Serve the People or Serve the Consumer? The Dilemma of Patient-Centred Health Care in China

Patient-centred medicine is being adopted as national policies in many countries, encouraged by positive outcomes of the practice at clinical and organisational levels. This study examines the patient-centred health care reform in China, which has adopted the approach as a national policy for two decades but has yet to achieve the intended goals. Focusing on conflicting interpretations of the nature of patients at national, organisational, and individual levels, this article argues that such conflicts lead to clashes between the political agenda of the state, priorities of health organisations, professional choices of individual practitioners, and expectations of patients in the process of implementing, practicing, and receiving patient-centred health care in China. It reveals that the national health authority has intended patient-centredness as a universal, anti-market, people-centred approach, based on the health ideology of serving the people. But hospitals, compelled by financial restraints, have implemented it as a market approach centring on patients as consumers. Medical professionals and patients also possess contradictory views towards whether a patient should be perceived as a consumer. The discordance in the interpretation of the patient identity has caused great confusion in the implementation and provision of patient-centred health care. The study points out that the success of patient-centredness as national policy cannot be assumed on the basis of its success at clinical and organisational levels. More efforts are needed to coordinate the fundamental understanding of patient-centredness by different actors.

THE HAUSDORFF CENTRED MEASURE OF THE SYMMETRY CANTOR SETS

Let 0<A≤1/3 ,K(λ) be the attractor of an iterated function system {ψ1,ψ2} on the line, where 1(x)= AT, ψ1(x) = 1-λ+λx, x∈[0,1]. We call K(λ) the symmetry Cantor sets. In this paper, we obtained the exact Hausdorff Centred measure of K(λ).

Monte Carlo study of the antiferromagnetical Ising model on a centred honeycomb lattice

We use the Monte Carlo method to study an antiferromagnetical Ising spin system on a centred honeycomb lattice, which is composed of two kinds of 1/2 spin particles A and B. There exist two different bond energies JA-A and JA--B in this lattice. Our study is focused on how the ratio of JA-B to JA--A influences the critical behaviour of this system by analysing the physical quantities, such as the energy, the order parameter, the specific heat, susceptibility, etc each as a function of temperature for a given ratio of JA-B to JA-A. Using these results together with the finite-size scaling method, we obtain a phase diagram for the ratio JA-B / JA--A. This work is helpful for studying the phase transition problem of crystals composed of compounds.

HAUSDORFF CENTRED MEASURE OF NON-SYMMETRY CANTOR SETS

Let 0<λ_1,λ_2<1 and 1-λ_1-λ_2≥max｛λ_1,λ_2｝.Let ~K(λ_1,λ_2) be the attractor of the iterated function system ｛φ_1,φ_2｝on the line,where φ_1(x)=λ_1x and φ_2(x)=1-λ_2+λ_2x,x∈R.~K(λ_1,λ_2) is called a non-symmetry Cantor set. In this paper,it is proved that the exact Hausdorff centred measure of K(λ_1,λ_2) equals 2s(1-λ)s,where λ=max｛λ_1,λ_2｝ and s is the Hausdorff dimension of K(λ_1,λ_2).

A Tentative Study on the Relevance of Progressivism to ELT: Perspective of Learner-centredness

For the sake of its inseparability to the science of language, English language teaching(ELT) tends to be researched,despite diverse voices within its domain, from the perspective of linguistics. It is noticeable, however, that ELT in this research conducted is literally referred to as an educational conception, though pertinent linguistics knowledge is to be inevitably involved. Given this situation, ELT is categorised as an intra-discipline of education, establishing the basic ground of the academic enquiries throughout the context. Relevant issues are to be further examined concerning to what extent learner-centredness manifests its definition within modern pedagogical approaches and methods of ELT, so as to indicate the philosophical significance of education in language teaching. A critical insight is to be given into the limitations of learner- centredness in ELT practice through two case studies thereafter, which is expected to benefit the development of ELT professionalism in the changing practice of language education.

National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26,2023,at the Pakistan Kidney and Liver Institute&Research Centre(PKLI&RC)after initial consultations with the experts.The Pakistan Society for the Study of Liver Diseases(PSSLD)and PKLI&RC jointly organised this meeting.This effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma(hCCA).The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these patients.This coordinated effort can minimise delays and give patients a chance for curative treatment and effective palliation.The diagnostic and staging workup includes high-quality computed tomography,magnetic resonance imaging,and magnetic resonance cholangiopancreato-graphy.Brush cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for diagnosis.However,histopathologic confirmation is not always required before resection.Endoscopic ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for staging.The only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette classification.Selected patients with unresectable hCCA can be considered for liver transplantation.Adjuvant chemotherapy should be offered to patients with a high risk of recurrence.The use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary discussions.Patients with acute cholangitis can be drained with endoscopic or percutaneous biliary drainage.Palliative chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA.

Early postoperative complications after transverse colostomy closure,a retrospective study

BACKGROUND Ostomy is a common surgery usually performed to protect patients from clinical symptoms caused by distal anastomotic leakage after colorectal cancer(CRC)surgery and perforation or to relieve intestinal obstruction.AIM To analyze the complications after transverse colostomy closure.METHODS Patients who underwent transverse colostomy closure from Jan 2015 to Jan 2022 were retrospectively enrolled in a single clinical center.The differences between the complication group and the no complication group were compared.Logistic regression analyses were conducted to find independent factors for overall complications or incision infection.RESULTS A total of 102 patients who underwent transverse colostomy closure were enrolled in the current study.Seventy(68.6%)patients underwent transverse colostomy because of CRC related causes.Postoperative complications occurred in 30(29.4%)patients and the most frequent complication occurring after transverse colostomy closure was incision infection(46.7%).The complication group had longer hospital stays(P<0.01).However,no potential risk factors were identified for overall complications and incision infection.CONCLUSION The most frequent complication occurring after transverse colostomy closure surgery in our center was incision infection.The operation time,interval from transverse colostomy to reversal,and method of anastomosis might have no impact on the postoperative complications.Surgeons should pay more attention to aseptic techniques.

Bridge in Slany:A Conjunction of History,Modern Technology and Sensitive Architectural Approach

The revitalization of the historic centre of Slany(Czech Republic)dealt by architects-experts in a historic town focused on their theoretical principles and verified practice.The bridge U Brodu is the first project of the revitalization.

A Finite Volume Upwind-Biased Centred Scheme for Hyperbolic Systems of Conservation Laws:Application to Shallow Water Equations

We construct a new first-order central-upwind numerical method for solving systems of hyperbolic equations in conservative form.It applies in multidimensional structured and unstructured meshes.The proposed method is an extension of the UFORCEmethod developed by Stecca,Siviglia and Toro[25],in which the upwind bias for the modification of the staggered mesh is evaluated taking into account the smallest and largest wave of the entire Riemann fan.The proposed first-order method is shown to be identical to the Godunov upwindmethod in applications to a 2×2 linear hyperbolic system.The method is then extended to non-linear systems and its performance is assessed by solving the two-dimensional inviscid shallow water equations.Extension to second-order accuracy is carried out using an ADER-WENO approach in the finite volume framework on unstructured meshes.Finally,numerical comparison with current competing numerical methods enables us to identify the salient features of the proposed method.

New Paths Towards Modernisation

The 13th Meeting of China-Africa Think Tank Forum held in Dar es Salaam,Tanzania,released a document titled Consensus Among African and Chinese Think Tanks on Deepening Global Development Cooperation.Also known as the Africa-China Dar es Salaam Consensus,the document calls on the international community to deepen development cooperation based on the principles of mutual respect,solidarity,win-win cooperation,openness,and common prosperity.It proposes to adopt a people-centred approach to development to create a friendly institutional environment for everyone to pursue a better life.

A Land of Vitality

People-centred development is the core concept underlining China’s endeavours to improve human rights in China.“People’s happiness is the ultimate human right,while development holds the key to delivering better lives to the people,”Chinese President Xi Jinping reiterated in a letter to the 2023 Forum on the Development of Xizang,China.

Combating Cholera

Lying in her makeshift hospital bed,Joyce Tembo thanked medical personnel for evacuating her to the designated national cholera treatment centre,6 km north of Zambia’s capital Lusaka.She was recently diagnosed with diarrhoeal disease.Tembo,43,commended the medical sta!stationed at the treatment centre for their great service to thousands of patients,especially women and children seeking urgent treatment.“I am very grateful to the Chinese doctors who attended to me as soon as the ambulance rushed me to the clinic where I received urgent treatment;they have really saved my life,”Tembo told ChinAfrica.But not all residents in her community are as lucky as her.Many in the densely populated slums die every day due to the area’s poor sanitation-one of the major causes of the cholera outbreak.

Old Skills Get New Life

Traditional craftsmanship takes centre stage as villages seek to restore ancient buildings.Visitors to Ye Changxian’s workshop in Anleshan Village,Songyang County,Lishui City,Zhejiang Province,are greeted by an intense aroma of cedar wood.The work bench is littered with tools-saws,chisels,planes,files and axes.Ye,57,is a highly respected carpenter with nearly 40 years of experience restoring ancient buildings.Adept at mortise and tenon,a traditional woodworking technique,he can create seamless and sturdy structures without the use of a single nail.He has been involved in the restoration of more than 160 old buildings since 2016 when the county began a programme to restore ancient buildings.“I never imagined that these old skills of mine would be of great use,”he said.

A Speculation: Avian Migration and the K-T Extinction

One caveat to the dinosaur’s extinction is the conclusion that avian dinosaurs survived and became ancestors of birds. Their mobility enabled them to migrate great distances and find the nutrients needed to survive. Given this scenario, could the current observable migration of birds (the “dinosaurian offspring”) now be related? Migration is the regular seasonal movement undertaken by many species of birds, with the most common pattern, flying north in the Northern spring to breed in the temperate or Arctic summer and returning in the Northern autumn to wintering grounds in warmer regions of the south. The primary motivation for migration appears to be food. None of the major North-South migratory pathways fly over the Caribbean but three main fly ways, past to the west of the theorized K-T impact centre. Due to their ability to fly, the “avian Dinosaurs” adapted and survived very quickly in response to the disaster that marked the K-T boundary. It is an interesting speculation that the avian migration that we witness today is rooted in an event that occurred 66 million years ago! But it does explain why the migratory birds mostly fly from Polar summer to polar summer when they could just be as easily fly from Polar zone to the warmer equatorial region and back. In the recent article in Nature by Melanie During about identifying the late spring timing of the “Astro disaster”, it can be cited as consistent with my speculation. A late April early May Impact as suggested by During would have seen these migrations completely. The western migratory routes would have been found to be “luxurious” in vegetation in that first northern autumn after the “Astro-impact” while all eastern routes would have still been barren.

Theory of Flexural Shear, Bending and Torsion for a Thin-Walled Beam of Open Section

Aspects of the general Vlasov theory are examined separately as applied to a thin-walled channel section cantilever beam under free-end end loading. In particular, the flexural bending and shear that arise under transverse shear and axial torsional loading are each considered theoretically. These analyses involve the location of the shear centre at which transverse shear forces when applied do not produce torsion. This centre, when taken to be coincident with the centre of twist implies an equivalent reciprocal behaviour. That is, an axial torsion applied concentric with the shear centre will twist but not bend the beam. The respective bending and shear stress conversions are derived for each action applied to three aluminium alloy extruded channel sections mounted as cantilevers with a horizontal principal axis of symmetry. Bending and shear are considered more generally for other thin-walled sections when the transverse loading axes at the shear centre are not parallel to the section = s centroidal axes of principal second moments of area. The fixing at one end of the cantilever modifies the St Venant free angular twist and the free warping displacement. It is shown from the Wagner-Kappus torsion theory how the end constrained warping generates an axial stress distribution that varies with the length and across the cross-section for an axial torsion applied to the shear centre. It should be mentioned here for wider applications and validation of the Vlasov theory that attendant papers are to consider in detail bending and torsional loadings applied to other axes through each of the centroid and the web centre. Therein, both bending and twisting arise from transverse shear and axial torsion applied to each position being displaced from the shear centre. Here, the influence of the axis position upon the net axial and shear stress distributions is to be established. That is, the net axial stress from axial torsional loading is identified with the sum of axial stress due to bending and axial stress arising from constrained warping displacements at the fixing. The net shear stress distribution overlays the distributions from axial torsion and that from flexural shear under transverse loading. Both arise when transverse forces are displaced from the shear centre.

Striving towards integrated people-centred health services:reflections on the Australian experience

Health systems around the world are under continuing pressure for reform.Health system reform involves both content and process.Content deals with changes to the structures of the health system;process deals with the strategies of change.In this paper,we reflect on the development of the Australian healthcare system and draw out lessons regarding both structural and developmental principles.We review the historical development and functional performance of a range of‘programmes’which comprise the Australian health system.We use WHO’s 2016‘framework on integrated people‐centred health services’as a standard against which to evaluate the performance of the different programmes.A model of health system development featuring incremental change,windows of opportunity and policy coherence is used to frame some lessons from the Australian experience regarding reform strategy.Several of the programmes reviewed can be shown to have contributed positively to integrated and people-centred services.However,there have also been significant shortfalls in performance.The successes and the shortfalls of the programmes reviewed reflect both their histories and their contemporary context.Structural principles emerging from this review include the policy leverage available under single payer purchasing and on the other hand the fragmenting effects of privatisation and marketisation.Lessons regarding strategies of reform include cultivating‘reform readiness’across all of the locations and levels where opportunities for change may emerge while cultivating system wide coherence through a shared vision of how the system as a whole should develop.

Long-term outcomes in patients with non-alcoholic fatty liver disease: further evidence that a multidisciplinary and patient-centred approach to treatment is needed

The prevalence of non-alcoholic fatty liver disease(NAFLD)is thought to be on the rise globally(1).An updated meta-analysis reported that in 2019 the pooled global prevalence of NAFLD was 29.8%[95%confidence interval(CI):28.6-31.1%]with the highest NAFLD prevalence observed in South America and North America(2).From 1991-2019,trend analysis also showed that NAFLD prevalence increased from~22%to 37%(with yearly increase of 0.7%),with South America showing the most rapid change of 2.7%per year followed by the Europe at 1.1%(2).

Intermediary roles of prospective memory and retrospective memory in the comorbidity of depression and pain

Background Patients who suffer comorbidity of major depressive disorder(MDD)and chronic pain(CP)maintain a complex interplay between maladaptive prospective memory(PM)and retrospective memory(RM)with physical pain,and their complications are still unknown.Aims We aimed to focus on the full cognitive performance and memory complaints in patients with MDD and CP,patients with depression without CP,and control subjects,considering the possible influence of depressed affect and chronic pain severity.Methods According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the criteria given by the International Association of Pain,a total of 124 participants were included in this cross-sectional cohort study.Among them,82 depressed inpatients and outpatients from Anhui Mental Health centre were divided into two groups:a comorbidity group(patients with MDD and CP)(n=40)and a depression group(patients with depression without CP)(n=42).Meanwhile,42 healthy controls were screened from the hospital’s physical examination centre from January 2019 to January 2022.The Hamilton Depression Rating Scale-24(HAMD-24)and Beck Depression Inventory-II(BDI-II)were used to evaluate the severity of depression.The Pain Intensity Numerical Rating Scale(PI-NRS),Short-Form McGill Pain Questionnaire-2 Chinese version(SF-MPQ-2-CN),Montreal Cognitive Assessment-Basic Section(MoCA-BC),and Prospective and Retrospective Memory Questionnaire(PRMQ)were used to assess pain-related features and the global cognitive functioning of study participants.Results The impairments in PM and RM differed remarkably among the three groups(F=7.221,p<0.001;F=7.408,p<0.001)and were severe in the comorbidity group.Spearman correlation analysis revealed the PM and RM were positively correlated with continuous pain and neuropathic pain(r=0.431,p<0.001;r=0.253,p=0.022 and r=0.415,p<0.001;r=0.247,p=0.025),respectively.Regression analysis indicated a significant positive relationship between affective descriptors and total BDI-II score(β=0.594,t=6.600,p<0.001).Examining the mediator pathways revealed the indirect role of PM and RM in patients with comorbid MDD and CP.Conclusions Patients with comorbid MDD and CP presented more PM and RM impairments than patients with MDD without CP.PM and RM are possibly mediating factors that affect the aetiology of comorbid MDD and CP.

Dual‑Doped Nickel Sulfide for Electro‑Upgrading Polyethylene Terephthalate into Valuable Chemicals and Hydrogen Fuel

Electro-upcycling of plastic waste into value-added chemicals/fuels is an attractive and sustainable way for plastic waste management.Recently,electrocatalytically converting polyethylene terephthalate(PET)into formate and hydrogen has aroused great interest,while developing low-cost catalysts with high efficiency and selectivity for the central ethylene glycol(PET monomer)oxidation reaction(EGOR)remains a challenge.Herein,a high-performance nickel sulfide catalyst for plastic waste electro-upcycling is designed by a cobalt and chloride co-doping strategy.Benefiting from the interconnected ultrathin nanosheet architecture,dual dopants induced upshifting d band centre and facilitated in situ structural reconstruction,the Co and Cl co-doped Ni_(3)S_(2)(Co,Cl-NiS)outperforms the singledoped and undoped analogues for EGOR.The self-evolved sulfide@oxyhydroxide heterostructure catalyzes EG-to-formate conversion with high Faradic efficiency(>92%)and selectivity(>91%)at high current densities(>400 mA cm^(−2)).Besides producing formate,the bifunctional Co,Cl-NiS-assisted PET hydrolysate electrolyzer can achieve a high hydrogen production rate of 50.26 mmol h^(−1)in 2 M KOH,at 1.7 V.This study not only demonstrates a dual-doping strategy to engineer cost-effective bifunctional catalysts for electrochemical conversion processes,but also provides a green and sustainable way for plastic waste upcycling and simultaneous energy-saving hydrogen production.