal direction and 65.1±25.8 μ-strain along the transverse direction. The anatomical position and the spring ligament both result in higher shear stress in the navicular bone. The load from the ankle joint to five branches of the forefoot is redistributed among the cuneiforms and cuboid bones. Further studies on the mechanism of loading redistribution will be helpful in understanding the biomechanics of the entire foot.

Objective With the success of DRGs (Diagnosis Related Groups) in developing countries, this prospective payment system has been imported into China from the early 21(st) century. However, DRGs has been struggling and has made little progress since (its adoption in) 2004. This study contributes to the debate on how to bridge the pay-for-service (system/scheme) and DRGs (Diagnosis Related Groups) during the transitional period of payment reform in China. Methods From 2008 to 2012, sixty regional general hospitals in Shanghai were divided into three groups according to their economic level, and one hospital was picked from each group randomly. After ranking of morbidity, 22130 patients with hypertension or coronary heart disease were chosen as sample. Using multiple linear regression analysis, the inter relationships between the total medical expenses of the inpatients, and age, gender of the inpatients, length of stay, region and economic level of the hospitals were examined. Results The main findings were (1) Age, LOS and the economic level of treatment location had a statistically significant impact on patients with hypertension or coronary heart disease. However, gender is only a significant factor to patients with coronary heart disease. The results suggested that age, LOS and the economic level of treatment location should be considered in formulating pricing standards for the hypertension patient group. Besides the above mentioned factors, gender should also be considered in formulating pricing standards for the coronary heart disease patient group. (2) Under the premise of limited resources, developing countries should first narrow down to screen for common and frequently occurring diseases, then study the key factors which affect the treatment cost of the diseases. Conclusion Simplification of the DRGs standard- setting process based on standardized clinical pathways and accurate costing will greatly increase the efficiency of implementing DRGs in the developing world.