To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Understand multiphase flows using multidisciplinary knowledge in physical principles, modelling theories, and engineering practices. This essential text methodically introduces the important concepts, governing mechanisms, and state-of-the-art theories, using numerous real-world applications, examples, and problems. Covers all major types of multiphase flows, including gas-solid, gas-liquid (sprays or bubbling), liquid-solid, and gas-solid-liquid flows. Introduces the volume-time-averaged transport theorems and associated Lagrangian-trajectory modelling and Eulerian-Eulerian multi-fluid modelling. Explains typical computational techniques, measurement methods and four representative subjects of multiphase flow systems. Suitable as a reference for engineering students, researchers, and practitioners, this text explores and applies fundamental theories to the analysis of system performance using a case-based approach.
Nationalism is pervasive in China today. Yet nationalism is not entrenched in China's intellectual tradition. Over the course of the twentieth century, the combined forces of cultural, social, and political transformations nourished its development, but resistance to it has persisted. Xin Fan examines the ways in which historians working on the world beyond China from within China have attempted to construct narratives that challenge nationalist readings of the Chinese past and the influence that these historians have had on the formation of Chinese identity. He traces the ways in which generations of historians, from the late Qing through the Republican period, through the Mao period to the relative moment of 'opening' in the 1980s, have attempted to break cross-cultural boundaries in writing an alternative to the national narrative.
We theoretically and experimentally investigate the mechanism underlying the generation of upstream-propagating waves induced by a steady current over a horizontal bottom with a patch of sinusoidal ripples. By considering the triad resonant wave–ripple interactions involving two unsteady wave components (which have the same frequency but different wavenumbers) and one bottom ripple component in the presence of a steady uniform current, we derive the general condition under which unsteady upstream- and/or downstream-propagating waves can be induced. The frequency and wavenumbers of the induced propagating waves are given by the triad resonance condition in terms of current speed, water depth and bottom ripple wavenumber. By means of a multiple-scale perturbation analysis, we obtain the nonlinear amplitude evolution equations governing the spatio-temporal evolution of resonance-generated waves. Based on these equations, we find that the amplitude of the generated upstream-propagating waves is dramatically amplified when the associated triad resonance occurs in the neighbourhood of the critical current speed/frequency (corresponding to zero group velocity of unsteady waves in the presence of a current). A series of laboratory experiments in a long wave flume with wide ranges of current speeds and water depths are conducted to verify the theory. The experiments confirm the observation of the phenomenon of upstream-propagating wave generation in a steady flow over a rippled bottom. In particular, the experimental measurements of the kinematics of upstream-propagating waves as well as the critical flow condition for the observation of such wave generation compare well with the theoretical prediction.
In glaciology, snow–firn temperature at 10 m is considered a representation of the mean annual air temperature at the surface (MAAT) of the studied site. Although MAAT is an important parameter in ice-sheet investigations, it has not been widely measured in Antarctica. To measure the 10 m snow–firn temperature in Antarctica, a shallow hot-point drill system is designed. In this simple and lightweight system, a hot-point drill can melt boreholes with a diameter of 34 mm in the snow–firn to a depth of 30 m and a temperature sensors string can measure the borehole temperature precisely. In the 2018/19 field season, 16 boreholes along the Zhongshan–Dome A traverse were drilled, and the borehole temperature was measured. Although certain problems existed pertaining to the hot-point drill, a total depth of ~244 m was successfully drilled at an average penetration rate of ~10 m h−1. After borehole drilling, ~12–15 h were generally required for the borehole to achieve thermal equilibrium with the surroundings. Preliminary results demonstrated that the 10 m snow–firn temperature along the traverse route was affected by the increasing altitude and latitude, and it decreased gradually with an increase in the distance from Zhongshan station.
X-ray powder diffraction data, unit-cell parameters, and space group for norethisterone enanthate, C27H38O3, are reported [a = 6.191(4) Å, b = 12.711(3) Å, c = 31.396(2) Å, α = 90°, β = 90°, γ = 90°, unit-cell volume V = 2471.16 Å3, Z = 4, ρcal = 1.104 g cm−3, and space group P212121]. All measured lines were indexed and are consistent with the P212121 space group. No detectable impurities were observed.
In December 2019, the first confirmed case of pneumonia caused by a novel coronavirus was reported. Coronavirus disease 2019 (COVID-19) is currently spreading around the world. The relationships among the pandemic and its associated travel restrictions, social distancing measures, contact tracing, mask-wearing habits and medical consultation efficiency have not yet been extensively assessed. Based on the epidemic data reported by the Health Commission of Wenzhou, we analysed the developmental characteristics of the epidemic and modified the Susceptible-Exposed-Infectious-Removed (SEIR) model in three discrete ways. (1) According to the implemented preventive measures, the epidemic was divided into three stages: initial, outbreak and controlled. (2) We added many factors, such as health protections, travel restrictions and social distancing, close-contact tracing and the time from symptom onset to hospitalisation (TSOH), to the model. (3) Exposed and infected people were subdivided into isolated and free-moving populations. For the parameter estimation of the model, the average TSOH and daily cured cases, deaths and imported cases can be obtained through individual data from epidemiological investigations. The changes in daily contacts are simulated using the intracity travel intensity (ICTI) from the Baidu Migration Big Data platform. The optimal values of the remaining parameters are calculated by the grid search method. With this model, we calculated the sensitivity of the control measures with regard to the prevention of the spread of the epidemic by simulating the number of infected people in various hypothetical situations. Simultaneously, through a simulation of a second epidemic, the challenges from the rebound of the epidemic were analysed, and prevention and control recommendations were made. The results show that the modified SEIR model can effectively simulate the spread of COVID-19 in Wenzhou. The policy of the lockdown of Wuhan, the launch of the first-level Public Health Emergency Preparedness measures on 23 January 2020 and the implementation of resident travel control measures on 31 January 2020 were crucial to COVID-19 control.
Since December 2019, a new coronavirus viral was initially detected in Wuhan, China. Population migration increases the risk of epidemic transmission. Here the objective of study is to estimate the output risk quantitatively and evaluate the effectiveness of travel restrictions of Wuhan city.
We proposed a modified SEIR dynamics model to predict the number of COVID-19 symptomatic and asymptomatic infections in Wuhan. And subsequently we estimated the export risk of COVID-19 epidemic from Wuhan to other provinces in China. Finally, we estimated the effectiveness of travel restrictions of Wuhan city quantitatively by the export risk on the assumption that the measure was postponed.
The export risks of COVID-19 varied from Wuhan to other provinces of China. The peak of export risk was January 21-23, 2020. With the travel restrictions of Wuhan delayed by 3, 5 and 7 days, the export risk indexes will increase by 38.50%, 55.89% and 65.63%, respectively.
The results indicate that the travel restrictions of Wuhan reduced the export risk and delayed the overall epidemic progression of the COVID-19 epidemic in China. The travel restrictions of Wuhan city may provide a reference for the control of the COVID-19 epidemic all over the world.
With the progress in science and technology, hazardous chemicals are becoming more essential in chemical products, industrial and agricultural production, and daily life. Hazardous chemicals have poisoning, corrosive, explosive, and combusting natures; once on fire, they can trigger a chain of catastrophic incidences, resulting in casualties, property loss, and environmental pollution and posing hazards to life and property. Using the “8–12” explosion of the Ruihai Logistics warehouse in Tianjin Port (Binhai New District, China), the present study analyzes the characteristics of trauma of the casualties in this accident and the emergency medical rescue strategies. The goals were to improve the ability of emergency rescue in such accidents and to save people’s lives and property to the maximum extent.
Previous studies have revealed associations of meteorological factors with tuberculosis (TB) cases. However, few studies have examined their lag effects on TB cases. This study was aimed to analyse nonlinear lag effects of meteorological factors on the number of TB notifications in Hong Kong. Using a 22-year consecutive surveillance data in Hong Kong, we examined the association of monthly average temperature and relative humidity with temporal dynamics of the monthly number of TB notifications using a distributed lag nonlinear models combined with a Poisson regression. The relative risks (RRs) of TB notifications were >1.15 as monthly average temperatures were between 16.3 and 17.3 °C at lagged 13–15 months, reaching the peak risk of 1.18 (95% confidence interval (CI) 1.02–1.35) when it was 16.8 °C at lagged 14 months. The RRs of TB notifications were >1.05 as relative humidities of 60.0–63.6% at lagged 9–11 months expanded to 68.0–71.0% at lagged 12–17 months, reaching the highest risk of 1.06 (95% CI 1.01–1.11) when it was 69.0% at lagged 13 months. The nonlinear and delayed effects of average temperature and relative humidity on TB epidemic were identified, which may provide a practical reference for improving the TB warning system.
The use of a corn-earthworm coculture (CE) system is an eco-agricultural technology that has been gradually extended due to its high economic output and diverse ecological benefits for urban agriculture in China. However, the effect of CE on weed occurrence has received little attention. A five-year successive experiment (2015 to 2019) was conducted to compare weed occurrence in CE and a corn (Zea mays L.) monoculture (CM). The results show that CE significantly decreased weed diversity, the dominance index, total weed density and biomass, but increased the weed evenness index. The five-year mean number of weed species per plot was 8.4 in CE and 10.7 in CM. Compared to those in CM, the five-year mean density and biomass of total weeds in CE decreased by 59.2% and 66.6%, respectively. The effect of CE on weed occurrence was species specific. The mean density of large crabgrass [Digitaria sanguinalis (L.) Scop.], green foxtail [Setaria viridis (L.) Beauv.], goosegrass [Eleusine indica (L.) Gaertn.], and common purslane (Portulaca oleracea L.) in CE decreased by 94.5, 78.1, 75.0, and 45.8%, whereas the mean biomass decreased by 96.2, 80.8, 76.9, and 41.4%, respectively. Our study suggests that the use of CE could suppress weed occurrence and reduce herbicide inputs in agriculture.
We aimed to examine whether baseline neutrophil counts affected the risk of new-onset proteinuria in hypertensive patients, and, if so, whether folic acid treatment is particularly effective in proteinuria prevention in such a setting. A total of 8,208 eligible participants without proteinuria at baseline were analyzed from the renal sub-study of the China Stroke Primary Prevention Trial (CSPPT). Participants were randomized to receive a double-blind daily treatment of 10mg enalapril and 0.8mg folic acid (n=4,101) or 10mg enalapril alone (n=4,107). The primary outcome was new-onset proteinuria, defined as a urine dipstick reading of ≥1+ at the exit visit. The mean age of the participants was 59.5 (SD, 7.4) years, 3,088 (37.6%) of the participants were male. The median treatment duration was 4.4 years. In the enalapril-alone group, a significantly higher risk of new-onset proteinuria was found among participants with higher neutrophil counts (quintile 5; ≥4.8×109/L, OR, 1.44; 95%CI: 1.00, 2.06), compared with those in quintile 1-4. For those with enalapril and folic acid treatment, compared with the enalapril-alone, the new-onset proteinuria risk was reduced from 5.2% to 2.8% (OR, 0.49; 95%CI: 0.29, 0.82) among participants with higher neutrophil counts (≥4.8×109/L), whereas there was no significant effect among those with neutrophil counts <4.8×109/L. In summary, among hypertensive patients, those with higher neutrophil counts had increased risk of new-onset proteinuria, and this risk was reduced by 51% with folic acid treatment. If confirmed, neutrophil counts may serve as a biomarker to identify high-risk individuals who could particularly benefit from folic acid treatment.
The association between dietary iron intake and diabetes risk remains inconsistent. We aimed to explore the association of dietary iron intake and type 2 diabetes mellitus (T2DM) risk in middle-aged and older adults in urban China. This study used data from the Guangzhou Nutrition and Health Study (GNHS), an on-going community-based prospective cohort study. Participants were recruited from 2008 to 2013 in Guangzhou community. 2,696 participants aged 40-75 years without T2DM at baseline were included in data analyses, with a median of 5.6 (IQR: 4.1-5.9) years of follow-up. T2DM was identified by self-reported diagnosis, fasting glucose ≥7.0 mmol/L, or glycosylated hemoglobin ≥6.5%. Cox proportional hazard models were used to estimate HRs and 95%CIs. We ascertained 205 incident T2DM cases during 13,476 person-years. The adjusted HR for T2DM risk in the fourth quartile of heme iron intake was 1.92 (95%CI: 1.07, 3.46; P-trend=0.010), compared with the first quartile intake. These significant associations were found in heme iron intake from total meat (HR:2.74; 95%CI: 1.22, 6.15; P-trend=0.011) and heme iron intake from red meat (HR:1.86; 95%CI: 1.01, 3.44; P-trend=0.034), but not heme iron intake from processed meat, poultry or fish/shellfish. The association between dietary intake of total iron or nonheme iron with T2DM risk had no significance. Our findings suggested that higher dietary intake of heme iron (especially from red meat), but not total iron or nonheme iron, was associated with greater T2DM risk in middle-aged and older adults.
Extensive environmental contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was reported in hospitals during pandemic coronavirus disease 2019 (COVID-19). We highlighted the practice of directly-observed environmental disinfection (DOED) in the community isolation facility (CIF) and community treatment facility (CTF) in Hong Kong.
CIF (250 single-room bungalows in a holiday camp) was opened on July 24, 2020 to receive step-down patients from hospitals, while CTF (500-bed of open-cubicle inside a conventional hall) was activated on August 1, 2020 to admit newly diagnosed COVID-19 patients from the community. Healthcare workers (HCWs) and cleaning staff received infection control training to reinforce donning and doffing of personal protective equipment and understand the practice of DOED, where the cleaning staff observed patients’ and staff activities and then performed environmental disinfection immediately after their use. Supervisors also observed cleaning staff to ensure the quality of work. In CTF, air and environmental samples were collected on day 7, 14, 21, and 28 for SARS-CoV-2 by RT-PCR, while patients’ compliance of wearing mask was recorded.
Of 291 HCWs and 54 cleaning staff, who managed 243 and 674 patients in CIF and CTF, respectively, from July 24 to August 29, 2020, none of them acquired COVID-19. All 24 air samples and 520 environmental samples collected in the patient area of CTF were negative for SARS-CoV-2. Patients’ compliance of wearing mask was 100%.
With appropriate infection control measures, zero environmental contamination and nosocomial acquisition of COVID-19 among HCWs and cleaning staff could be achieved.
The epidemic of coronavirus disease 2019 (COVID-19) began in China and had spread rapidly to many other countries. This study aimed to identify risk factors associated with delayed negative conversion of SARS-CoV-2 in COVID-19 patients. In this retrospective single-centre study, we included 169 consecutive patients with confirmed COVID-19 in Zhongnan Hospital of Wuhan University from 15th January to 2nd March. The cases were divided into two groups according to the median time of SARS-CoV-2 negative conversion. The differences between groups were compared. In total, 169 patients had a median virus negative conversion time of 18 days (interquartile range: 11–25) from symptom onset. Compared with the patients with short-term negative conversion, those with long-term conversion had an older age, higher incidence of comorbidities, chief complaints of cough and chest distress/breath shortness and severer illness on admission, higher level of leucocytes, neutrophils, aspartate aminotransferase, creatine kinase and erythrocyte sedimentation rate (ESR), lower level of CD3+CD4+ lymphocytes and albumin and more likely to receive mechanical ventilation. In multivariate analysis, cough, leucocytes, neutrophils and ESR were positively correlated with delayed virus negative conversion, and CD3+CD4+ lymphocytes were negatively correlated. The integrated indicator of leucocytes, neutrophils and CD3+CD4+ lymphocytes showed a good performance in predicting the negative conversion within 2 weeks (area under ROC curve (AUC) = 0.815), 3 weeks (AUC = 0.804), 4 weeks (AUC = 0.812) and 5 weeks (AUC = 0.786). In conclusion, longer quarantine periods might be more justified for COVID-19 patients with cough, higher levels of leucocytes, neutrophils and ESR and lower levels of CD3+CD4+ lymphocytes.
According to the World Health Organization, there were approximately 0.5 million new cases of rifampicin-resistant tuberculosis in 2018, of which 78 percent were multidrug-resistant tuberculosis (MDR-TB), and China has one of the largest shares of the global burden (14%). In recent years, the Chinese government has made progress in TB control and prevention, but for MDR-TB, treatment options are still limited and expensive, and novel drugs are not always available. This research aims to evaluate the cost-effectiveness of adding bedaquiline to a background regimen (BR) of drugs for MDR-TB treatment in China, and to provide evidence for government to improve public health policies.
A cohort-based Markov model was developed to evaluate the incremental cost-effectiveness ratio (ICER) of bedaquiline plus BR (BBR) versus BR alone in MDR-TB treatment, over a 10-year time horizon. Data were sourced from a phase II clinical trial, real-world data in China, published literature, and expert opinion. Outcomes were evaluated in quality-adjusted life years (QALYs) and life-years gained (LYG). The discount rate was 3.5%. Probabilistic and deterministic sensitivity analyses were conducted.
The discounted costs per person for BBR was CNY 135,706 [USD 19,172], compared with CNY 92,465 [USD 13,063] for BR. The discounted utility per person for BBR was also higher than that for BR (3.943 QALYs versus 3.193 QALYs). The ICER of BBR was CNY 58,096 [USD 8,208]/QALY, which was lower than the willingness-to-pay threshold of CNY 212,676 [USD 30,046] (three-times the gross domestic product per capita). Therefore, BBR was considered to be cost-effective. The sensitivity analysis confirmed the robustness of the results. BBR remained cost-effective in the sensitivity analysis, with a 77.2 percent probability of being cost-effective versus BR.
In China, bedaquiline is not included in the National Reimbursement Medicine List, which results in a heavy financial burden for MDR-TB patients. From this study, BBR was cost-effective by significantly reducing time to sputum culture conversion and increasing QALYs and LYGs, which offset the higher drug costs.
A general multi-type population model is considered, where individuals live and reproduce according to their age and type, but also under the influence of the size and composition of the entire population. We describe the dynamics of the population as a measure-valued process and obtain its asymptotics as the population grows with the environmental carrying capacity. Thus, a deterministic approximation is given, in the form of a law of large numbers, as well as a central limit theorem. This general framework is then adapted to model sexual reproduction, with a special section on serial monogamic mating systems.
China bears a considerably high burden of multidrug-resistant tuberculosis (MDR-TB). Second-line anti-TB drugs are urgently needed yet domestic MDR-TB drugs are expensive and lack policy support. Patients’ living conditions are closely related to the drug affordability. The national TB prevention programs should play a critical role. The purpose of this study is to measure the cost of treating MDR-TB patients under different treatment schemes and price sources. The results of this study are expected to inform the relevant drug protection policies and provide inputs for further cost-effectiveness analyses.
Based on the treatment plan of China's Multidrug-Resistant Pulmonary Tuberculosis Clinical Path (2012 edition) and the World Health Organization (WHO) Drug-Resistant Tuberculosis Treatment Guide (2018 edition), the treatment costs of MDR-TB were measured under different scenarios. Catastrophic health expenditure was then calculated if the treatment cost exceeds 40 percent of the household's non-subsistence income. National, rural and disposable income per capita in 2018, were used to represent Chinese patients’ affordability.
Under varied treatment schemes and market price sources in China, the total costs for MDR-TB patients range from 19,401 to 126,703 CNY [2,853 to 18,633 USD] per person. Under current prices, all treatment schemes recommended by the WHO will incur catastrophic costs for Chinese MDR-TB patients. Significant differences were found between rural and urban areas as 52.8 percent of the treatment listed in the 2012 China Guideline would lead to catastrophic cost for rural patients but not urban ones.
Our study concludes that the domestic drugs are more expensive than the international purchase price and the treatment of MDR-TB imposes substantial economic burden on patients, especially in the rural areas. The results of the study also indicate that it is urgent for the state to emphasize government responsibility and initiate centralized procurement for price negotiations to reduce the market price of MDR-TB drugs. The urban-rural gap should also be addressed in the design of future policies to ensure the drug affordability for all patients in need.
Malignant tumors have become a major public health problem and their treatment cost is increasing rapidly in China, but treatment aimed at healing diseases or extending patients’ life. There is little empirical research on utilization of healthcare resources of terminally ill cancer patients. In order to explore the optimal treatment decision for patients and provide information for relevant decision makers, this study analyzed the consumption status of medical resources in patients with cancer during the whole treatment period, and the current medical resource utilization efficiency in different levels of hospital for end-stage cancer patients.
This study was based on the clinical treatment and payment data of 2,536 cases of patients with lung cancer from the medical insurance database during the period of 2007 to 2014 in Hubei province. We retrospectively analyzed patients’ medical expenditure and utilization of different medical resources during their whole treatment period as well as at the end stage.
The per capita inpatient expenditures of patients under 50 years old was 193,000 CNY (27,451 USD), while that of the patients over 70 years were 80,000–90,000 CNY (11,379–12,802 USD). Secondly, the medical expenditures spent during the last 6 months of life accounted for 66.1 percent of the total expenditures. Lastly, the medical expenditure spent in tertiary hospitals accounted for 95.3 percent of the total expenditure, and the expenditure was 14,200 ± 17,030 CNY (2,019.82 ± 2,422.36 USD) per visit.
Population aging is not the only factor causing the rise of medical expenditure. The unclear objectives of treatment and the reverse of medical resource allocation are also important factors to boost the growth of medical expenditure. It is necessary to improve the healthcare insurance payment system, strengthen the capacity of primary medical institutions, and develop the palliative care system in China.
Since the 18th National Congress of the Communist Party of China (CPC), remarkable achievements have been made in poverty alleviation. Over the past five years, the population of people living in poverty had decreased by 68.53million, fallen from 98.99 million in 2012 to 30.46 million at the end of 2017. As an impoverished province, Hebei province has been implementing the CPC Central Committee's guidance in the battle against poverty. In 2016, the government released the Implementation Scheme Plan for Improving the Level of Medical Security and Assistance. The plan introduces multi-layer medical security and assistance mechanisms which covers basic medical insurance, major disease insurance and medical assistance. In 2017, the government formulated the Implementation Plan for the Three-Batch Action Plan on the Health Care Program for Poverty Alleviation in Hebei Province, for people with major disease. Hebei Province has carried out many explorations on the health care program for poverty alleviation, and its effectiveness is a problem worthy of attention.
Based on data including basic medical insurance, major illness insurance, medical assistance, and other related information, we used descriptive statistics and quantitative methods to evaluate the overall expenditure of the poverty alleviation for Hebei province and the areas under its jurisdiction. Additionally, the expenditure of different levels of medical security system, the medical burden for people facing poverty and the distribution of disease in the population with assistance were evaluated.
The out-of-pocket payment per capita has decreased year by year, and it has dropped to 3% of catastrophic medical expenditure and 20% below the poverty line by June 2018. An imbalanced situation occurred with the implementation, with the more impoverished areas having greater the pressure on medical care and poverty alleviation. For people with medical assistance, diseases with higher population and overall expenditure are cerebrovascular disease, malignant tumor, diabetes and some other chronic diseases.
The health policies for poverty alleviation in Hebei province has achieved a remarkable success, and the medical burden of the poor has been significantly reduced. However, the implementation of the policies in various cities has shown an imbalanced situation, and the poverty alleviation policies need to be further improved.
China is one of the twenty-seven countries with a high burden of Multidrug-resistant tuberculosis (MDR-TB) in the world. Of the new TB patients in China in 2017, about 63,000 are MDR-TB patients, accounting for one-third of the number of new MDR-TB patients worldwide.
In the latest “China's 13th Five-Year Plan” national TB prevention and control plan promulgated in 2017, it is clearly emphasized that all regions should gradually incorporate TB into the payment catalogue of special outpatient medical insurance, according to local conditions. However, for this special group of MDR-TB patients, there is no specialized prevention and control policy at the national level, and there are also blind spots in the medical security policy.
Responding to the drug needs of MDR-TB patients, it is necessary to provide patients with stable and affordable second-line anti-TB drugs. It is also necessary to understand the overall drug demand for second-line drugs nationwide to guide further policy formulation and budget research.
Through semi-structured group interviews and key informant interviews, five provinces and cities were investigated. Qualitative analysis was conducted based on stakeholder theory selected doctors and staff from Centers for Disease Control.
Through investigations in this study, problems like low purchasing price, insufficient purchasing volume, low drug supply efficiency, and monopoly producers were found. Through the analysis of roles and relationships among the major stakeholders in the second-line drug supply system, together with the motivation and resistance factors, it was found that all stakeholders have the motivation to solve the problem and face their dilemmas and obstacles at the same time.
Patients with MDR-TB still have difficulties in obtaining medicines. The interests of various stakeholders need to be balanced to improve drug accessibility and affordability. It is recommended to take advantage of the country's centralized procurement, encourage the development and listing of new anti-tuberculosis drugs and generic drugs, and improve the supervision system to ensure the supply of drugs to benefit more patients with tuberculosis.