Impact of Sedation Protocols on Elderly Patients Undergoing Mechanical Ventilation and Off-Line Weaning

The proportion of elderly patients in intensive care is increasing, and a significant proportion of them require mechanical ventilation. How to implement safe and effective mechanical ventilation for elderly patients, and when appropriate off-line is an important issue in the field of critical care medicine. Appropriate sedation can improve patient outcomes, but excessive sedation may lead to prolonged mechanical ventilation and increase the risk of complications. Elderly patients should be closely monitored and evaluated on an individual basis while offline, and the sedation regimen should be dynamically adjusted. This requires the healthcare team to consider the patient’s sedation needs, disease status, and pharmacodynamics and pharmacokinetics of the drug to arrive at the best strategy. Although the current research has provided valuable insights and strategies for sedation and off-line management, there are still many problems to be further explored and solved.

分布式水文-土壤-植被模式的改进及气候水文Off-line模拟试验

文中对引进的高分辨率 (94 2 .5m× 94 2 .5m)分布式水文 土壤 植被模式 (DHSVM) ,针对海、滦河流域的特点进行了改进 ,主要包括 :(1)改变蒸散发模拟方法 ,用改进的Penman Monteith模式模拟海滦河流域的蒸发 ,较好地模拟出 1a内的两个峰值 ,最大值出现在 4～ 6月 ,次大值出现在 7～ 8月 ;(2 )改变水文模式结构 ,用多站点气候观测资料内插到模式网格点 ,充分实现了分布式水文模拟 ;(3)发展新的水文、植被、土壤参数化方案 ,对 33个参数分区计算和确定 ,并重点对土壤孔隙度 φ、土壤蓄水能力θfc、叶面指数LAI、随机阻抗γs 等 11个参数进行调试和修订 ,提高了水文模拟精度。用改进的DHSVM模式分别对滦河、桑干河流域蒸散发、地下水位、土壤湿度、土壤水下渗、产流、汇流与径流等水文过程进行Off line模拟试验 ,模拟结果与实测值一致性较好 ,滦河流域 1979～ 1991年、桑干河流域 1979～ 1987年水文模拟效率系数分别为 0 .89和 0 .82 。

A Land Surface Model(IAP94) for Climate Studies PartI:Formulation and Validation in Off-line Experiments

The IAP (Institute of Atmospheric Physics) land-surface model (IAP94) is described. This model is a comprehensive one with detailed description for the processes of vegetation, snow and soil. Particular attention has been paid to the cases with three water phases in the surface media. On the basis of the mixture theory and the theory of fluid dynamics of porous media, the system of universal conservational equations for water and heat of soil, snow and vegetation canopy has been constructed. On this background, all important factors that may affect the water and heat balance in media can be considered naturally, and each factor and term possess distinct physical meaning. In the computation of water content and temperature, the water phase change and the heat transportation by water flow are taken into account. Moreover, particular attention has been given to the water vapor diffusion in soil for arid or semi-arid cases, and snow compaction. In the treatment of surface turbulent fluxes, the difference between aerodynamic and thermal roughness is taken into account. The aerodynamic roughness of vegetation is calculated as a function of canopy density, height and zero-plane displacement. An extrapolation of log linear and exponential relationship is used when calculating the wind profile within canopy. The model has been validated against field measurements in off-line simulations. The desirable model′s performance leads to the conclusion that the IAP94 is able to reproduce the main physical mechanisms governing the energy and water balances in the global land surface. Part II of the present study will concern the validation in a 3-D experiment coupled with the IAP Two-Level AGCM.

Designing and Optimization of an Off-line Programming System for Robotic Belt Grinding Process

Off-line programming （OLP） system becomes one of the most important programming modules for the robotic belt grinding process, however there lacks research on increasing the grinding dexterous space depending on the OLP system. A new type of grinding robot and a novel robotic belt grinding workcell are forwarded, and their features are briefly introduced. An open and object-oriented off-line programming system is developed for this robotic belt grinding system. The parameters of the trimmed surface are read from the initial graphics exchange specification （IGES） file of the CAD model of the workpiece. The deBoor-Cox basis function is used to sample the grinding target with local contact frame on the workpiece. The numerical formula of inverse kinematics is set up based on Newton＇s iterative procedure, to calculate the grinding robot configurations corresponding to the grinding targets. After the grinding path is obtained, the OLP system turns to be more effective than the teach-by-showing system. In order to improve the grinding workspace, an optimization algorithm for dynamic tool frame is proposed and performed on the special robotic belt grinding system. The initial tool frame and the interval of neighboring tool frames are defined as the preparation of the algorithm. An optimized tool local frame can be selected to grind the complex surface for a maximum dexterity index of the robot. Under the optimization algorithm, a simulation of grinding a vane is included and comparison of grinding workspace is done before and after the tool frame optimization. By the algorithm, the grinding workspace can be enlarged. Moreover the dynamic tool frame can be considered to add one degree-of-freedom to the grinding kinematical chain, which provides the theoretical support for the improvement of robotic dexterity for the complex surface grinding.

An off-line simulation of land surface processes over the northern Tibetan Plateau

In order to further understand the land surface processes over the northern Tibetan Plateau, this study produced an off-line simulated examination at the Bujiao site on the northern Tibetan Plateau from June 2002 to April 2004, using the Noah Land Surface Model （Noah LSM） and observed data from the CAMP/Tibet experiment. The observed data were neces- sarily corrected and the number of soil layers in the Noah LSM was changed from 4 to 10 to enable this off-line simulation and analysis. The main conclusions are as follows： the Noah LSM performed well on the northern Tibetan Plateau. The simulated net radiation, upward longwave radiation, and upward shortwave radiation demonstrated the same remarkable annual and seasonal variation as the observed data, especially the upward longwave radiation. The simulated soil temperatures were acceptably close to the observed temperatures, especially in the shallow soil layers. The simulated freezing and melting processes were shown to start from the surface soil layer and spread down to the deep soil layers, but they took longer than the observed processes. However, Noah LSM did not adequately simulate the soil moisture. Therefore, additional high-quality, long-term observations of land surface-atmosphere processes over the Tibetan Plateau will be a key factor in proper adiustments of the model parameters in the future.

A word level segmentation for off-line Arabic characters

Segmentation of cursive text has been one of the major problems in Arabic writing. The problem is the shape of the letter which is context sensitive, depending on it’s location within a word. Many text recognition systems recognize text imagery at the character level and assemble words from the recognized characters. Unfortunately this approach does not work with Arabic text. In this paper we describe a new approach to segment Arabic text imagery at a word level, without analyzing individual characters. This approach avoids the problem of individual characters segmentation, and can overcome local errors in character recognition.

Off-line simulation of robot welding of radar pedestal

A study of the interference simulation based on robot welding of the radar pedestal was carried out by using the KUKA Sim Pro simulation software and off-line program technology. Compared with the actual robot welding process, it was found that the trajectory of the simulated robot welding process in line with that recorded in the actual welding process, and the actual limit and interference appeared at the same place as the simulation process. There was no interference phenomenon on the outside weld-seam; on the internal weld-seam, especially on the weld-joint of support plate connected to the cylinder, a phenomenon of interference appeared. It was helpful to use the simulation method to guide the actual robot welding so as to protect robot from impacting and reduce the weld defects.

Study on path planning and compensation of off-line programming for thick walled curve welding

Thick walled curve welding are usually joined by multi-layer and multi-pass welding, which quality and efficiency could be improved by off-line programming of robot welding. However, the precision of off-line programming welding path was decreased due to the deviation between the off-line planned welding path and the actual welding path. A path planning algorithm and a path compensation algorithm of multi-layer and multi-pass curve welding seam for off-line programming of robot welding are developed in this paper. Experimental results show that the robot off-line programming improves the welding efftcieney and precision for thick walled curve welding seam.

Payment for Water-Related Ecosystem Services as a Strategic Watershed Management Approach

Payments for ecosystem services (PES) have been created worldwide to assist watershed management and improve or maintain water quality. Considering their importance, we conducted a holistic review of payment for water-related ecosystem services to understand how this instrument has been applied in watershed management worldwide. First, we identified the watershed management actions considered by the PES programs and the challenges of implementing water-related PES. After we identified the methods and criteria used to define priority areas for water-related PES. Our review considered articles published on the Web of Science from 2011 to 2022. We found 236 articles relating PES to water resources, highlighting the main water conservation strategies: native vegetation conservation, native vegetation restoration, and implementing best agricultural practices. The method most frequent was interview, followed by the use of technologies, document analysis, and hydrological models. Another significant result was that priority areas for receiving PES are mainly riparian zones, areas near or with native vegetation cover, areas with higher erosion potential, steep areas, and areas with socially vulnerable communities. This review was crucial to identify efficient water resource conservation strategies and potential challenges in the implementation and development of PES programs.

Financial literacy,behavioral traits,and ePayment adoption and usage in Japan

This study investigates how financial literacy and behavioral traits affect the adoption of electronic payment(ePayment)services in Japan.We construct a financial literacy index using a representative sample of 25,000 individuals from the Bank of Japan’s 2019 Financial Literacy Survey.We then analyze the relationship between this index and the extensive and intensive usage of two types of payment services:electronic money(e-money)and mobile payment apps.Using an instrumental variable approach,we find that higher financial literacy is positively associated with a higher likelihood of adopting ePayment services.The empirical results suggest that individuals with higher financial literacy use payment services more frequently.We also find that risk-averse people are less likely to adopt and use ePayment services,whereas people with herd behavior tend to adopt and use ePayment services more.Our empirical results also suggest that the effects of financial literacy on the adoption and use of ePayment differ among people with different behavioral traits.

Online payment fraud:from anomaly detection to risk management

Online banking fraud occurs whenever a criminal can seize accounts and transfer funds from an individual’s online bank account.Successfully preventing this requires the detection of as many fraudsters as possible,without producing too many false alarms.This is a challenge for machine learning owing to the extremely imbalanced data and complexity of fraud.In addition,classical machine learning methods must be extended,minimizing expected financial losses.Finally,fraud can only be combated systematically and economically if the risks and costs in payment channels are known.We define three models that overcome these challenges:machine learning-based fraud detection,economic optimization of machine learning results,and a risk model to predict the risk of fraud while considering countermeasures.The models were tested utilizing real data.Our machine learning model alone reduces the expected and unexpected losses in the three aggregated payment channels by 15%compared to a benchmark consisting of static if-then rules.Optimizing the machine-learning model further reduces the expected losses by 52%.These results hold with a low false positive rate of 0.4%.Thus,the risk framework of the three models is viable from a business and risk perspective.

Inspiration of Foreign Innovative Drug Pricing Methods and Medical Insurance Payment Standards to China

Objective To study the innovative drug pricing methods and medical insurance payment standards in foreign countries and to provide reference for China’s government.Methods The official websites were searched for information and related literature,and literature review was used.Results and Conclusion In foreign countries,the clinical value of innovative drugs and their impact on medical insurance funds were comprehensively evaluated based on factors such as quality-adjusted life years,clinical benefit,and improvement of clinical benefit.Then,the evaluation results were taken as an important basis for whether innovative drugs were admitted to the medical insurance catalog and establishing medical insurance payment standards.By using international experience for reference,innovative drug pricing methods and medical insurance payment standards for China’s national conditions can be improved by establishing a basic database of clinical value and drug economic evaluation of innovative drugs,as well as innovative drug payment models based on decision thresholds.

SPECTRAL TECHNIQUES FOR OFF-LINE TESTING AND DIAGNOSIS OF COMPUTER SYSTEMS

In this paper we present some of our recent results on applications of spectral techniques over finite fields to the problems of testing and diagnosis of computer systems.

未来5~10年中国医疗保障待遇设计的改革思路

医疗保障待遇包括起付线、报销比例、封顶线等内容。典型国家社会医疗保险报销起付线多设置在人均年收入的3%以内,对门诊、住院和药剂服务设立了不同的支付政策,医疗费用个人自付占可支配收入的比例在0.25%~2%。借鉴国际经验,展望中国社会医疗保险制度未来的发展,建议提高门诊保障待遇,以可支配收入为基数设置报销起付线,不同层级医疗机构实行相同的报销比例,设置个人自付封顶线,取消门诊报销封顶线,门诊和住院共用个人最高自付限额。

我国不同付费模式信用评级校验机制研究

我国债券市场刚性兑付被打破后,不断出现高评级债券违约事件。为此,监管部门积极发展多种评级,以期提高债券评级质量。通过理论建模与实证分析,研究了不同付费模式信用评级如何综合发挥校验作用。基于博弈模型的理论分析发现,不同付费模式评级发挥校验作用的机制在于投资者的反应:当投资者付费和发行人付费两种模式评级差值增大,投资者不以单一评级结果进行债券定价,而是根据评级差值调整债券价格。基于2011—2020年企业债评级数据的经验证据显示,随着评级差值增大,发行人付费评级机构会降低后续评级,且评级差值对单一信用评级与债券信用利差之间的负向关系具有抑制作用。进一步检验发现,发行人付费评级机构提供的偏正面的私有信息会降低债券信用利差,而以中债资信为代表的投资者付费评级机构提供的私有信息则不会显著影响债券信用利差,均体现出单一评级模式在定价方面的弊端。因此,监管部门应继续鼓励发展投资者付费评级模式,并鼓励机构投资者发展内部评级,以充分发挥多种评级模式的交叉校验作用。

价值支付视角下门诊按人头付费的理论内涵和改革建议

按人头付费是医保门诊统筹改革的核心任务之一。价值支付视角下按人头付费应具有控制医疗成本、提升服务质量、改善患者健康结果的价值目标,其核心要素包括:以整合型医疗卫生服务组织和基层家庭医生签约团队为供方主体,为特定疾病人群或签约人群提供连续性医疗服务;支付标的为固定时间范围内发生的医疗费用总额,通过合理设定人头基础费率和风险调整因子,建立以质量和健康结果为核心的绩效支付和结余分享、风险分担机制等,建立起支付方、供方、患者三方价值均衡且相容的激励约束机制。

以价值为导向的住院康复服务价值调节因子构建研究

目的:本研究旨在建立实现康复治疗效果可比的价值调节因子,为将康复服务价值作为医保支付依据、基于现行医保制度建立按价值付费机制提供可行思路。方法:课题组于2022年1月1日—2023年3月31日收集样本医院脑损伤住院患者功能相关信息,并与样本地区医保结算清单数据库关联。采用神经网络模型拟合康复结果与康复效果影响因素之间的函数关系,根据康复结果实际值与预测值差值的分布区间判断康复服务价值。结果:共计878例脑损伤患者的住院康复病案与医保结算清单资料纳入分析;根据预测精度评价指标及其标准,选取了最优模型,并根据其预测结果对康复治疗效果进行了评价,确定了包含四个档次的价值调节因子。结论:本研究构建的价值调节因子,不仅为评价住院康复服务治疗效果、实现康复效果可比提供了重要工具,也为进一步推动医保对住院康复服务实施按价值付费提供了可行方向。

基于疾病特征的医保支付方式优化策略研究——以结核病为例

目的:探索符合结核病疾病特征的医保支付方式。方法:基于文献研究,分析当前我国结核病的医保支付方式。结果:当前我国结核病支付政策存在制度安排与临床实际不匹配、患者经济负担较重等问题,有必要从疾病特征出发,优化结核病医保支付方式。结论:实行科学动态的结核病门诊单病种支付方式,紧扣疾病特征优化按病种分值付费支付方式,建立全程治疗管理体系,探索捆绑支付模式,减轻结核病患者经济负担。

惠民保可持续发展研究

在多层次医疗保障体系建设中,惠民保是连接基本医疗保险与商业健康保险的中间层,是化解重大疾病风险、推进共同富裕的一项保障。本文探讨惠民保在多层次医疗保障体系中的地位,分析其参保、赔付以及产品现状,总结惠民保面临参保率不足、参保人群结构不良、赔付率不稳定且赔付不均等问题。基于此,本文提出实行基于DRG/DIP按病组支付的惠民保发展模式,旨在不影响相关主体利益的基础上改善参保率,优化参保结构,增强参保人获得感,从而吸引健康人群投保,提升制度普惠性和可持续性,为完善多层次医疗保障体系建设做出贡献。

基于双重差分法的DRG付费对中医医院的影响研究

目的:评估按疾病诊断相关分组(DRG)付费对中医医院住院患者例均总费用、费用结构、住院时长、出院人数及中医特色的影响。方法:以某中医类国家区域医疗中心为研究对象,使用双重差分回归模型(DID)分析付费改革政策实施前后医保患者(干预组)与非医保患者(对照组)的各项指标差异,通过平行趋势检验和安慰剂检验证实模型可靠性和稳定性。结果:例均住院总费用、病例数、住院天数、医疗服务收入占比、饮片收入占比等十一项指标的DID交互项系数显著(P<0.05),费用指标回归系数均小于0。饮片使用率、中医非药物疗法收入占比等四项指标DID交互项系数不显著(P>0.05)。结论:DRG付费政策显著降低付费病组例均总费用,其中耗材、医技费用下降显著,费用结构优化,中药饮片费用占比略微下降。应持续关注DRG付费对中医医院影响,进一步扩大样本范围,跟踪分析政策影响,全面评价DRG付费政策对我国中医医疗机构的影响。