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Haomiao Li,1 Jiangyun Chen,2 Dai Su,3 Xiwu Xu,4 Ruibo He1,5 1School of Political Science and Public Administration, Wuhan University, Wuhan, Hubei, People’s Republic of China; 2Institute of Health Management, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China; 3Department of Health Management and Policy, School of Public Health, Capital Medical University, Beijing, People’s Republic of China; 4School of Economics and Management, Beijing Jiaotong University, Beijing, People’s Republic of China; 5College of Finance and Public Administration, Hubei University of Economics, Wuhan, Hubei, People’s Republic of ChinaCorrespondence: Ruibo He, School of Political Science and Public Administration, Wuhan University, Wuhan, Hubei, 430072, People’s Republic of China, Email heruibo27@163.comPurpose: The coexistence of multimorbidity and frailty is more likely to increase the risk of physical limitations, mortality and other adverse health outcomes in older adults than their individual occurrence. However, whether and how this coexistence is associated with catastrophic health expenditure (CHE) has not been well assessed. This study aimed to evaluate the independent and coexisting effects of frailty and multimorbidity on CHE.Participants and Methods: A total of 4838 participants obtained from the China Health and Retirement Longitudinal Study (CHARLS) without CHE at baseline (2011) were included in the analytical sample. Marginal structural model (MSM) and time-varying Cox regression model were used to assess the independent and co-occurring impact of frailty and multimorbidity on CHE, respectively.Results: Suffering from single chronic disease (HR, 1.26; 95% CI, 1.13– 1.40; P < 0.001), multimorbidity (HR, 1.80; 95% CI, 1.63– 1.99; P < 0.001) and frailty (HR, 1.32; 95% CI, 1.21– 1.45; P < 0.001) were associated with a higher risk of CHE. Frailty co-occurring with a single chronic disease (HR, 1.28; 95% CI, 1.03– 1.60; P = 0.027) or multimorbidity (HR, 1.91; 95% CI, 1.56– 2.32; P < 0.001), and multimorbidity co-occurring with frailty also increased CHE risk (HR, 1.32; 95% CI, 1.17– 1.48; P < 0.001) compared with single frailty or multimorbidity status.Conclusion: Preventing, postponing, or reducing frailty, and enhancing standard management of chronic diseases are essential in reducing healthcare costs and preventing families from poverty. More efficient interventions for frailty and multimorbidity are urgently required.Keywords: frailty, multimorbidity, catastrophic health expenditure, co-occurrence

ObjectivesThis study aims to examine trends in neighbourhood availability of community-based home visiting services (CHVS) (ie, coverage by local primary healthcare providers) over time and disparities in service availability according to individual characteristics using nationwide data of oldest-old individuals (age >80) in China.DesignRepeated, cross-sectional study.SettingThis study derived nationally representative data from the 2005–2018 Chinese Longitudinal Health Longevity Survey.ParticipantsA final analytical sample of 38 032 oldest-old individuals.Primary outcome measuresAvailability of CHVS was defined as having home visiting services in one’s neighbourhood. Cochran-Armitage tests were used to test linear trends in the proportions of oldest-old with service availability. Weighted logistic regression models were used to examine variations in service availability across individual characteristics.ResultsOf 38 032 oldest-old individuals, availability of CHVS decreased from 9.7% in 2005 to 7.8% in 2008/2009, followed by continual increases to 33.7% in 2017/2018. These changes were similar between rural and urban oldest-old. After accounting for individual characteristics, in 2017/2018, compared with their counterparts, urban residents who had white-collar jobs before retirement and those residing in Western and Northeast China were less likely to have service availability. Oldest-old with disabilities, those living alone and those with low incomes did not report having greater availability of CHVS in either 2005 or 2017/2018.ConclusionsDespite the increasing service availability over the past 13 years, persistent geographical disparities in the availability of CHVS remain. As of 2017/2018, only one in three oldest-old in China reported having service availability, which raises concerns regarding continuity of care across different settings of services for those most in need, especially those living alone or with disabilities. National policies and targeting efforts are necessary to improve the availability of CHVS and reduce inequity in service availability for optimal long-term care to the oldest-old population in China.

Background Although the common risk factors were identified and controlled for many years, the overall prevalence of chronic diseases continued to increase in China. Objective We presumed the leisure sedentariness as a latent but pivotal factor of chronic diseases, and examined its distribution and changing trend, analysed its interaction effects on common risk factors, which could provide a new perspective for the prevention and management. Methods A total of 5013 participants were screened out from China Health and Nutrition Survey. Random-effects ordered logistic models were used for ordinal dependent variables, and fixed-effects or random-effects logit models were used for binary dependent variables. Results From 2004 to 2011, the prevalence of high leisure sedentary time (LSED) increased by 58.58%. Members of the high LSED group were likely to choose fast food, salty snacks, soft drinks and more likely to smoke or drink alcohol compared with those of the low LSED group. However, they preferred walking, sports and body building more than those of the low LSED group. Conclusions For the unhealthy dietary, tobacco and alcohol consumption, more targeted introduction and guidance related to sedentary time should be promoted. Meanwhile, the appeal for physical exercise as well as adequate facilities should be initiated.

Background Extending service scope of primary care facilities (PCFs) has been widely concerned in China. However, no current data about association between service scope of PCFs with patient outcomes are available. This study aims to investigate association between service scope of PCFs and patient outcomes. Methods A multistage, stratified clustered sampling method was used to collect information about service scope of PCFs from rural Guizhou, China. Claim data of 299,633 inpatient cases covered by 64 PCFs were derived from local information system of New Rural Cooperation Medical Scheme. Service scope of PCFs was collected with self-administrated questionnaires. Primary outcomes were (1) level of inpatient institutions, (2) length of stay, (3) per capita total health cost, (4) per capita out-of-pocket cost, (5) reimbursement ratio, (6) 30-day readmission. A total of 64 PCFs were categorized into five groups per facility-level service scope scores. Generalized linear regression models, logistic regression model, and ordinal regression model were conducted to identify association between service scope of PCFs and patient outcomes. Results On average, the median service scope score of PCFs was 20, with wide variation across PCFs. After controlling for demographic and clinical characteristics, patients living in communities with PCFs of greatest service scope (Quintile V vs. I) tended to have smaller rates of admission by county-level hospitals (-6.2 % [-6.5 %, -5.9 %], city-level hospitals (-1.9 % [-2.0 %, -1.8 %]), and provincial hospitals (-2.1 % [-2.2 %, -2.0 %]), smaller rate of 30-day readmission (-0.5 % [-0.7 %, -0.2 %]), less total health cost (-201.8 [-257.9, -145.8]) and out-of-pocket cost (-210.2 [-237.2, -183.2]), and greater reimbursement ratio (2.3 % [1.9 %, 2.8 %]) than their counterparts from communities with PCFs of least service scope. Conclusions Service scope of PCFs varied a lot in rural Guizhou, China. Greater service scope was associated with a reduction in secondary and tertiary hospital admission, reduced total cost and out-of-pocket cost, and 30-day readmission and increased reimbursement ratio. These results raised concerns about access to care for patients discharged from hospitals, which suggests potential opportunities for cost savings and improvement of quality of care. However, further evidence is warranted to investigate whether extending service scope of PCFs is cost-effective and sustainable.

Objective To determine factors influence place of death (POD) for end-stage cancer patients and investigate how the healthcare utilization mediates on the effect of socioeconomic status (SES) on POD. Design A population-based, retrospective study from July 2015 to June 2017. Setting Yichang, China. Participants 894 end-stage cancer patients. Main outcome measure POD. Results Patients of hospital death experience more inpatient hospitalization services (IHS) and emergency department visits. Patients enrolled in the New Rural Cooperative Medical Scheme (OR = 7.60, P < 0.001) and Urban Employee Basic Medical Insurance (OR = 28.0, P < 0.001) have higher rates of hospital death than those in the Urban Resident-based Basic Medical Insurance. Living with spouse (OR = 1.72, P = 0.019) and receiving higher education (OR = 1.92, P = 0.004), increase the likelihood of hospital death by 72% and 92%, respectively. The probability of hospital death will increase by 14% and decrease by 4% per IHS and outpatient services occur, respectively. Outpatient services (Z = −2.28, P < 0.001), and IHS (Z = 2.17, P < 0.001) mediate 1.81% and 1.89%, respectively, of the effect of health insurance on POD. The overall effect of the mediators is non-statistically significant (Z = 0.09, P = 0.825). Conclusion POD is mainly driven by SES. The relationship between health insurance and POD is partly mediated by outpatient services and IHS, respectively. The results corroborated that hospital and home services should be coherently bridged. Furthermore, benefit packages for end-stage cancer patients could be redesigned.

To construct a value-based healthcare system for rural Chinese hypertensive patients through an increasing outpatient care reimbursement ratio.This comparative study sampled two similar counties, Dangyang County and Zhijiang County, in Hubei Province of China, as the intervention group and the control group, respectively. The Social Health Insurance Fund of the intervention group budgeted 600 yuan per capita per year to insured patients with third stage hypertension to cover their outpatient expenditures, while the outpatient expenditures of the control group were not covered by its Social Health Insurance Fund. The inpatient expenditure reimbursement policies in both groups were not adjusted during the study. Value improvement in this study was defined as reduction in medical costs and improvement in health outcomes within the pilot healthcare system. A propensity score matching model combined with a difference-in-differences model was used to estimate the changes in medical costs and health outcomes.In total, 1,673 pairs of patients were enrolled into statistical analysis after the propensity score matching. The intervention increased per capita annual outpatient expenditure by 81.2 (+31.8%) yuan (p .05), but decreased the per capita annual inpatient expenditure and total medical expenditure by 475.4 (-40.7%) yuan and 394.2 (-27.7%) yuan, respectively (p .05). Accordingly, the per capita annual total medical expenditure reimbursement decreased by 192.3 (-28.5%) yuan (p .05), and the per capita annual total out-of-pocket expenditure by 201.9 (-29.9%) yuan (p .05). The diastolic blood pressure of the intervention group decreased significantly by 2.9 mmHg (p .05), but no significant change was found in systolic blood pressure and prevalence of hypertension complications (p .05).Increasing the outpatient expenditures, the reimbursement ratio was beneficial to the value of the healthcare system for hypertensive patients. Outpatient care for patients with chronic diseases should be prioritized for rural China and healthcare settings with inadequate health insurance funds.

Background: Extending the service scope of primary care facilities (PCFs) has been widely concerned in China. However, no current data about the association between service scope of PCFs with patient outcomes are available. This study aims to investigate the association between service scope of PCFs and patient outcomes. Methods: We first sampled four counties randomly from rural Guizhou, China. Claim data of 299,633 inpatient cases covered by 64 PCFs were derived from the local information system of New Rural Cooperation Medical Scheme. The service scope of PCFs was collected with self-administrated questionnaires. Primary outcomes were 1) level of inpatient institutions, 2) length of stay, 3) per capita total health cost, 4) per capita out-of-pocket cost, 5) reimbursement ratio, 6) 30-day readmission. A total of 64 PCFs were categorized into five groups per facility-level service scope scores. Generalized linear regression models, logistic regression model, and ordered regression model were conducted to identify the association between service scope of PCFs and patient outcomes. Results: On average, the median service scope score of PCFs was 20, with wide variation across PCFs. After controlling for demographic and clinical characteristics, patients living in communities with PCFs of greatest service scope (Quintile V vs. I) tended to have smaller rates of admission by county-level hospitals (-6.2% [-6.5%, -5.9%], city-level hospitals (-1.9% [-2.0%, -1.8%]), and provincial hospitals (-2.1% [-2.2%, -2.0%]), smaller rate of 30-day readmission (-0.5% [-0.7%, -0.3%]), less total health cost (-201.8 [-257.9, -145.8]) and out-of-pocket cost (-210.2 [-237.2, -183.2]), and greater reimbursement ratio (2.3% [1.9%, 2.8%]) than their counterparts from communities with PCFs of least service scope.Conclusion: The service scope of PCFs varied a lot in rural Guizhou, China. PCFs' greater service scope was associated with a reduction in secondary and tertiary hospital admission, reduced total cost and out-of-pocket cost, and 30-day readmission and increased reimbursement ratio. These results raised concerns about access to care for patients discharged from hospitals, which suggests potential opportunities for cost savings and improvement of quality of care. However, further evidence is warranted to investigate whether extending the service scope of PCFs is cost-effective and sustainable.

Global budget (GB) is considered one of the most important payment methods available. Since a new round of healthcare system reforms in 2009, the Chinese government has been paying attention to this prospective payment. However, it is unclear whether GB has influenced cost control and how it works in rural China.YC county was chosen as the intervention group, with 33,175 inpatients before and 36,883 inpatients after the reform (2012 and 2014, respectively). ZJ county acted as the control group, with 23,668 and 29,555 inpatients, respectively. The inpatients' information was collected from a local insurance agency. The difference-in-difference method (controlling for age, gender, living status, severity of the disease, whether the patient had surgery, the level of medical institutions, and the secular trends of the two groups) was applied to estimate the effects on total spending (TS), reimbursement expense (RE), out-of-pocket payment (OOP), readmission rate, and seven kinds of medical service items.At per practice level, the GB was associated with a ¥263.35 (p .001) and ¥447.46 (p .001) decrease in growth of TS and RE, respectively, while OOP increased by ¥188.06 (p .001). At per capital level, the decrease in growth of TS and RE was ¥64.39 (p = .301) and ¥467.45 (p .001), respectively, whereas the increase of OOP was more significant at ¥408.19 (p .001). Savings were concentrated in unclassified items (¥197.68, p .001), drug prescription (¥69.03, p .001), surgery (¥40.18, p .001), cure (¥4.95, p = .565), and diagnosis (¥3.61, p = .064). Meanwhile, the readmission rate increased by 11.4% (p .001).The GB has a prominent impact on curbing the growth of insurance fund expenditures, as well as drug and medical consumable costs. However, the patients' out-of-pocket payment has risen. Doctors decomposed hospitalization to deal with supervision, which was harmful to patients. Any medical insurance payment reform should be undertaken prudently, and its likely outcomes should be weighed comprehensively.

Background Self-treatment is a common and widespread behaviour, of which the risks are multiplied in old age. However, the determinants of self-treatment among elders in rural China remain unclear. This study aims to explore the prevalence and associated factors of self-treatment among elders in rural China, trying to discover the vulnerable groups as well as the service gaps among the rural elders. Methods Based on a multi-stage stratified random sampling method, a cross-sectional household survey was conducted among 30 villages in Sinan County, an impoverished county in western China. Data were collected through a household–individual combined questionnaires. The analysis was restricted to elders who reported illness within the last 2 weeks, and the final sample size was 330 (individuals). Bivariate and multiple logistic regression analysis were performed in the whole sample group and four subgroups to obtain the prevalence ratios regarding the associated factors. Results In the present study, 35.2% of the elders with illness within the last 2 weeks reported self-treatment. The variables associated with self-treatment in the whole sample group were health status (OR 6.75, 95%CI 1.93–23.60), recent alcohol consumption (OR 0.42, 95%CI 0.21–0.83) and the utilisation of family practice services (OR 0.59, 95%CI 0.36–0.96); the same predictors were found in the subgroup of elders with chronic diseases. No significant predictors were found in the subgroup of elders without chronic diseases. Empty-nest elders with higher affinity to traditional Chinese medicine (OR 0.39, 95%CI 0.18–0.86) or drinking alcohol recently (OR 0.28, 95%CI 0.09–0.82) were less likely to self-treat, while the non-empty-nest elders who were no less than 75 years old (OR 3.10, 95%CI 1.33, 7.22) or at better health status (OR 9.20, 95%CI 1.73–48.75) were more likely to self-treat. Conclusion Self-treatment was prevalent among the elders in rural China. Better health status, no recent alcohol consumption and no utilisation of family practice are associated with self-treatment among rural elders. Older elders in the non-empty nest group were more likely to self-treat, while the empty-nest elders with self-care habits in traditional Chinese medicine were less likely to self-treat. Deeper understanding of the self-treatment behaviour among rural elders may provide insights for identifying the potential service gaps and developing improvement strategies in the health care delivery system for the elderly in China.

Background Self-treatment is a common and widespread behaviour, of which the risks are multiplied in old age. However, the determinants of self-treatment among elders in the current rural China remain unclear. This study aims to explore the determinants of self-treatment among elders in rural China, focusing on context-specific and multi-dimensional factors. Methods Based on a multi-stage stratified random sampling method, a cross-sectional household survey was conducted among 30 villages in Sinan County, Guizhou Province in western China. Data were collected through a self-administered questionnaire on the healthcare needs of residents. The analysis was restricted to elders who reported illness within the last 2 weeks, and the final sample size was 338 (individuals). Pearson’s chi-squared test and binary logistic regression analysis were performed among the whole sample group and four subgroups. Results Approximately 25.94% of the 1303 elders reported illness within the last 2 weeks, of whom 34.4% indicated self-treatment. The variables independently associated with a greater probability of self-treatment in the whole sample group were better health status, no recent alcohol consumption and no utilisation of family practice services; the same predictors were found in the subgroup of elders with chronic diseases. No significant predictors were found in the subgroup of elders without chronic diseases. Empty-nest elders with higher affinity to traditional Chinese medicine (TCM) and drinking alcohol recently were less likely to self-treat. Non-empty-nest elders who were no less than 75 years old and at better health status were more likely to self-treat. Conclusion Better health status, no recent alcohol consumption and no utilisation of family practice are associated with self-treatment among rural elders. Advanced age and self-care habits in TCM also play roles in some subgroups. Deeper understanding of the self-treatment behaviour among rural elders may provide insights for developing improvement strategies of the family practice system in China.

Background: As the principal means of reimbursing medical institutions, the effects of case payment still need to be evaluated due to special environments and short exploration periods, especially in rural China. Methods: Xi County was chosen as the intervention group, with 36,104, 48,316, and 59,087 inpatients from the years 2011 to 2013, respectively. Huaibin County acted as the control group, with 33,073, 48,122, and 51,325 inpatients, respectively, from the same period. The inpatients&rsquo, information was collected from local insurance agencies. After controlling for age, gender, institution level, season fixed effects, disease severity, and compensation type, the generalised additive models (GAMs) and difference-in-differences approach (DID) were used to measure the changing trends and policy net effects from two levels (the whole county level and each institution level) and three dimensions (cost, quality and efficiency). Results: At the whole-county level, the cost-related indicators of the intervention group showed downward trends compared to the control group. Total spending, reimbursement fee and out-of-pocket expense declined by &yen, 346.59 (p &lt, 0.001), &yen, 105.39 (p &lt, 0.001) and &yen, 241.2 (p &lt, 0.001), respectively (the symbol &yen, represents Chinese yuan). Actual compensation ratio, length of stay, and readmission rates exhibited ascending trends, with increases of 7% (p &lt, 0.001), 2.18 days (p &lt, 0.001), and 1.5% (p &lt, 0.001), respectively. The intervention group at county level hospital had greater length of stay reduction (&yen, 792.97 p &lt, 0.001) and readmission rate growth (3.3% p &lt, 0.001) and lower reimbursement fee reduction (&yen, 150.16 p &lt, 0.001) and length of stay growth (1.24 days p &lt, 0.001) than those at the township level. Conclusions: Upgraded case payment is more reasonable and suitable for rural areas than simple quota payment or cap payment. It has successfully curbed the growth of medical expenses, improved the efficiency of medical insurance fund utilisation, and alleviated patients&rsquo, economic burden of disease. However, no positive effects on service quality and efficiency were observed. The increase in readmission rate and potential hidden dangers for primary health care institutions should be given attention.

This study was conducted to investigate the trajectory of hospitalization costs, and to assess the determinants related to the membership of the identified trajectories, with the view of recommending future research directions. A retrospective study was performed in urban Yichang, China, where a total of 134 end-stage lung cancer patients were selected. The latent class analysis (LCA) model was used to investigate the heterogeneity in the trajectory of hospitalization cost amongst the different groups that were identified. A multi-nominal logit model was applied to explore the attributes of different classes. Three classes were defined as follows: Class 1 represented the trajectory with minimal cost, which had increased over the last two months. Classes 2 and 3 consisted of patients that incurred high costs, which had declined with the impending death of the patient. Patients in class 3 had a higher average cost than those in Class 2. The level of education, hospitalization, and place of death, were the attributes of membership to the different classes. LCA was useful in quantifying heterogeneity amongst the patients. The results showed the attributes were embedded in hospitalization cost trajectories. These findings are applicable to early identification and intervention in palliative care. Future studies should focus on the validation of the proposed model in clinical settings, as well as to identify the determinants of early discharge or aggressive care.

Background Through a review of the literature, we have observed that existing studies primarily focus on defining and measuring poverty, identifying the factors that affect poverty, and proposing anti-poverty strategies. The impact of health on income in the context of extreme poverty has not been adequately studied. In China, 30 million people live below the poverty line, and poverty caused by illness accounts for nearly 44% of the total number of recorded incidents. Health impaired by disease has become the largest obstacle to escaping extreme poverty. Objective To determine whether health has a greater effect on the incomes of individuals in the extreme poverty group compared with the nonimpoverished group. Methods The poverty threshold of China in 2010 was adopted for the definition of extreme poverty. The China Health and Nutrition Survey (CHNS) Database 2014 was selected as the data source. Ordinary least squares (OLS) test was conducted to estimate the model, and the endogeneity of the variables was analyzed by the random effects model. Waist-to-hip ratio (WHR) was used instead of body mass index (BMI) to perform the robustness test. Results We found that the influence of individual health conditions on income was augmented in the case of extreme poverty, which indicates that health indeed influences income more strongly for individuals in the extreme poverty group. Conclusions In addition to education, investment, and social security projects, further public policy attention should be given to the improvement of the health status of the extremely impoverished population.

Background China has set up a universal coverage social health insurance system since the 2009 healthcare reform. Due to the inadequate funds, the social health insurance system reimbursed the inpatient expenditures with much higher ratio than outpatient expenditure. The gap in reimbursement ratios resulted in a rapid rising hospitalization rate but poor health outcomes among the Chinese population. A redistribution of social health insurance funds has become one of the main challenges for the performance of Social Health Insurance. Methods Two comparable counties, Dangyang County and Zhijiang County, in Hubei Province of China, were sampled as the intervention group and the control group, respectively. The Social Health Insurance Management Department of the intervention group budgeted 600 yuan per capita per year to the patients with 3rd stage hypertension to cover their outpatient expenditures. The outpatient spending in the control group were paid out-of-pocket. The inpatient expenditures reimbursement policies in both groups were not changed. Besides, the Social Health Insurance Management Department of the intervention group budgeted 100 yuan per patient per year to township physicians and hospitals to provide health management services for the patients. While, the health management services in the control group were still provided by health workers. A Propensity Score Matching model and Difference-in-differences model were used to estimate the net effects of the intervention in dimensions of medical services utilization, medical expenditures, SHI reimbursement, and health outcomes. Results One thousand, six hundred and seventy three pairs of patients were taken as valid subjects to conduct Difference-in-differences estimation after the Propensity Score Matching. The net intervention effect is to increase outpatient frequency by 3.3 (81.0%) times (P 0.05). Conclusion For China and countries attempting to establish a universal coverage SHI with inadequate funds, inpatient services were expensive but might not produce good health outcomes. Outpatient care for patients with chronic diseases should be fundamental, and outpatient expenditures should be reimbursed with a higher ratio.

The three-blade planetary mixer is one of the important solid propellant mixing equipment, the layout of blades will affect the blades’ torque load and the power consumption. In this paper, the effects of the eccentric distance (Es=0∼16 mm), the solid blade form (two paddles, and four paddlers), and the blade arrangement (linear arrangement, triangle arrangement) on the blades’ torque load are investigated during the mixer stirring the solid propellant process.

Air entrainment is among the key issues in solid–liquid mixing operations. In this paper, both analytical and finite element methods are employed to study the relationship between the volume of entrained air and the changes of capacitance. With a capacitance sensor installed at the bottom of the stirred tank, an experimental platform is established, which integrates a stirring system and a capacitive detection system. The pitched-blade turbines with four blades (PBT-4) are employed as the impellers in the experimental system and made of Plexiglas. Afterwards, the experiments are conducted with an empty tank to study the influences of propellers on capacitance. The capacitance values are measured at different stirring speeds in the single-phase (deionized water) and two-phase (deionized water and glass beads) stirring systems and applied in the assessment of air entrainment. The results are as follows. In the single-phase system, there is scarcely any air entrained in stirred tanks at low stirring speeds, and air entrainment occurs after the stirring speed ( N ) reaches a certain value. In the two-phase system, air entrainment is not observed obviously when the solid particles are at rest, but can be found after solid particles are mixed uniformly. Nevertheless, in the transition period between the two regions above, the capacitance becomes increasingly larger along with the growth of N due to the decrease of volume fraction of solid particles in the sensing area, which hinders the assessment of air entrainment. The discussions in this paper may serve as guidelines for solid–liquid mixing processes and can be further generalized for the assessment of air entrainment in solid–liquid mixing operations under other different parameters.

SUMMARYBased on product of exponentials (POE) formula, three explicit error models are given in this paper for kinematic calibration of serial robot through measuring its end-effector positions. To obtain these error models, the tool frame should be chosen as reference frame at first, and then each position–error-related segment in the error models using pose measurement should be selected. And during kinematic parameter identification, all the errors in joint twists are identifiable, and the initial transformation errors and the joint zero-position errors can be identified conditionally. Namely, the initial transformation errors are identifiable if they do not contain orientation errors. And the joint zero-position errors are identifiable when a robot only consists of prismatic joints and the coordinates of its joint twists are linearly independent.The effectiveness of this calibration method has been validated by simulations and experiments. The results show that: (1) the identification algorithms are robust and practical. (2) The method of position measurement is superior to that of pose measurement.

Background : Continuity of care (COC) is considered a principle of primary care and is widely believed to reduce healthcare utilization and mortality. Yet, little is known about the association between COC and patients’ satisfaction in China. Objective : To assess the effect of COC on satisfaction in adult patients with hypertension in China. Design : A cohort study was carried out in six towns of the Qianjiang District, Chongqing from July 2012 to June 2014. Claim-based longitudinal data from hypertension follow-up services records were used to calculate the continuity of care index (COCI). Survey-based self-reported data were used to assess patients’ satisfaction and to estimate the propensity score. A total of 1079 hypertensive patients aged 35 years and older were selected as a study sample. Methods : Hypertensive patients were categorized into two groups according to COCI. The group with poor continuity served as the control and then matched to the high continuity group using the propensity score. The average treatment effect on the treated (ATT) was estimated. Results : There were no statistically difference between high COC group and low COC group on satisfaction. Conclusion : After eliminating the selection bias and reversing causality, continuity of hypertension care may not improve hypertensive patients’ satisfaction.

ObjectiveThis study aimed to define the end-of-life (EOL) healthcare utilisation and its cost and determinants for cancer patients and to proactively inform related strategies in mainland China.DesignA population-based retrospective study.Setting and participantsData from 894 cancer patients were collected in urban Yichang, China from 01 July 2015 to 30 June 2017.Outcome measuresEmergency department (ED) visits, outpatient and inpatient hospitalisation services, intensive care unit (ICU) admission and total costs were used as the main outcomes.ResultsIn this study, 66.8% of the 894 patients were male, and the average age was 60.4 years. Among these patients, 37.6% died at home, and patients had an average of 4.86 outpatient services, 2.23 inpatient hospitalisation services and 1.44 ED visits. Additionally, 5.9% of these patients visited the ICU at least once. During the EOL periods, the costs in the last 6 months, 3 months, 1 month and 1 week were US$18 234, US$13 043, US$6349 and US$2085, respectively. The cost increased dramatically as death approached. The estimation results of generalised linear regression models showed that aggressive care substantially affected expenditure. Patients with Urban Employee Basic Medical Insurance spent more than those with Urban Resident-based Basic Medical Insurance or the New Rural Cooperative Medical Scheme. The place of death and the survival time are also risk factors for increased EOL cost.ConclusionThe findings suggested that the EOL cost for cancer patients is associated with aggressive care, insurance type and survival time. Timing palliative care is urgently needed to address ineffective and irrational healthcare utilisation and to reduce costs.Ethics and disseminationThis study was approved by the Ethics Committee of the Tongji Medical College, Huazhong University of Science and Technology (IORG No.: IORG0003571). All the data used in this study were de-identified.

This paper presents a generic error model, which is based on the product of exponentials (POEs) formula, for serial-robot calibration. The identifiability of parameters in this error model was analyzed. The analysis shows the following: 1) Errors in all joint twists are identifiable. 2) The joint zero-position errors and the initial transformation errors cannot be identified when they are involved in the same error model. With either or neither of them, three practicable error models were obtained. The joint zero-position errors are identifiable when the following condition is satisfied: Coordinates of joint twists are linearly independent. 3) The maximum number of identifiable parameters is 6n + 6 for an n-degree-of-freedom (DOF) generic serial robot. Simulation results show the following: 1) The maximum number of identifiable parameters is 6r + 3t + 6, where r is the number of revolute joints, and t is the number of prismatic joints. 2) All the kinematic parameters of the selective compliant assembly robot arm (SCARA) robot and programmable universal machine for assembly (PUMA) 560 robots were identified by using the three error models, respectively. The error model based on the POE formula can be a complete, minimal, and continuous kinematic model for serial-robot calibration.

OBJECTIVE To study the effect of geniposide on treating experimental CP rats. METHOD The animal model of CP was made with rats by injecting hemorrhoid injection. Rats in experiment group were randomly devided into model group, Qianliekang tablets group (2 g x kg(-1)) and geniposide high, middle, low dose groups (20, 10, 5 mg x kg(-1)). Subsequently, the state of all rats, prostate index, WBC and lecithine corpuscle, LDH5/LDH1, and prostatic histopathological changes were observed. Count of total cellular score (TCS) and quantitation of inflammatory cell, fibroblasts, glandular organ, calculation of glandular cavity area, and their changes of morphology were analyzed. RESULT Compared with model group, the prostate index, WBC and LDHS/LDH1 of the rats in Qianliekang tablets group, high dose geniposide group and middle dose geniposide group were significantly decreased, while the quantities of lecithine corpuscle were remarkably increased (P < 0.01 or P < 0.05). Compared with model group, the number of inflammatory cells and fibroblasts in Qianliekang tablets group, high dose geniposide group were decreased, and the quantity of glandular organ and area of glandular cavity in these groups were increased (P < 0.05 or P < 0.01). CONCLUSION Geniposide of high and middle dose can reduce leucocytes infiltration, restrain the hyperplasia of fibrous tissue, and recover the secretion function of prostate. It show that geniposide is significantly potential to cure rats which are exposed to chronic prostatitis.

This article has studied the impact of double-shaft mixing paddle undergoing planetary motion on laminar flow mixing system using flow field visualization experiment and computational fluid dynamics simulation. Digital image processing was conducted to analyze the mixing efficiency of mixing paddle in co-rotating and counter-rotating modes. It was found that the double-shaft mixing paddle undergoing planetary motion would not produce the isolated mixing regions in the laminar flow mixing system, and its mixing efficiency in counter-rotating modes was higher than that in co-rotating modes, especially at low rotating speed. According to the tracer trajectory experiment, it was found that the path line of the tracer in the flow field in co-rotating modes was distributed in the opposite direction to the path line in counter-rotating modes. Planetary motion of mixing paddle had stretching, shearing, and folding effects on the trajectory of the tracer. By means of computational fluid dynamics simulation, it was found that axial flows and tangential flows produced in co-rotating and counter-rotating modes have similar flow velocity but opposite flow directions. It is deduced from the distribution rule of axial flow, radial flow, and tangential flow in the flow field that axial flow is the main reason for causing different mixing efficiencies between co-rotating and counter-rotating modes.