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.

Factors Affecting Cotrimoxazole Prophylactic Therapy Compliance in HIV Patients Attending a Care and Treatment Clinic at Bugando Medical Centre in Mwanza, Tanzania

Introduction: Cotrimoxazole Prophylactic Therapy (CPT) compliance lowers the risk of opportunistic infections and other Acquired Immune Deficiency Syndrome (AIDS)-related diseases. The aim of this study was to examine factors that influence compliance with CPT among HIV patients in the Care and Treatment Clinic (CTC) at Bugando Medical Centre (BMC) in Mwanza, Tanzania. Methods: A descriptive cross-sectional study was conducted at the BMC between April 1, 2021, and June 30, 2021. Data were collected using face-to-face interviews and a semi-structured questionnaire. Data are presented in frequency, percentages, and cross-tabulation tables. A P-value of less than 0.05 was considered statistically significant. Results: The prevalence of compliance with CPT by self-reported measurement was 158 (63.7%). Most CPT-compliant participants were more likely to have a spouse who is familiar with CPT, have a family member who is aware of their HIV status, and be aware of the benefits of CPT. The majority of participants who complied with CPT were more likely to have experienced counseling during refill, felt that the length of time spent seeing doctors for treatment was reasonable, and received accurate information from them. Conclusion: Most adult HIV patients attending CTC at BMC were reported to be in compliance with CPT. These findings suggest that improving social support and patient-provider communication may be effective strategies for improving compliance with CPT among HIV patients.

A Study on Reconstruction of Surface Wind Speed in China Due to Various Climate Variabilities

Using European Centre for Medium-Range Weather Forecasts Reanalysis V5(ERA5)reanalysis data,this study investigated the reconstruction effects of various climate variabilities on surface wind speed in China from 1979 to 2022.The results indicated that the reconstructed annual mean wind speed and the standard deviation of the annual mean wind speed,utilizing various climate variability indices,exhibited similar spatial modes to the reanalysis data,with spatial correlation coefficients of 0.99 and 0.94,respectively.In the reconstruction of six major wind power installed capacity provinces/autonomous regions in China,the effects were notably good for Hebei and Shanxi provinces,with the correlation coefficients for the interannual regional average wind speed time series being 0.65 and 0.64,respectively.The reconstruction effects of surface wind speed differed across seasons,with spring and summer reconstructions showing the highest correlation with reanalysis data.The correlation coefficients for all seasons across most regions in China ranged between 0.4 and 0.8.Among the reconstructed seasonal wind speeds for the six provinces/autonomous regions,Shanxi Province in spring exhibited the highest correlation with the reanalysis,with a coefficient of 0.61.The large-scale climate variability indices showed good reconstruction effects on the annual mean wind speed in China,and could explain the interannual variability trends of surface wind speed in most regions of China,particularly in the main wind energy provinces/autonomous regions.

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.

Influence of vapor pressure deficit on vegetation growth in China

Vapor pressure deficit(VPD)plays a crucial role in determining plant physiological functions and exerts a substantial influence on vegetation,second only to carbon dioxide(CO_(2)).As a robust indicator of atmospheric water demand,VPD has implications for global water resources,and its significance extends to the structure and functioning of ecosystems.However,the influence of VPD on vegetation growth under climate change remains unclear in China.This study employed empirical equations to estimate the VPD in China from 2000 to 2020 based on meteorological reanalysis data of the Climatic Research Unit(CRU)Time-Series version 4.06(TS4.06)and European Centre for Medium-Range Weather Forecasts(ECMWF)Reanalysis 5(ERA-5).Vegetation growth status was characterized using three vegetation indices,namely gross primary productivity(GPP),leaf area index(LAI),and near-infrared reflectance of vegetation(NIRv).The spatiotemporal dynamics of VPD and vegetation indices were analyzed using the Theil-Sen median trend analysis and Mann-Kendall test.Furthermore,the influence of VPD on vegetation growth and its relative contribution were assessed using a multiple linear regression model.The results indicated an overall negative correlation between VPD and vegetation indices.Three VPD intervals for the correlations between VPD and vegetation indices were identified:a significant positive correlation at VPD below 4.820 hPa,a significant negative correlation at VPD within 4.820–9.000 hPa,and a notable weakening of negative correlation at VPD above 9.000 hPa.VPD exhibited a pronounced negative impact on vegetation growth,surpassing those of temperature,precipitation,and solar radiation in absolute magnitude.CO_(2) contributed most positively to vegetation growth,with VPD offsetting approximately 30.00%of the positive effect of CO_(2).As the rise of VPD decelerated,its relative contribution to vegetation growth diminished.Additionally,the intensification of spatial variations in temperature and precipitation accentuated the spatial heterogeneity in the impact of VPD on vegetation growth in China.This research provides a theoretical foundation for addressing climate change in China,especially regarding the challenges posed by increasing VPD.

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.

Collective Undertaking

Medical institutions and enterprises in Shanghai join hands for technological breakthroughs The medical equipment valley in Jiading District of Shanghai,known as Shanghai MedValley,is a powerhouse of medical innovation.As an industrial park centred on creative medical equipment development,the valley has gathered a cluster of high-end medical device enterprises and highly qualified professionals.

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.