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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.

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BACKGROUND Distal tibial fracture often present a challenge to the orthopaedic surgeon. The best option for surgical management of distal tibial fracture is still unclear, whether nail or plate. MATERIALS AND METHODS The study consists of 24 patients of distal tibial fracture treated either with reamed intramedullary nails or locked plating/MIPPO with open reduction method or minimally-invasive techniques. RESULTS 24 patients included in the present study were divided into two groups as nailing group A and plating group B. Nailing group included 12 patients and plating group included 12. Age range of patients was 21-62 years. Most common mode of trauma in both groups as RTA followed by accidental fall in 2 cases. The average time for union and weightbearing was 19 weeks in group A and 20.08 weeks in group B. Complications like malalignment, more surgical time were seen in group A and surgical site infection, skin necrosis, prolonged immobilisation were seen in group B. CONCLUSION Both IM nailing and plating are optional methods of treatment. Intramedullary nailing in distal tibial fractures result in early mobilisation is an easier technique, more economical and has fewer complications rate. Plating is preferred in cases where fracture is very close to ankle mortise and associate with higher rate of wound complications.

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.

A density functional theory (DFT) approach employing generalized gradient approximation (GGA) and the modified Becke Johnson (TB-mBJ) potential has been used to study the electronic and thermoelectric (TE) properties of ZrxHf1−x−yTayNiSn.

The structural and magnetic properties of Co2CrGe, a Heusler alloy have been evaluated by first principles density functional theory through total energy calculations at 0 K by the full potential linearized augmented plane wave (FP-LAPW) method as implemented in WIEN2K code. The calculated results were compared with the previously reported results. Generalized gradient approximation (GGA) was used to study the structural and magnetic properties of Co2CrGe.

An experiment was conducted on 48 New Zealand White rabbits of either sex for evaluating the effect of supplementing spirulina and thyme on nutrient digestibility and feed conversion ratio (FCR). Rabbits were randomly assigned to four treatments in three tier cages, divided into two compartments, housing six rabbits in each compartment, in controlled environmental conditions during the feeding trial of 56 days. The experiment consisted of four dietary treatments. Treatment group T1 was fed with control diet as per ICAR (2008) guidelines with concentrate mixture formulated using maize, soybean meal, ground nut cake, gram, mineral mixture and common salt. In treatment groups T2, T3 and T4, concentrate mixture as used in control group was supplemented with 5% spirulina, 3% thyme and 5% spirulina plus 3% thyme, respectively. At the end of experiment a digestibility trial was conducted for 7 days and the results revealed that digestibility of dry matter, crude protein, crude fiber and NFE of rabbits fed with supplementation of 5% spirulina and 3% thyme in combination was significantly higher than rabbits fed control diet. The EE and ash digestibility of rabbits under different treatments remain statistically similar. The results of the study also revealed that mean values of FCR of rabbits fed with thyme or combination of thyme with spirulina supplementation was higher than rabbits of control group or supplemented with spirulina alone.

INTRODUCTION Albumin is the name used to describe proteins readily soluble in water and coagulate by heating. The most abundant protein found in the serum is albumin in humans. Albumin is the key transporting medium i.e. it helps to transport the hydrophobic substances from the blood stream. The normal serum level is 3.2-5.1g/dL. It forms 56% of the total protein. Anything below 2g/dL is known as hypoalbuminemia. The aim of the study is to find out the pre-operative serum level and try to find out the complications associated with hypoalbuminemia and surgical complications. The study was done in KVG Medical College, Sullia. Seventy five patients were selected irrespective of the sex and divided into three groups based on the age. In the present study it is very clear that the serum albumin reflects the overall outcome of the surgery. As the age progresses the amount of hypoalbuminemia encountered is high. The amount of hospital stay also depends on the protein level. Albumin is no doubt the healer protein of the body. As the albumin level decreases the complications faced by the patients drastically increases.