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Qualitative analysis of direction of public hospital reforms in China

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《医学前沿（英文）》 2018年第12卷第2期页码 218-223 doi: 10.1007/s11684-017-0534-7

摘要：

Reforms in public hospitals are among the most important improvements in China’s health care system over the last two decades. However, the reforms that should be implemented in public hospitals are unclear. Thus, a feasible direction of reforms in Chinese public hospitals is suggested and reliable policy suggestions are provided for the government to reform public hospitals. The data used in this study were mainly derived from a qualitative study. Focus group discussions and in-depth interviews were conducted in Shanghai, Guangdong, and Gansu between May and December 2014. Government funding accounted for approximately eight percent of the total annual revenue of public hospitals in China, and the insufficient government subsidy considerably affects the operation mechanism of public hospitals. However, solely increasing this subsidy cannot address the inappropriate incentives of public hospitals in China. The most crucial step in setting the direction of reforms in public hospitals in China is transforming inappropriate incentives by implementing a new evaluation index system for directors and physicians in public hospitals.

关键词： public hospital government hospital public funding operation mechanism

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Prevalence and determinations of physical inactivity among public hospital employees in Shanghai, China

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《医学前沿（英文）》 2015年第9卷第1期页码 100-107 doi: 10.1007/s11684-014-0372-9

摘要：

This study aims to explore the prevalence and determinations of physical inactivity among hospital employees in Shanghai, China. A cross-sectional study of 4612 employees aged 19 to 68 years was conducted through stratified cluster sampling from different classes of Shanghai hospitals in 2011. The total physical activity was evaluated using the metabolic equivalent according to the Global Physical Activity Questionnaire. Among the participants, 38.5%, 32.3%, and 64.6% of the employees are inactive at work, commuting, and taking leisure time, respectively. Up to 41.8% of the men and 37.8% of the women (P = 0.012) are physically inactive. When the age and educational level are adjusted, male doctors and medical technicians show a higher percentage of physical inactivity than male workers in logistics (P = 0.001). Among females, employees who are working in second- and third-class hospitals show a higher proportion of physical inactivity than those who are working in community health care centers. Logistic regression analyses show that the odds ratios (ORs) of leisure-time physical inactivity associated with the intensity of physical activity at work are 2.259, 2.897, and 4.266 for men (P<0.001) and 2.456, 3.259, and 3.587 for women (P<0.001), respectively. The time during commuting activities is significantly associated with leisure-time physical inactivity in either sex (OR= 2.116 for men and 2.173 for women, P<0.001). Hospital employees, particularly doctors and medical technicians, show a higher proportion of physical inactivity than other inhabitants in Shanghai. The time and intensity of activity at work and commuting are associated with leisure-time activities.

关键词： prevalence determination employee public hospital cross-sectional study physical inactivity

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Membrane bioreactors for hospital wastewater treatment: recent advancements in membranes and processes

《化学科学与工程前沿（英文）》 2022年第16卷第5期页码 634-660 doi: 10.1007/s11705-021-2107-1

摘要： Discharged hospital wastewater contains various pathogenic microorganisms, antibiotic groups, toxic organic compounds, radioactive elements, and ionic pollutants. These contaminants harm the environment and human health causing the spread of disease. Thus, effective treatment of hospital wastewater is an urgent task for sustainable development. Membranes, with controllable porous and nonporous structures, have been rapidly developed for molecular separations. In particular, membrane bioreactor (MBR) technology demonstrated high removal efficiency toward organic compounds and low waste sludge production. To further enhance the separation efficiency and achieve material recovery from hospital waste streams, novel concepts of MBRs and their applications are rapidly evolved through hybridizing novel membranes (non hydrophilic ultrafiltration/microfiltration) into the MBR units (hybrid MBRs) or the MBR as a pretreatment step and integrating other membrane processes as subsequent secondary purification step (integrated MBR-membrane systems). However, there is a lack of reviews on the latest advancement in MBR technologies for hospital wastewater treatment, and analysis on its major challenges and future trends. This review started with an overview of main pollutants in common hospital wastewater, followed by an understanding on the key performance indicators/criteria in MBR membranes (i.e., solute selectivity) and processes (e.g., fouling). Then, an in-depth analysis was provided into the recent development of hybrid MBR and integrated MBR-membrane system concepts, and applications correlated with wastewater sources, with a particular focus on hospital wastewaters. It is anticipated that this review will shed light on the knowledge gaps in the field, highlighting the potential contribution of hybrid MBRs and integrated MBR-membrane systems toward global epidemic prevention.

关键词： membrane technology membrane bioreactor hospital wastewater hybrid MBR integrated MBR-membrane system

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SinoSCORE: a logistically derived additive prediction model for post-coronary artery bypass grafting in-hospital

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《医学前沿（英文）》 2013年第7卷第4期页码 477-485 doi: 10.1007/s11684-013-0284-0

摘要：

This study aims to construct a logistically derived additive score for predicting in-hospital mortality risk in Chinese patients undergoing coronary artery bypass surgery (CABG). Data from 9839 consecutive CABG patients in 43 Chinese centers were collected between 2007 and 2008 from the Chinese Coronary Artery Bypass Grafting Registry. This database was randomly divided into developmental and validation subsets (9:1). The data in the developmental dataset were used to develop the model using logistic regression. Calibration and discrimination characteristics were assessed using the validation dataset. Thresholds were defined for each model to distinguish different risk groups. After excluding 275 patients with incomplete information, the overall mortality rate of the remaining 9564 patients was 2.5%. The SinoSCORE model was constructed based on 11 variables: age, preoperative NYHA stage III or IV, chronic renal failure, extracardiac arteriopathy, chronic obstructive pulmonary disease, preoperative atrial fibrillation or flutter (within 2βweeks), left ventricular ejection fraction, other elective surgery, combined valve procedures, preoperative critical state, and BMI. In the developmental dataset, calibration using a Hosmer-Lemeshow (HL) test was at =β0.44 and discrimination based on the area under the receiver operating characteristic curve (ROC) was 0.80. In the validation dataset, the HL test was at =β0.34 and the area under the ROC (AUC) was 0.78. A logistically derived additive model for predicting in-hospital mortality among Chinese patients undergoing CABG was developed based on the most up-to-date multi-center data from China.

关键词： coronary artery bypass grafting risk stratification in-hospital mortality

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Removal efficiencies of natural and synthetic progesterones in hospital wastewater treated by different

《环境科学与工程前沿（英文）》 2022年第16卷第10期 doi: 10.1007/s11783-022-1558-z

摘要：

● The concentrations of 61 progesterones in HWW, PFTE, SBTE were evaluated.

关键词： Progesterones Hospital wastewater Primary filtration treatment effluent Secondary biological treatment effluent Disinfection process

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Association between ICU quality and in-hospital mortality of V-V ECMO-supported patients—the ECMO quality

《医学前沿（英文）》 doi: 10.1007/s11684-023-1014-x

摘要： This cohort study was performed to explore the influence of intensive care unit (ICU) quality on in-hospital mortality of veno-venous (V-V) extracorporeal membrane oxygenation (ECMO)-supported patients in China. The study involved all V-V ECMO-supported patients in 318 of 1700 tertiary hospitals from 2017 to 2019, using data from the National Clinical Improvement System and China National Critical Care Quality Control Center. ICU quality was assessed by quality control indicators and capacity parameters. Among the 2563 V-V ECMO-supported patients in 318 hospitals, a significant correlation was found between ECMO-related complications and prognosis. The reintubation rate within 48 hours after extubation and the total ICU mortality rate were independent risk factors for higher in-hospital mortality of V-V ECMO-supported patients (cutoff: 1.5% and 7.0%; 95% confidence interval: 1.05–1.48 and 1.04–1.45; odds ratios: 1.25 and 1.23; P = 0.012 and P = 0.015, respectively). Meanwhile, the V-V ECMO center volume was a protective factor (cutoff of ≥ 50 cases within the 3-year study period; 95% confidence interval: 0.57–0.83, odds ratio: 0.69, P = 0.0001). The subgroup analysis of 864 patients in 11 high-volume centers further strengthened these findings. Thus, ICU quality may play an important role in improving the prognosis of V-V ECMO-supported patients.

关键词： veno-venous extracorporeal membrane oxygenation in-hospital mortality high-volume centers quality control intensive care unit capacity parameters

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The Routine and Emergency Coordinated Management of Public Security

Ning Liu

《工程管理前沿（英文）》 2015年第2卷第4期页码 331-338 doi: 10.15302/J-FEM-2015063

摘要： The paper presents a study based on the observation of public security programme situations. Nowadays, public security management is faced with challenges such as the increase in non-traditional safety threats, high occurrence probability, obvious complex chain reactions, high security demand, vulnerable bearing systems and world-wide influences. For the new adapted requirements of public security management, this paper puts forward the concept of the coordinated routine and emergency management, which combines the routine management at normal status and the emergency management at the abnormal status based on the whole process of public security management. This paper analyzes the coordinated management system and establishes the decision-making objectives, decision-making model and constraints. In addition, this paper proposes the basic strategy of achieving the coordinated management of public security.

关键词： public security routine management emergency management coordinated management

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Connecting Information to Promote Public Health

Xue-mei Su,Jia Zhao

《工程管理前沿（英文）》 2016年第3卷第4期页码 384-389 doi: 10.15302/J-FEM-2016054

摘要： With the development of information technology in the past 12 years, China has established the specialized or vertical web-based information systems for data collection of disease and related risk factor. These information systems are described as public health information systems (PHIS) in China. When PHIS has thus evolved in a haphazard and fragmented way under the pressure administrative, economic and legal, local health workers who are overburdened with multiple and time-consuming reporting requirements cannot deliver timely, accurate and complete data. Seeing that the information of disease surveillance is provided by hospitals and health service centers in China and that the development of electronic medical record (EMR) and electronic health record (EHR) occurs under the policy and investment of health since 2009 in China, there should be a connection and data sharing mechanism between EMR (EHR) and PHIS to support public health surveillance and public health decision-making. The paper aims at discussing current status and problems of PHIS in China, making a brief introduction on the blueprint of health information technology in China, exploring solution for interoperability between PHIS and EHR (EMR), and sharing some experiences and lessons from pilot project on automatic notifiable infectious disease reporting.

关键词： public health information system data exchange China

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Changes in public trust in physicians: empirical evidence from China

Dahai Zhao, Zhiruo Zhang

《医学前沿（英文）》 2019年第13卷第4期页码 504-510 doi: 10.1007/s11684-018-0666-4

摘要： Studies examining the trends in public trust in physicians have provided a considerable amount of valuable policy implications for policymakers compared with cross-sectional studies on this topic in many countries. This study investigated changes in public trust in physicians in China based on two cross-sectional national surveys conducted in 2011 and 2016 and identified the determinants of these changes. The results indicated 83.4% of respondents in 2011 reported trust or strong trust in physicians in China, which decreased to 64.2% by 2016. The results of ordinal logistic regression demonstrated that public trust in physicians in China had decreased significantly from 2011 to 2016 ( <0.001) after adjusting for other independent variables. Self-reported health status, self-rated happiness, and self-identified social class were all associated positively with public trust in physicians in China. The results also confirmed that decreasing public satisfaction with the most recent treatment experience was the major determinant of decreasing public trust in physicians in China. The findings of this study suggest that decreasing public trust in physicians deserves considerable attention from national policymakers and that improving satisfaction with treatment experiences would be the most effective strategy for enhancing public trust in physicians in China.

关键词： trust in physicians public trust physician-patient relationship health system performance

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Tender evaluation through efficiency analysis for public construction contracts

Stefan NIEWERTH, Peter VOGT, Markus THEWES

《工程管理前沿（英文）》 2022年第9卷第1期页码 148-158 doi: 10.1007/s42524-020-0119-z

摘要： Given the European Public Procurement Directive 2014/24/EU, policymakers have ordered the inclusion of various criteria, such as the price, life-cycle costs, environmental, and social aspects, in the evaluation of tenders for public construction projects. Consequently, the relevance of non-monetary award criteria has gained significant value. However, the established evaluation formulas, which are used to obtain the best value for money procurement, have resulted in legal disputes. The existing evaluation formulas exhibit mathematical weaknesses, wherein scoring indices do not express economic efficiency adequately. Thus, a conflict is observed between the political requirement of non-monetary award criteria and their evaluation by contracting authorities. To overcome such dilemma, an extensive literature review is conducted. Specifically, this study explores the essential problems of existing evaluation formulas and develops a more reliable method. The technique from the field of efficiency analysis, i.e., Data Envelopment Analysis (DEA), is adopted in this study. For contract awarding, the DEA is extended by introducing a decision theoretical framework. For public procurement, the proposed method combines two advantages. First, the proposed method ensures the derivation of a robust tender ranking given that with respect to clients’ preferences, irrelevant and insufficiently tailored tenders do not influence the scoring. Second, the proposed method supports the intention of policy makers to promote public goals, such as sustainable aspects. By disclosing the strengths and weaknesses of bidders with respect to their competitors, all bidders can obtain a precise overview of their performance regarding the award criteria. In sum, the proposed method allows a targeted improvement of certain criteria values in future tenders and consequently leads to an enhancement of public goals.

关键词： bid evaluation public procurement best value for money data envelopment analysis contractor selection

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Investigating the impact of air pollution on AMI and COPD hospital admissions in the coastal city of

《环境科学与工程前沿（英文）》 2022年第16卷第5期 doi: 10.1007/s11783-021-1490-7

摘要：

• The impact of air pollution on AMI/COPD hospital admissions were examined.

关键词： AMI COPD Air pollution exposure GAM

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Urban design based on public safety-Discussion on safety-based urban design

Kaizhen CAI, Jianguo WANG

《结构与土木工程前沿（英文）》 2009年第3卷第2期页码 219-227 doi: 10.1007/s11709-009-0023-4

摘要： Because of public safety problems in construction of urban surroundings, this paper expounds the necessity of the study on public safety-based urban design in perspective of modern city. It brings forward the concept of safety-based urban design and attempts to explore the basic connotation and contents with framework for studies.

关键词： urban public safety urban design safety-based urban design

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Robust public-private partnerships for joint railway and property development

Ka Fai NG, Hong K. LO, Yue HUAI

《工程管理前沿（英文）》 2017年第4卷第4期页码 437-450 doi: 10.15302/J-FEM-2017068

摘要： The involvement of the private sector in the construction or operation of an infrastructure project may enhance the financial viability of projects, which facilitates the formation of public-private partnership (PPP) for project delivery. PPP exploits the strength of the private sector by shifting certain project risks from the public party to the private sector who can efficiently manage certain risks. In joint railway and housing development, the approach of bundling railway and housing development (R&HD) allows cross-subsidization between immense railway construction cost and profitable housing rental revenue. This approach also provides flexibility in incorporating PPP models by distributing railway and housing revenues and costs and their inherent risks properly to the public and private sectors. Ng and Lo (2015a) developed an evaluation framework for joint railway and property development, which evaluates PPPs based on financial and construction criteria for selecting the best suitable PPP for a particular project. This study, which is based on the framework in Ng and Lo (2015a), aims to examine the robustness of various PPP configurations. This study analyzes the effects of PPP configurations on stakeholders’ risks and returns under population or demand growth and railway construction cost uncertainties. The eventual outcome of particular PPP configurations is also examined. This study also seeks to answer the following questions: How would optimal configuration change under highly volatile population and railway construction cost? Are there PPP configurations that are robust to these uncertainties and those that are sensitive to a particular uncertainty? This understanding is critical for managing risks and facilitating the formation of appropriate PPP for R&HD.

关键词： public-private partnership BFOOD housing and railway development

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Assessment of leaching behavior and human bioaccessibility of rare earth elements in typical hospital

Chunfeng Wang, Guanfei Chen, Yanchen Zhu, Dan Yao, Wanfeng Wang, Lianjun Wang

《环境科学与工程前沿（英文）》 2017年第11卷第6期 doi: 10.1007/s11783-017-0946-2

摘要： Leaching behavior and gastrointestinal bioaccessibility of rare earth elements (REEs) from hospital waste incineration (HWI) fly and bottom ash samples collected from Beijing and Nanjing Cities were assessed. In the same ash sample, the leaching concentrations of individual REEs determined by the Toxicity Characteristic Leaching Procedure (TCLP) were higher than those detected by the European standard protocol (EN-type test), thereby suggesting that the low pH value of leaching solution was an important factor influencing the leachability of REE. The REE bioaccessibility results, which were evaluated using the physiologically based extraction test (PBET), indicated that REEs were highly absorbed during gastric phase by dissolution; and subsequently precipitated and/or re-adsorbed in small intestinal phase. The relative amounts of the total REEs extracted by the TCLP method, EN-type test and PBET test were compared. In addition to the pH value of extraction solutions, the chelating role of REEs with organic ligands used in the PBET method was also an important parameter affecting REE adsorption in human body. Additionally, this study showed that REEs were extracted by these methods as concomitants of heavy metals and anions (NO , F , SO , and Cl ) from HWI ash, which probably caused the remarkably complex toxicity on human body by the exposure pathway.

关键词： Assessment Rare earth elements Leaching behavior Bioaccessibility Hospital waste

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Heat prices for public buildings in Tianjin

Boyuan HAO,Zhe TIAN,Yan DING,Peng PENG

《能源前沿（英文）》 2016年第10卷第3期页码 249-259 doi: 10.1007/s11708-016-0412-z

摘要： Energy-saving awareness of heat users and heating enterprises can be stimulated by implementing heat metering for public buildings and by establishing scientific and reasonable policies for heat prices in China. In this paper, a two-part heat price for public buildings in Tianjin is introduced, which divides the heat price into a basic part and a metering part. According to the statistical analysis of information collected from two pilot heating enterprises, the specific heat load for public buildings in Tianjin is calculated, and three candidate schemes of heat price are proposed. A simulation of heat cost is also conducted, and the benefits for both heat users and heating enterprises are balanced. Finally, the two-part heat price for public buildings in Tianjin is determined: the basic heat price is recommended to be 20 CNY/m , and the metering heat price is recommended to be 76.10 CNY/GJ. Such a price could be implemented in the initial stage of heat metering for public buildings in Tianjin.

关键词： heat metering public buildings two-part heat price specific heat load