Cost analysis of radical resection of malignant breast tumors under the China Healthcare Security Diagnosis Related Groups payment system

BACKGROUND Breast cancer is one of the most common malignant tumors in women worldwide and poses a severe threat to their health.Therefore,this study examined patients who underwent breast cancer surgery,analyzed hospitalization costs and structure,and explored the impact of China Healthcare Security Diagnosis Related Groups(CHS-DRG)management on patient costs.It aimed to provide medical institutions with ways to reduce costs,optimize cost structures,reduce patient burden,and improve service efficiency.AIM To study the CHS-DRG payment system’s impact on breast cancer surgery costs.METHODS Using the CHS-DRG(version 1.1)grouping criteria,4073 patients,who underwent the radical resection of breast malignant tumors from January to December 2023,were included in the JA29 group;1028 patients were part of the CHS-DRG payment system,unlike the rest.Through an independent sample t-test,the length of hospital stay as well as total hospitalization,medicine and consumables,medical,nursing,medical technology,and management expenses were compared.Pearson’s correlation coefficient was used to test the cost correlation.RESULTS In terms of hospitalization expenses,patients in the CHS-DRG payment group had lower medical,nursing,and management expenses than those in the diagnosis-related group(DRG)non-payment group.For patients in the DRG payment group,the factors affecting the total hospitalization cost,in descending order of relevance,were medicine and consumable costs,consumable costs,medicine costs,medical costs,medical technology costs,management costs,nursing costs,and length of hospital stay.For patients in the DRG nonpayment group,the factors affecting the total hospitalization expenses in descending order of relevance were medicines and consumable expenses,consumable expenses,medical technology expenses,the cost of medicines,medical expenses,nursing expenses,length of hospital stay,and management expenses.CONCLUSION The CHS-DRG system can help control and reduce unnecessary medical expenses by controlling medicine costs,medical consumable costs,and the length of hospital stay while ensuring medical safety.

Insulation fault diagnosis based on group grey relational grade analysis method for power transformers

Utilising dissolved gases analysis, a new insulation fault diagnosis methodfor power transformers is proposed. This method is based on the group grey relational grade analysismethod. First, according to the fault type and grey reference sequence structure, some typicalfault samples are divided into several sets of grey reference sequences. These sets are structuredas one grey reference sequence group. Secondly, according to a new calculation method of the greyrelational coefficient, the individual relational coefficient and grade are computed. Then accordingto the given calculation method for the group grey relation grade, the group grey relational gradeis computed and the group grey relational grade matrix is structured. Finally, according to therelational sequence, the insulation fault is identified for power transformers. The results of alarge quantity of instant analyses show that the proposed method has higher diagnosis accuracy andreliability than the three-ratio method and the traditional grey relational method. It has goodclassified diagnosis ability and reliability.

Diagnosis related group grouping study of senile cataract patients based on E-CHAID algorithm

AIM： To figure out the contributed factors of the hospitalization expenses of senile cataract patients（HECP） and build up an area-specified senile cataract diagnosis related group（DRG） of Shanghai thereby formulating the reference range of HECP and providing scientific basis for the fair use and supervision of the health care insurance fund.METHODS： The data was collected from the first page of the medical records of 22 097 hospitalized patients from tertiary hospitals in Shanghai from 2010 to 2012 whose major diagnosis were senile cataract. Firstly, we analyzed the influence factors of HECP using univariate and multivariate analysis. DRG grouping was conducted according to the exhaustive Chi-squared automatic interaction detector（E-CHAID） model, using HECP as target variable. Finally we evaluated the grouping results using non-parametric test such as Kruskal-Wallis H test, RIV, CV, etc.RESULTS： The 6 DRGs were established as well as criterion of HECP, using age, sex, type of surgery and whether complications/comorbidities occurred as the key variables of classification node of senile cataract cases.CONCLUSION： The grouping of senile cataract cases based on E-CHAID algorithm is reasonable. And the criterion of HECP based on DRG can provide a feasible way of management in the fair use and supervision of medical insurance fund.

Analysis of Length of Stay (LOS) Data from the Medical Records of Tertiary Care Hospital in Saudi Arabia for Five Diagnosis Related Groups: Application of Cox Prediction Model

Background: One of the main objectives of hospital managements is to control the length of stay (LOS). Successful control of LOS of inpatients will result in reduction in the cost of care, decrease in nosocomial infections, medication side effects, and better management of the limited number of available patients’ beds. The length of stay (LOS) is an important indicator of the efficiency of hospital management by improving the quality of treatment, and increased hospital profit with more efficient bed management. The purpose of this study was to model the distribution of LOS as a function of patient’s age, and the Diagnosis Related Groups (DRG), based on electronic medical records of a large tertiary care hospital. Materials and Methods: Information related to the research subjects were retrieved from a database of patients admitted to King Faisal Specialist Hospital and Research Center hospital in Riyadh, Saudi Arabia between January 2014 and December 2016. Subjects’ confidential information was masked from the investigators. The data analyses were reported visually, descriptively, and analytically using Cox proportional hazard regression model to predict the risk of long-stay when patients’ age and the DRG are considered as antecedent risk factors. Results: Predicting the risk of long stay depends significantly on the age at admission, and the DRG to which a patient belongs to. We demonstrated the validity of the Cox regression model for the available data as the proportionality assumption is shown to be satisfied. Two examples were presented to demonstrate the utility of the Cox model in this regard.

Current Situation and Suggestions on the Development of Diagnosis Related Group(DRG)Policy in China

Objective To implement the national diagnosis related group(DRG)policy smoothly,and gradually move towards value medicine and fine management,some suggestions are put forward for improving medical service efficiency,saving medical insurance fund,and reducing the burden of patients,so as to realize the win-win situation of medical insurance and patients.Methods Based on the experience of the United States,Australia,and Germany,the policy implementation background and development process in China were summarized.The advantages and disadvantages of single disease payment method,disease score payment method,and diagnosis related groups-prospective payment system(DRG-PPS)method were compared,and then the problems were found out.Results and Conclusion In view of the imperfect information system,lack of professional talents,and uneven progress of each pilot,it is proposed that relevant departments should pay more attention to the construction and improvement of coding and other information systems,cultivate professional talents,promote the reform of DRG payment technology specification and grouping technology combined with national pilot project,thus enhancing the application and in-depth development of DRG policy in China.

Generating Relations for Grothendieck Groups of Trivial Extension Algebras

In this paper we describe explicitly the generating relations for the Grothendieck groups of trivial extension algebras of tame hereditary algebras.

The statistical laws of strong seismic motion phase characteristics

Under the assumption of an effective point source model,this paper introduces a conception of equivalent phase velocity to describle the average propagation processes and dispersion properties of seismic waves from seismic source to the site,then illuminates the relation between the phase properties of seismic motion and equivalent phase velocity and obtains a simple formula of estimating the equivalent phase velocity through the use of the phase difference spectrum of seismic motion.After the parts of strong seismic records in the western American and the SMART-1 array are used to identify the method presented by this paper in reason,the statistical relations of equivalent phase velocity are given in the above two regions.The results of the paper have demonstrated that the phase spectrum of seismic motion has its inner law as same as the amplitude spectrum does.

DRG Payment System in the United States and Its Enlightenment to China

Objective To study the successful experience of implementing diagnosis related group(DRG)payment system in the United States and provide a reference for China’s reform of health insurance payment.Since the United States is the first country to develop and apply the DRG in the world,its research and practice of DRG are always at the forefront.Methods Literature research method was used to investigate DRG payment system,the specific steps of the payment,the setting method of relevant indicators,and the quality supervision measures.Results and Conclusion There are mainly three aspects from the experience of DRG payment system in the United States.Firstly,the government’s responsibility for health insurance is clarified.Secondly,the relevant indexes are set reasonably.Thirdly,the DRG weight and base rate are adjusted dynamically to ensure the fairness of DRG payment.Therefore,China should pay attention to the following three aspects:clarifying the main responsibility of the government in the reform of health insurance payment,establishing the quality control system of the first page of medical records,and improving the supervision mechanism for medical quality.

Evaluation of Soybean Cultivars of Contrasting Cycles according to the Level of Investment in Fertilization

The objective of the present study was to characterize the duration of the phenological stages, the agronomic characteristics and grain yield in soybean cultivars with contrasting cycles and indeterminate growth type, submitted to different fertilization investment environments under no-tillage system in the central region of Minas Gerais. The work was conducted under field conditions, in an experimental area of Embrapa Maize and Sorghum, in Sete Lagoas, MG, in the harvest of 2015/2016. Ten soybean cultivars with different relative maturity groups (RMG) were studied, representing almost all RMG materials currently sown in Minas Gerais, in two environments with different levels of fertilizer investment. The variables were submitted to analysis of joint variance, in order to verify the existence of interaction between cultivars and investment in fertilization environments. Fertilizer investment levels influence grain yield of soybean cultivars of contrasting cycles. The higher height of the soybean plants implies higher lodging and lower grain yield. This situation is aggravated by the greater investment in fertilization. The difference between the cycles of the cultivars is in the duration of the vegetative stages, being greater in the later cultivars.

Morita Equivalences Induced by Two-Sided Group Relative Hopf-Module

Let H be a Hopf π-coalgebra over a commutative ring k with bijective antipode S, and A and B right π-H-comodulelike algebras. We show that the pair of adjoint functors （F3 = A Bop A□ HBop -,G3 = （-）coH） between the categories A□HBopM and AMπB-H is a pair of inverse equivalences, when A is a faithfully flat π-H-Galois extension. Furthermore, the categories Moritaπ-H（A,B） and Morita □π-H（AcoH,BcoH） are equivalent, if A and B are faithfully flat π-H-Galois extensions.

Patterson–Sullivan Measures and Growth of Relatively Hyperbolic Groups

We prove that for a relatively hyperbolic group,there is a sequence of relatively hyperbolic proper quotients such that their growth rates converge to the growth rate of the group.Under natural assumptions,a similar result holds for the critical exponent of a cusp-uniform action of the group on a hyperbolic metric space.As a corollary,we obtain that the critical exponent of a torsion-free geometrically finite Kleinian group can be arbitrarily approximated by those of proper quotient groups.This resolves a question of Dal’bo–Peigné–Picaud–Sambusetti.Our approach is based on the study of Patterson–Sullivan measures on Bowditch boundary of a relatively hyperbolic group and gives a series of results on growth functions of balls and cones.

On K_2-group of a Formal Matrix Ring

Let S be a formal matrix ring, T the subring consisting of all diagonal elements, I the set consisting of all off-diagonal elements. Then I is a split radical ideal under certain conditions. In this paper, we show that K2（S）≈ K2（T） G K2（S, I）, and a presentation of K2（S, I） is given.

流动、位置与关联:解读贵州山地民族与国家互动历史的角度

人文世界是一块充满着动态和相互关联的领域,也是人们与周围环境互动的过程。诸如文明、国家、民族、社会的概念都可理解为关系的建构。贵州可为考察这样一种关系建构的人文景观之地。本篇基于流动性(Mobility)、位置性(Positionality)与关联性(Relationality)的观点,分别从文明与野蛮、国家与无国家、高地与河谷、山地与边缘等维度,将贵州置于纳入一个互动的空间场域,分析历史上贵州的山地族群如何根据自己的位置性(Positionality),能动地采取多种策略与部落、国家进行互动;如何以灵活的他者(Flexible others)印象建构自己文化认同;如何以一幅多面相、混杂化(Hybridization)的人文图景去诠释着当地人对于文明、无国家、山地社会以及边缘性的理解。

ENERGY DISPERSION EFFECTS ON EXPLOSIVE DEVELOPMENT OF MARINE CYCLONES

A dominant role played by energy dispersion in the explosive development of extratropical marine cyclones over the Northwest Pacific has been revealed based on both the eddy energy equations and the energy flux vectors of nonlinear wave packet.At the initial and explosive time. the eddy energy from neighboring upstream systems beyond the radius of Rossby deformation is dispersed into the eddy energy center associated with the cyclone via ageostrophic geopotential fluxes,and results in the rapid increase of eddy kinetic energy and the occurrence of explosive cyclogenesis.When the cyclone begins to decay,its corresponding eddy energy is exported downstream and hence triggers the growth of new perturbation downstream.Through generalizing the energy flux vectors of quasigeostrophic wave packets to the nonlinear forms and making use of the relationship between the energy flux vectors and the total eddy energy,the approximation expressions of the total group velocity and relative group velocity are derived,and then they are used to compute an explosive case.The normalized ageostrophic geopotential fluxes by dividing the volume integral of ageostrophic geopotential fluxes by the integral of the total eddy energy determine the relative group velocity at which the eddy energy is spreading out,and they can be used to evaluate the position of next new disturbance.The nonlinear advective fluxes influence primarily the phase speed and translation of the cyclones.The results in this paper facilitate to expanding the mechanism research on explosive cyclones and have great significance for predicting the explosive intensification and downstream disturbance growth.

On Proper and Exact Relative Homological Dimensions

In Enochs'relative homological dimension theory occur the(co)resolvent and(co)proper dimensions,which are defined by proper and coproper resolutions constructed by precovers and preenvelopes,respectively.Recently,some authors have been interested in relative homological dimensions defined by just exact sequences.In this paper,we contribute to the investigation of these relative homological dimensions.First we study the relation between these two kinds of relative homological dimensions and establish some transfer results under adjoint pairs.Then relative global dimensions are studied,which lead to nice characterizations of some properties of particular cases of self-orthogonal subcategories.At the end of this paper,relative derived functors are studied and generalizations of some known results of balance for relative homology are established.

Coarse Embedding into Uniformly Convex Banach Spaces

In this paper, the author studies the coarse embedding into uniformly convex Banach spaces. The author proves that the property of coarse embedding into Banach spaces can be preserved under taking the union of the metric spaces under certain condi- tions. As an application, for a group G strongly relatively hyperbolic to a subgroup H, the author proves that B（n） = {g ∈ G／ │g│suЭe≤ n} admits a coarse embedding into a uniformly convex Banach space if H does.