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.

Surgical treatment of liver cancer and pancreatic cancer under the China Healthcare Security Diagnosis Related Groups payment system

BACKGROUND Data from the World Health Organization’s International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022.Liver and pancreatic cancers accounted for the highest number of new cases.Real-world data(RWD)is now widely preferred to traditional clinical trials in various fields of medicine and healthcare,as the traditional research approach often involves highly selected populations and interventions and controls that are strictly regulated.Additionally,research results from the RWD match global reality better than those from traditional clinical trials.AIM To analyze the cost disparity between surgical treatments for liver and pancreatic cancer under various factors.METHODS This study analyzed RWD 1137 cases within the HB1 group(patients who underwent pancreatectomy,hepatectomy,and/or shunt surgery)in 2023.It distinguished different expenditure categories,including medical,nursing,technical,management,drug,and consumable costs.Additionally,it assessed the contribution of each expenditure category to total hospital costs and performed cross-group comparisons using the non-parametric Kruskal–Wallis test.This study used the Steel–Dwass test for post-hoc multiple comparisons and the Spearman correlation coefficient to examine the relationships between variables.RESULTS The study found that in HB11 and HB13,the total hospitalization costs were significantly higher for pancreaticoduodenectomy than for pancreatectomy and hepatectomy.Although no significant difference was observed in the length of hospital stay between patients who underwent pancreaticoduodenectomy and pancreatectomy,both were significantly longer than those who underwent liver resection.In HB15,no significant difference was observed in the total cost of hospitalization between pancreaticoduodenectomy and pancreatectomy;however,both were significantly higher than those in hepatectomy.Additionally,the length of hospital stay was significantly longer for patients who underwent pancreaticoduodenectomy than for those who underwent pancreatectomy or liver resection.CONCLUSION China Healthcare Security Diagnosis Related Groups payment system positively impacts liver and pancreatic cancer surgeries by improving medical quality and controlling costs.Further research could refine this grouping system and ensure continuous effectiveness and sustainability.

Nonlinear Relationship and Its Evolutionary Trace between Average Degree and Average Path Length of Edge Vertices of China Aviation Network Based on Complex Network

In order to reveal the complex network characteristics and evolution principle of China aviation network,the relationship between the average degree and the average path length of edge vertices of China aviation network in 1988,1994,2001,2008 and 2015 was studied.According to the theory and method of complex network,the network system was constructed with the city where the airport was located as the network node and the airline as the edge of the network.On the basis of the statistical data,the average degree and average path length of edge vertices of China aviation network in 1988,1994,2001,2008 and 2015 were calculated.Through regression analysis,it was found that the average degree had a logarithmic relationship with the average path length of edge vertices and the two parameters of the logarithmic relationship had linear evolutionary trace.

Nonlinear Relationship and Its Evolutionary Trace between Node Degree and Average Path Length of China Aviation Network Based on Complex Network

In order to reveal the complex network characteristics and evolution principle of China aviation network,the relationship between the node degree and the average path length of China aviation network in 1988,1994,2001,2008 and 2015 was studied.According to the theory and method of complex network,the network system was constructed with the city where the airport was located as the network node and the airline as the edge of the network.On the basis of the statistical data,the node average path length of China aviation network in 1988,1994,2001,2008 and 2015 was calculated.Through regression analysis,it was found that the node degree had a logarithmic relationship with the average length of node path,and the two parameters of the logarithmic relationship had linear evolutionary trace.Key word:China aviation network,complex network,node degree,average length of node path,logarithmic relationship,evolutionary trace.

SYNTHESIS AND AVERAGE SEQUENCE LENGTH DETERMINATION OF AROMATIC-ALIPHATIC COPOLYESTERS CONTAINING POLY(ALKYLENE OXALATE)UNITS

Two series of aromatic-aliphatic random copolyesters(PEBTOXS)with diverse diol ratios have been synthesized by direct melting polycondensation.Two kinds of diols(glycol(EG)and 1,4-butanediol(BD))are used in combination in order to adjust crystallization and tensile properties,and three kinds of diacids(dimethyl terephthalate(DMT),diethyl oxalate(DEOX),and sebacic acid(SA))are involved.~1H-NMR spectra quantify both composition and structure,and show that the final contents in copolyesters appropriate to the ...

The Correlation of Hospital Operational Efficiency and Average Length of Stay in China: A Study Based on Provincial Level Data

Objective: To measure the hospital operation efficiency, study the correlation between average length of stay and hospital operation efficiency, analyze the importance of shortening average length of stay to the improvement of the hospital operation efficiency and put forward relevant policy suggestion. Methods: Based on China provincial panel data from 2003 to 2012, the hospital operation efficiencies are calculated using Super Efficiency Data Envelopment Analysis model, and the correlation between average length of stay and hospital operation efficiency is tested using Spearman rank correlation coefficient test. Results: From 2003 to 2012, the average of national hospital operation efficiency was increasing slowly and the hospital operations were inefficient in most of the areas. The national hospital operation efficiency is negatively correlated to the average length of stay. Conclusion: Measures should be taken to set average length of stay in a scientific and reasonable way, improve social and economic benefits based on the improvement of efficiency.

Association between upper leg length and metabolic syndrome among US elderly participants-results from the NHANES （2009-2010）

Objective To examine the relationship between upper leg length （ULL） and metabolic syndrome （MetS） in older adults.Methods Data was collected from National Health and Nutritional Examination Survey （NHANES, 2009-2010）. 786 individuals （385 males and 401 females） who were 60 years of age or older were included in this analysis. MetS was defined as having at least three of following conditions, i.e., cen-tral obesity, dyslipidemia, insulin resistance, and hypertension based on National Cholesterol Education Program guidelines. ULL was grouped into gender-specific tertiles.Results328 （41.7%） of participants were categorized as having MetS （38.7% in men and 49.1% in women,P = 0.002）. Compared to individuals in the 1st tertile （T1） of ULL, those in the 3rd tertile （T3） had lower levels of triglycerides （120.8 vs. 153.1 mg/dL,P = 0.045）, waist circumference （100.7vs. 104.2 cm,P = 0.049）, and systolic blood pressure （126.7vs. 131.4 mmHg, P = 0.005）, but higher levels of high-density-lipoprotein cholesterol （58.1vs. 52.4 mg/dL,P = 0.024）. The odds ratios （95% CI） of MetS from multivariate logistic regression were 0.57 （0.32-1.03） for individuals in the T2 of ULL and 0.39 （0.24-0.64） for individuals in the T3 of ULL, respectively （P-value for the trend 0.022）.Conclusions ULL was negatively associated with MetS in older adults. Further research is needed to identify potential mechanisms.

Average Odontometric Value of the Width of the Upper Central Incisor in the Congolese Bantu of Kinshasa, Democratic Republic of Congo

Objective: The aim of this study was to determine the average values of width of the upper central incisor (WUCI) in Congolese Bantu and compare them to those of Caucasians and Asiatic. Material and Methods: It was a prospective cross-sectional study carried out at the Université de Kinshasa on the Congolese Bantu, Department of Dental Medicine, from March 2020 to March 2021. A maxillary imprint was taken by Jeltrate-type alginate. The measurement of two healthy upper central incisors (UCI) was carried out by the hard plaster casting type 4, with a brand caliper, carbon fiver composite mark. The study was approved by the Ethics Committee of the School of Public Health in the Université de Kinshasa and verbal consent was obtained from each participant. Results: The Average Width of the UCI was 8.74 mm ± 0.56. The average width of the right Upper Central incisor (RUCI) and the left UCI (LUCI) was 8.71 mm ± 0.57 and 8.77 mm ± 0.56, respectively. The average width of the RUCI and LUCI was not the same for men and women (p 0.001). A significant difference was observed between the average of the RUCI and the 18 - 28 and 40 - 50 age group (p = 0.056) as well as for the average LUCI (p = 0.085). The width average of UCI between the Congolese Bantu with those of Caucasians and Asians was significantly different (p = 0.000 and p = 0.009). Conclusion: The average width of the RUCI and LUCI was different among sex and age group. The average width of UCI of the Congolese Bantu is different from that of Caucasians and Asians.

Memory-Type Control Charts Through the Lens of Cost Parameters

A memory-type control chart utilizes previous information for chart construction.An example of a memory-type chart is an exponentially-weighted moving average(EWMA)control chart.The EWMA control chart is well-known and widely employed by practitioners for monitoring small and moderate process mean shifts.Meanwhile,the EWMA median chart is robust against outliers.In light of this,the economic model of the EWMA and EWMA median control charts are commonly considered.This study aims to investigate the effect of cost parameters on the out-of-control average run lengthðARL_(1)Þin implementing EWMA and EWMA median control charts.The economic model was used to compute the ARL_(1) parameter.The 14 input parameters were identified and the analysis was carried out based on the one-parameter-at-a-time basis.When the input parameters change based on a predetermined percentage,the ARL_(1) is affected.According to the results of the EWMA chart,nine input parameters had an effect andfive input parameters had no effect on the ARL_(1) parameter.Further,only seven of the 14 input parameters had an effect on the ARL_(1) of the EWMA median chart.However,the effect of each input parameter on the ARL_(1) was different.Moreover,the ARL_(1) for the EWMA median chart was smaller than the EWMA chart.This analysis is crucial to observe and determine the input parameters that have a significant impact on the ARL_(1) of the EMWA and EWMA median control charts.Hence,practitioners can obtain an overview of the influence of the input parameters on the ARL_(1) when implementing the EWMA and EWMA median control charts.

Compressed H3S: Fits to the Empirical Hc2(T) Data and a Discussion of the Meissner Effect

Based on μ-, T- and H-dependent pairing and number equations and the premise that μ(T) is predominantly the cause of the variation of the upper critical field Hc2(T), where μ, T and H denote the chemical potential, temperature and the applied field, respectively, we provide in this paper fits to the empirical Hc2(T) data of H3S reported by Mozaffari, et al. (2019) and deal with the issue of whether or not H3S exhibits the Meissner effect. Employing a variant of the template given by Dogan and Cohen (2021), we examine in detail the results of Hirsch and Marsiglio (2022) who have claimed that H3S does not exhibit the Meissner effect and Minkov, et al. (2023) who have claimed that it does. We are thus led to suggest that monitoring the chemical potential (equivalently, the number density of Cooper pairs Ns at T = Tc) should shed new light on the issue being addressed.

Sensitivity analysis of the vane length and passage width for a radial type swirler employed in a triple swirler configuration

The design of axial or radial swirlers typically governs a number of geometrical parameters that are determined by the desired flow field.In the meantime,the number of unknown parameters increases with the number of concentrically mounted swirlers.The available literature is nonetheless limited,and designers are obligated to increase the number of initial assumptions.In this article,three kinds of triple swirlers are employed and simulations are performed to determine the effect of each parameter on the swirler performance.Based on the correlation provided,overlengthening the radial vane length could result in significant changes in the flow field from the jetlike pattern to a wide swirl-jet angle due to the Coanda effect.Passage width should also have the potential to alter the swirl-jet angle and velocity field at the exit of the swirler.

In-hospital acute upper gastrointestinal bleeding: What is the scope of the problem?

BACKGROUND Acute upper gastrointestinal bleeding(AUGIB)is a frequently encountered condition in the Gastroenterology field with a mortality rate of 10-14%.Despite recent newer innovations and advancements in endoscopic techniques and available medications,the mortality rate associated with AUGIB remained persistently elevated.AIM To explore mortality,characteristics and outcome differences between hospitalized patients who develop AUGIB while in-hospital,and patients who initially present with AUGIB.METHODS This is a retrospective of patients who presented to Northwell Health Staten Island University Hospital from October 2012 to October 2016 with AUGIB that was confirmed endoscopically.Patients were divided in two groups:Group 1 comprised patients who developed AUGIB during their hospital stay;group 2 consisted of patients who initially presented with AUGIB as their main complaint.Patient characteristics,time to endoscopy,endoscopy findings and interventions,and clinical outcomes were collected and compared between groups.RESULTS A total of 336 patients were included.Group 1 consisted of 139 patients and group 2 of 196 patients.Mortality was significantly higher in the 1st group compared to the 2nd(20%vs 3.1%,P≤0.05).Increased length of stay(LOS)was noted in the 1st group(13 vs 6,P≤0.05).LOS post-endoscopy,vasopressor use,number of packed red blood cell units and patients requiring fresh frozen plasma were higher in group 1.Inpatients were more likely to be on corticosteroids,antiplatelets and anticoagulants.Conversely,the mean time from bleeding to undergoing upper endoscopy was significantly lower in group 1 compared to group 2.CONCLUSION In-hospital AUGIB is associated with high mortality and morbidity despite a shorter time to endoscopy.Larger scale studies assessing the role of increased comorbidities and antithrombotic use in this setting are warranted.

On constructing symmetrical reversible variable-length codes independent of the Huffman code

Reversible variable length codes (RVLCs) have received much attention due to their excellent error resilient capabilities. In this paper, a novel construction algorithm for symmetrical RVLC is proposed which is independent of the Huffman code. The proposed algorithm's codeword assignment is only based on symbol occurrence probability. It has many advantages over symmetrical construction algorithms available for easy realization and better code performance. In addition, the proposed algorithm simplifies the codeword selection mechanism dramatically.

Analysis for MIMO correlated frequency-selective channel in the presence of interference

The space time spreading, superimposed training sequences, and space-time coding are used to present a multiple input and multiple output （MIMO） systems model, and a closed-form of average error probability upper bound expression for MIMO correlated frequency-selective channel in the presence of interference （co-channel interference and jamming signals） is derived. Moreover, the correlation at both ends of the wireless link that can be incorporated equivalently into correlation at the transmit end is also derived, which is significant to analyze space-time link algorithm of MIMO systems.

The Impact of Climatic and Environmental Factors on n-Alkanes Indices in Southwestern Tibetan Plateau

n-Alkanes are widely used in paleoenvironmental reconstructions.However,our understanding of changes in the distribution of n-alkanes with climatic and environmental factors remains unclear in arid/semi-arid regions.We sampled 26 surface sediments from three climatic zones across the southwestern Tibetan Plateau to evaluate the sensitivity of chain length distributions of n-alkanes to climatic and environmental parameters.Our observations demonstrate that average chain length(ACL),proportion of aquatic macrophyte(Paq),carbon preference index(CPI)and ratio of the contents of nC_(27)and nC_(31)(nC_(27)/nC_(31))are all sensitive to hydroclimatic conditions.In contrast to commonly-adopted assumptions,the correlations between these indices and hydrological parameters are not always good,which indicates that the interpretation of n-alkane indices is special on the southwestern Tibetan Plateau.These might be related to the vegetation characteristics and seasonality of biological activity,and need to be considered in paleoclimatic reconstruction.The impact of seasonal precipitation on n-alkanes indices was also evaluated.

Monte-Carlo Simulation on the Failure of Fiber in a Single Filament Composite

A Monte-Carlo method is used to simulate gradual fracture of fiber in a single filament composite with the increase of virtual stress. A simple computational algorithm is developed to judge where breaking point will happen in the composite and a probability model based on Weibull- distribution is designed to calculate the average fragment length by producing stable and uniform random number in (0, 1). Compared to the published experiment results, the simulating average fragment length is quite perfect.

Incidence trends and predictors for cost and average lengths of stay in colorectal cancer surgery

AIM:To evaluate the changing trends and outcomes of colorectal cancer(CRC)surgery performed at a large single institution in Taiwan.METHODS:This study retrospectively analyzed 778patients who received colorectal cancer surgery at E-Da Hospital in Taiwan from 2004 to 2009.These patients were from health examination,inpatient or emergency settings.The following attributes were analyzed in patients who had undergone CRC surgical procedures:gender,age,source,surgical type,tumor number,tumor size,number of lymph node metastasis,pathologic differentiation,chemotherapy,distant metastases,tumor site,tumor stage,average hospitalization cost and average lengths of stay(ALOS).The odds ratio and95%confidence intervals were calculated to assess the relative rate of change.Regression models were employed to predict average hospitalization cost and ALOS.RESULTS:The study sample included 458(58.87%)males and 320(41.13%)females with a mean age of64.53 years(standard deviation,12.33 years;range,28-86 years).The principal patient source came from inpatient and emergency room(96.02%).The principal tumor sites were noted at the sigmoid colon(35.73%)and rectum(30.46%).Most patients exhibited a tumor stage of 2(37.28%)or 3(34.19%).The number of new CRC surgeries performed per 100000 persons was12.21 in 2004 and gradually increased to 17.89 in 2009,representing a change of 46.52%.During the same period,the average hospitalization cost and ALOS decreased from$5303 to$4062 and from 19.7 to 14.4 d,respectively.The following factors were associated with considerably decreased hospital resource utilization:age,source,surgical type,tumor size,tumor site,and tumor stage.CONCLUSION:These results can be generalized to patient populations elsewhere in Taiwan and to other countries with similar patient profiles.

Space-time spreading and space-time coding for correlated frequency-selective channel in the presence of interference

The space-time spreading （SIS）, superimposed training sequences and space-time coding （STC） are adopted to obtain a closed-form of average error probability upper bound and maximum likelihood esti- mation expression for multiple input and multiple output （MIMO） correlated frequency-selective channel in the presence of interference （colored interference）. Moreover, the correlation at both ends of the wire- less link that can be incorporated equivalently into correlation at the transmit end is derived. Finally, the mean square error （MSE） of the maximum likelihood estimate is also derived.

Computation of Average Run Length for Residual-Based T^2 Control Chart for Multivariate Autocorrelated Processes

The expression of residual is obtained according to its dynamic response to mean shift, then the distribu- tion of T2 statistic applied to the residual is derived, thus the probability of the 7a statistic lying outside the control limit is calculated. The above-mentioned results are substituted into the infinite definition expression of the average run length （ARL）, and then the final finite ARL expression is obtained. An example is used to demonstrate the procedures of the proposed method. In the comparative study, eight autocorrelated processes and four different mean shifts are performed, and the ARL values of the proposed method are compared with those obtained by simulation method with 50 000 replications. The accuracy of the proposed method can be illustrated through the comparative results.

The permanence and global attractivity of a competitive system with feedback controls and toxic substance

In this paper,we consider a nonautonomous competitive system with feedback controls and toxic substance.Some average couditions for the permanence and global attractivity of the system are obtained.It is shown that our results are generalization or improvement of those of Zhao,Jiang and Lazer [Nonlinear Analysis:Real World Applications,5(4)(2004),265-276],Xia,Cao,Zhang and Chen [Journal of Mathematical Analysis and Applications,294(2)(2004),503-522] and Chen [Nonlinear Analysis:Real World Applications,in press]