CHS-DRG付费下超支病例分析及对策

按疾病诊断相关分组(diagnosis related groups,DRG)付费是国际公认较为先进和科学的支付方式之一。实践证明,DRG的引入能够增强医疗服务的可比性,提高医疗服务效率、降低医疗服务成本[1~4]。近年来,国家医保局加快推进医保支付方式改革。北京市作为国家医疗保障疾病诊断相关分组(China health-care security DRG,CHS-DRG)国家试点城市于2022年3月15日启动66家试点医院的实际付费。

CHS-DRG和耗材集采下关节置换病组费用结构变化研究

目的:研究CHS-DRG付费联合人工关节集采改革措施实施前后关节置换病组(IC29)住院患者费用结构变化情况及影响因素,揭示改革给医院运营带来的影响。方法:分析北京某三级医院改革实施前后IC29病组住院患者的信息以及住院费用变化情况;运用结构变动度分析法,分析病组费用变化的主要类别和方向。结果:改革前后IC29病组次均住院费的结构变动度为39.4%,其中耗材费、手术费是影响住院费用变动的主要项目,累计贡献率为80.15%。改革后月均住院患者人次增加,次均住院费与耗材费下降,手术费占比升高,DRG医保盈余升高。结论:改革措施推进了CHS-DRG落地实施,使IC29病组住院费用结构趋于合理化,增加了医院可支配收入,降低了患者就医负担。但体现医务人员劳动技术价值的手术治疗费增幅有限,改革面临可能出现的诸多负性问题,需要进一步研究制定配套政策。

CHS-DRG付费改革对医院医疗质量和运行效率影响的实证分析

[目的]分析北京市某三甲医院在CHS-DRG实际付费改革前、后的医院医疗质量和运行效率的变化情况,评价改革实施效果。[方法]通过Donabedian模型建立指标集,收集其中8个指标2021年4月-2023年3月的住院数据进行中断时间序列分析。[结果]CHS-DRG付费改革后,CMI值在改革时短暂下降了0.04,但后续呈上升趋势(P<0.05),显示在长期受到了政策正向的积极影响;平均住院日在观测期内水平下降0.183天,但改革后趋势显著上升(P<0.05);住院例均费用在改革时显著下降,降低了493.45元,但改革后趋势变为上升;费用消耗指数在改革后变为上升趋势(P<0.05)。[结论]CHS-DRG支付改革推动了技术难度的提升、平均住院日和患者医疗经济负担的即时下降,但改革后长期的时间消耗和费用消耗未得到显著优化。

青蒿查尔酮合成酶(AaCHS)基因家族鉴定及光调控分析

[目的]为了解青蒿(Artemisia annua L.)查尔酮合成酶(chalcone synthase,CHS)基因家族的分子进化特性及其在不同组织部位的表达情况。[方法]从Pfam数据库下载CHS蛋白HMM模型,并使用HUMMER 3.0、Blastp和CD-search鉴定出青蒿基因组中的CHS基因家族成员。采用TBtools、EXPASy、CELLO v.2.5、MEGA 7.0、MEME、SOPMA、SWISSMODEL和PlantCARE等软件对其氨基酸与碱基序列进行生物信息学分析,通过8个不同组织部位的转录组数据对AaCHS基因家族成员进行表达分析。[结果]青蒿基因组中共有16个AaCHS基因家族成员,蛋白结构分析显示AaCHS蛋白质结构并不稳定,将其分为4个组,基因结构分析显示所有AaCHS基因蛋白均具有外显子,数量为2~4,内含子数量为0~2,其中8个AaCHS基因不具有内含子。启动子顺式作用元件分析表明该基因家族成员启动子上含有大量光响应、植物激素响应元件;CD-search验证结果发现每个AaCHS蛋白均有Chal-sti-synt_N结构域。[结论]AaCHS家族成员表达分析结果表明,16个AaCHS基因在不同组织和光处理下表达不同。GO富集结果得到GO二级分类的生物过程和分子功能,生物过程共富集了80条序列;细胞组分共富集了19条序列,其中二级分类过程细胞质中富集了11条序列,数量最多,与亚细胞定位预测结果一致;推测AaCHS基因在细胞质中调控黄酮类化合物的累积。通过青蒿光调控差异表达分析,推测AaCHS7、AaCHS10在青蒿受到红光光处理中起正向调控作用。

Reaction视频中用户弹幕信息交互行为的情感反应生成机理研究

深入挖掘Reaction视频中弹幕信息交互行为的情感反应机理有助于理解用户弹幕创作背后的情感生成原因及情感变化过程。本文基于情感反应模型,利用定向内容分析法对哔哩哔哩网站中11个热门视频的弹幕信息资源、视频内容以及reactor反应情况展开编码研究,构建了Reaction视频中用户弹幕信息交互行为的情感反应生成机理模型。研究发现,Reaction视频弹幕信息交互行为中的情感反应生成机理总体上遵循“信息刺激-情感反应”的路径,信息刺激有时会独立唤醒情绪或特定情感态度,有时也会通过唤醒特定情感态度进而影响情绪或内化情感态度的生成。该模型有助于提升情感反应理论在计算机协助交流中的情境化探索,也将为社交媒体中用户与信息交互提供优化建议。

多花黄精查尔酮合酶PcCHS的原核表达、亚细胞定位及表达分析

【目的】探究查尔酮合酶(chalcone synthase,PcCHS)基因在多花黄精类黄酮合成中的作用,为后续解析PcCHS功能以及多花黄精新品种选育提供可靠的理论依据。【方法】以多花黄精为cDNA模板,克隆多花黄精PcCHS基因的编码序列,对该基因进行生物信息学分析。通过构建PcCHS的原核表达载体,纯化目的重组蛋白,验证该酶的体外表达活性。利用瞬时超表达体系探究该基因过表达后总黄酮的含量变化。利用Gateway技术构建亚细胞定位载体35S::PcCHS-GFP,通过本氏烟草表达系统确定目的蛋白亚细胞定位情况。【结果】PcCHS基因的开放阅读框为1 251 bp,理论分子量为44.63 kD,等电点为5.89,属于亲水蛋白,与石刁柏(Asparagus officinalis)CHS亲缘关系较近。原核表达实验表明,pET28a-PcCHS经IPTG(异丙基-β-D-硫代半乳糖苷)诱导表达可溶性重组蛋白,Western-blot显示大小约为45 kD,与预期大小一致,且纯化的目的蛋白具有一定的酶活性,能催化对香豆酰辅酶A和丙二酰辅酶A转化为柚皮素查尔酮。此外,PcCHS瞬时超表达中,PcCHS组的表达量显著高于空载K组,总黄酮含量也显著高于空载K组,最高可达1.83倍。亚细胞定位结果显示,该基因在细胞膜和细胞核中发挥作用。【结论】PcCHS基因原核表达的酶具有体外酶活性,其亚细胞定位于细胞膜和细胞核,且瞬时超表达能够显著提高多花黄精叶片总黄酮含量。

Tuning electronic structure of RuO_(2)by single atom Zn and oxygen vacancies to boost oxygen evolution reaction in acidic medium

The poor stability of RuO_(2)electrocatalysts has been the primary obstacles for their practical application in polymer electrolyte membrane electrolyzers.To dramatically enhance the durability of RuO_(2)to construct activity-stability trade-off model is full of significance but challenging.Herein,a single atom Zn stabilized RuO_(2)with enriched oxygen vacancies(SA Zn-RuO_(2))is developed as a promising alternative to iridium oxide for acidic oxygen evolution reaction(OER).Compared with commercial RuO_(2),the enhanced Ru–O bond strength of SA Zn-RuO_(2)by forming Zn-O-Ru local structure motif is favorable to stabilize surface Ru,while the electrons transferred from Zn single atoms to adjacent Ru atoms protects the Ru active sites from overoxidation.Simultaneously,the optimized surrounding electronic structure of Ru sites in SA ZnRuO_(2)decreases the adsorption energies of OER intermediates to reduce the reaction barrier.As a result,the representative SA Zn-RuO_(2)exhibits a low overpotential of 210 mV to achieve 10 mA cm^(-2)and a greatly enhanced durability than commercial RuO_(2).This work provides a promising dual-engineering strategy by coupling single atom doping and vacancy for the tradeoff of high activity and catalytic stability toward acidic OER.

Exciting lattice oxygen of nickel–iron bi-metal alkoxide for efficient electrochemical oxygen evolution reaction

High efficiency,cost-effective and durable electrocatalysts are of pivotal importance in energy conversion and storage systems.The electro-oxidation of water to oxygen plays a crucial role in such energy conversion technologies.Herein,we report a robust method for the synthesis of a bimetallic alkoxide for efficient oxygen evolution reaction(OER)for alkaline electrolysis,which yields current density of 10 mA cm^(-2)at an overpotential of 215 mV in 0.1 M KOH electrolyte.The catalyst demonstrates an excellent durability for more than 540 h operation with negligible degradation in activity.Raman spectra revealed that the catalyst underwent structure reconstruction during OER,evolving into oxyhydroxide,which was the active site proceeding OER in alkaline electrolyte.In-situ synchrotron X-ray absorption experiment combined with density functional theory calculation suggests a lattice oxygen involved electrocatalytic reaction mechanism for the in-situ generated nickel–iron bimetal-oxyhydroxide catalyst.This mechanism together with the synergy between nickel and iron are responsible for the enhanced catalytic activity and durability.These findings provide promising strategies for the rational design of nonnoble metal OER catalysts.

Deformable Catalytic Material Derived from Mechanical Flexibility for Hydrogen Evolution Reaction

Deformable catalytic material with excellent flexible structure is a new type of catalyst that has been applied in various chemical reactions,especially electrocatalytic hydrogen evolution reaction(HER).In recent years,deformable catalysts for HER have made great progress and would become a research hotspot.The catalytic activities of deformable catalysts could be adjustable by the strain engineering and surface reconfiguration.The surface curvature of flexible catalytic materials is closely related to the electrocatalytic HER properties.Here,firstly,we systematically summarized self-adaptive catalytic performance of deformable catalysts and various micro–nanostructures evolution in catalytic HER process.Secondly,a series of strategies to design highly active catalysts based on the mechanical flexibility of lowdimensional nanomaterials were summarized.Last but not least,we presented the challenges and prospects of the study of flexible and deformable micro–nanostructures of electrocatalysts,which would further deepen the understanding of catalytic mechanisms of deformable HER catalyst.

Precisely Control Relationship between Sulfur Vacancy and H Absorption for Boosting Hydrogen Evolution Reaction

Ef fective and robust catalyst is the core of water splitting to produce hydrogen.Here, we report an anionic etching method to tailor the sulfur vacancy(VS) of NiS_(2) to further enhance the electrocatalytic performance for hydrogen evolution reaction(HER). With the VS concentration change from 2.4% to 8.5%, the H* adsorption strength on S sites changed and NiS_(2)-VS 5.9% shows the most optimized H* adsorption for HER with an ultralow onset potential(68 m V) and has long-term stability for 100 h in 1 M KOH media. In situ attenuated-total-reflection Fourier transform infrared spectroscopy(ATR-FTIRS) measurements are usually used to monitor the adsorption of intermediates. The S-H* peak of the Ni S_(2)-VS 5.9% appears at a very low voltage, which is favorable for the HER in alkaline media. Density functional theory calculations also demonstrate the Ni S_(2)-VS 5.9% has the optimal |ΔG^(H*)| of 0.17 e V. This work offers a simple and promising pathway to enhance catalytic activity via precise vacancies strategy.

一份新的玉米永久性失绿突变体chs10的鉴定及基因克隆

【目的】利用60Co-γ射线处理自交系齐319获得了一份新的玉米叶色突变体,对该突变体进行遗传分析、基因定位与克隆,并对候选基因的功能进行初步分析。【方法】以该突变体为亲本,构建遗传分析群体和基因定位群体;通过图位克隆技术获得关键候选基因;利用生物信息学方法分析关键候选基因的结构和进化关系;通过qRT-PCR技术检测候选基因在不同组织中的表达差异;同时运用烟草瞬时表达技术对候选基因进行亚细胞定位表达分析。【结果】鉴定了一份玉米永久性失绿突变体chs10(Permanent chlorosis 10),chs10自V2时期开始,叶片从幼苗基部到顶部逐渐由绿转黄,后期的生长发育过程中不再复绿,并且,整个植株包括叶鞘、叶环、茎秆、苞叶和雄穗也均为黄色。该突变体受一对隐性核基因控制,可稳定遗传,植株生长发育正常,可正常授粉结实。突变基因被定位于玉米第10染色体长臂标记SNP-2和SNP-3之间约0.17 Mb范围内,确定了关键候选基因Zm00001d025860,qRT-PCR结果显示Zm00001d025860在玉米根、茎、叶和叶鞘中均有表达,但在叶片中高表达,亚细胞定位结果显示目标蛋白被定位在细胞膜和叶绿体中。利用STRING预测发现Zm00001d025860与卟啉结合蛋白GUN4基因互作,GUN4与叶绿素合成中的镁离子螯合酶(MgCh)具有反馈调节作用。【结论】Zm00001d025860基因的突变导致突变体chs10叶色的改变,并且Zm00001d025860可能通过参与叶绿素合成途径来调控叶色变化。突变体chs10的发现一方面丰富了玉米叶色突变体研究的基因资源,同时为解析镁离子螯合酶在叶绿素合成途径中的作用机理奠定了材料基础。

Particle agglomeration and inhibition method in the fluidized pyrolysis reaction of waste resin

This work investigated the pyrolysis reaction of waste resin in a fluidized bed reactor.It was found that the pyrolysis-generated ash would adhere to the surface of ceramic particles,causing particle agglomeration and defluidization.Adding kaolin could effectively inhibit the particle agglomeration during the fluidized pyrolysis reaction through physical isolation and chemical reaction.On the one hand,kaolin could form a coating layer on the surface of ceramic particles to prevent the adhesion of organic ash generated by the pyrolysis of resin.On the other hand,when a sufficient amount of kaolin(-0.2%(mass))was added,the activated kaolin could fully contact with the Na+ ions generated by the pyrolysis of resin and react to form a high-melting aluminosilicate mineral(nepheline),which could reduce the formation of low-melting-point sodium sulfate and thereby avoid the agglomeration of ceramic particles.

Optimizing 3d spin polarization of CoOOH by in situ Mo doping for efficient oxygen evolution reaction

Transition-metal oxyhydroxides are attractive catalysts for oxygen evolution reactions(OERs).Further studies for developing transition-metal oxyhydroxide catalysts and understanding their catalytic mechanisms will benefit their quick transition to the next catalysts.Herein,Mo-doped CoOOH was designed as a high-performance model electrocatalyst with durability for 20 h at 10 mAcm−2.Additionally,it had an overpotential of 260 mV(glassy carbon)or 215 mV(nickel foam),which was 78 mV lower than that of IrO_(2)(338 mV).In situ,Raman spectroscopy revealed the transformation process of CoOOH.Calculations using the density functional theory showed that during OER,doped Mo increased the spin-up density of states and shrank the spin-down bandgap of the 3d orbits in the reconstructed CoOOH under the electrochemical activation process,which simultaneously optimized the adsorption and electron conduction of oxygen-related intermediates on Co sites and lowered the OER overpotentials.Our research provides new insights into the methodical planning of the creation of transition-metal oxyhydroxide OER catalysts.

Interfacial reaction between AZ91D magnesium alloy melt and mild steel under high temperature

The metallurgical quality control of magnesium(Mg)and Mg alloys in melting process is required to ensure a satisfied mechanical and corrosion performance,while the typical used steel crucible introduces impurities and interfacial interaction during melting process.Therefore,a systematic study about impurities diffusion and interfacial interaction between molten Mg and steel is necessary.In the present study,the interfacial reaction between molten AZ91D Mg alloy and mild steel during melting process was investigated with the melting temperatures of 700℃,750℃ and 800℃.The results show that Al(Fe,Mn)intermetallic layer is the intermetallic primarily formed at the interfaces of AZ91D melt and mild steel.Meanwhile,Al_(8)(Mn,Fe)5is indexed between Al(Fe,Mn)and AZ91D.AlFe_(3)C appears between the mild steel and Al(Fe,Mn)at 700℃ and 750℃,but absent at 800℃ due to the increased solubility of carbon in Mg matrix.It is found that the growth of the intermetallic layer is controlled by diffusion mechanism,and Al and Mn are the dominant diffusing species in the whole interfacial reaction process.By measuring the thickness of different layers,the growth constant was calculated.It increases from 1.89(±0.03)×10^(-12)m^(2)·s^(-1)at 700℃ to 3.05(±0.05)×10^(-12)m^(2)·s^(-1)at 750℃,and 5.18(±0.05)×10^(-12)m^(2)·s^(-1)at 800℃.Meanwhile,the content of Fe is linearly increased in AZ91D with the increase of holding time at 700℃ and 750℃,while it shows a significantly increment after holding for 8 h at 800℃,indicating holding temperature is more crucial to determine the Fe content of AZ91D than holding time.

“Buckets effect”in the kinetics of electrocatalytic reactions

In this study,we systematically investigated the effect of proton concentration on the kinetics of the oxygen reduction reaction(ORR)on Pt(111)in acidic solutions.Experimental results demonstrate a rectangular hyperbolic relationship,i.e.,the ORR current excluding the effect of other variables increases with proton concentration and then tends to a constant value.We consider that this is caused by the limitation of ORR kinetics by the trace oxygen concentration in the solution,which determines the upper limit of ORR kinetics.A model of effective concentration is further proposed for rectangular hyperbolic relationships:when the reactant concentration is high enough to reach a critical saturation concentration,the effective reactant concentration will become a constant value.This could be due to the limited concentration of a certain reactant for reactions involving more than one reactant or the limited number of active sites available on the catalyst.Our study provides new insights into the kinetics of electrocatalytic reactions,and it is important for the proper evaluation of catalyst activity and the study of structureperformance relationships.

Possibilities for the synthesis of superheavy element Z=121 in fusion reactions

Based on the dinuclear system model,the calculated evaporation residue cross sections matched well with the current experimental results.The synthesis of superheavy elements Z=121 was systematically studied through combinations of stable projectiles with Z=21-30 and targets with half-lives exceeding 50 d.The influence of mass asymmetry and isotopic dependence on the projectile and target nuclei was investigated in detail.The reactions^(254)Es(^(46)Ti,3n)^(297)121 and^(252)Es(^(46)Ti,3n)^(295)121 were found to be experimentally feasible for synthesizing superheavy element Z=121,with maximal evaporation residue cross sections of 6.619 and 4.123 fb at 219.9 and 223.9 MeV,respectively.

Effects of Maillard reaction and its product AGEs on aging and age-related diseases

Maillard reaction(MR)is a non-enzymatic browning reaction commonly seen in food processing,which occurs between reducing sugars and compounds with amino groups.Despite certain advantages based on Maillard reaction products(MRPs)found in some food for health and storage application have appeared,however,the MR occurring in human physiological environment can produce advanced glycation end products(AGEs)by non-enzymatic modification of macromolecules such as proteins,lipids and nucleic acid,which could change the structure and functional activity of the molecules themselves.In this review,we take AGEs as our main object,on the one hand,discuss physiologic aging,that is,age-dependent covalent cross-linking and modification of proteins such as collagen that occur in eyes and skin containing connective tissue.On the other hand,pathological aging associated with autoimmune and inflammatory diseases,neurodegenerative diseases,diabetes and diabetic nephropathy,cardiovascular diseases and bone degenerative diseases have been mainly proposed.Based on the series of adverse effects of accelerated aging and disease pathologies caused by MRPs,the possible harm caused by some MR can be slowed down or inhibited by artificial drug intervention,dietary pattern and lifestyle control.It also stimulates people's curiosity to continue to explore the potential link between the MR and human aging and health,which should be paid more attention to for the development of life sciences.

The reaction mechanism and interfacial crystallization of Al nanoparticle-embedded Ni under shock loading

The shock-induced reaction mechanism and characteristics of Ni/Al system,considering an Al nanoparticle-embedded Ni single crystal,are investigated through molecular dynamics simulation.For the shock melting of Al nanoparticle,interfacial crystallization and dissolution are the main characteristics.The reaction degree of Al particle first increases linearly and then logarithmically with time driven by rapid mechanical mixing and following dissolution.The reaction rate increases with the decrease of particle diameter,however,the reaction is seriously hindered by interfacial crystallization when the diameter is lower than 9 nm in our simulations.Meanwhile,we found a negative exponential growth in the fraction of crystallized Al atoms,and the crystallinity of B2-NiAl(up to 20%)is positively correlated with the specific surface area of Al particle.This can be attributed to the formation mechanism of B2-NiAl by structural evolution of finite mixing layer near the collapsed interface.For shock melting of both Al particle and Ni matrix,the liquid-liquid phase inter-diffusion is the main reaction mechanism that can be enhanced by the formation of internal jet.In addition,the enhanced diffusion is manifested in the logarithmic growth law of mean square displacement,which results in an almost constant reaction rate similar to the mechanical mixing process.

Metal-organic-framework-derived copper-based catalyst for multicomponent C-S coupling reaction

Copper-based metal-organic frameworks(Cu-MOFs)are a promising multiphase catalyst for catalyzing C-S coupling reactions by virtue of their diverse structures and functions.However,the unpleasant odor and instability of the organosulfur,as well as the mass-transfer resistance that exists in multiphase catalysis,have often limited the catalytic application of Cu-MOFs in C-S coupling reactions.In this paper,a Cu-MOFs catalyst modified by cetyltrimethylammonium bromide(CTAB)was designed to enhance mass transfer by increasing the adsorption of organic substrates using the long alkanes of CTAB.Concurrently,elemental sulfur was used to replace organosulfur to achieve a highly efficient and atom-economical multicomponent C-S coupling reaction.

Influence of initial check, information exchange, final accuracy check, reaction information nursing on the psychology of elderly with lung cancer

BACKGROUND As one of the fatal diseases with high incidence,lung cancer has seriously endangered public health and safety.Elderly patients usually have poor self-care and are more likely to show a series of psychological problems.AIM To investigate the effectiveness of the initial check,information exchange,final accuracy check,reaction(IIFAR)information care model on the mental health status of elderly patients with lung cancer.METHODS This study is a single-centre study.We randomly recruited 60 elderly patients with lung cancer who attended our hospital from January 2021 to January 2022.These elderly patients with lung cancer were randomly divided into two groups,with the control group taking the conventional propaganda and education and the observation group taking the IIFAR information care model based on the conventional care protocol.The differences in psychological distress,anxiety and depression,life quality,fatigue,and the locus of control in psychology were compared between these two groups,and the causes of psychological distress were analyzed.RESULTS After the intervention,Distress Thermometer,Hospital Anxiety and Depression Scale(HADS)for anxiety and the HADS for depression,Revised Piper’s Fatigue Scale,and Chance Health Locus of Control scores were lower in the observation group compared to the pre-intervention period in the same group and were significantly lower in the observation group compared to those of the control group(P<0.05).After the intervention,Quality of Life Questionnaire Core 30(QLQ-C30),Internal Health Locus of Control,and Powerful Others Health Locus of Control scores were significantly higher in the observation and the control groups compared to the pre-intervention period in their same group,and QLQ-C30 scores were significantly higher in the observation group compared to those of the control group(P<0.05).CONCLUSION The IIFAR information care model can help elderly patients with lung cancer by reducing their anxiety and depression,psychological distress,and fatigue,improving their tendencies on the locus of control in psychology,and enhancing their life qualities.