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As the corona virus disease 2019 (COVID-19) pandemic continues around the world, understanding the transmission characteristics of COVID-19 is vital for prevention and control. We conducted the first study aiming to estimate and compare the relative risk of secondary attack rates (SARs) of COVID-19 in different contact environments. Until 26 July 2021, epidemiological studies and cluster epidemic reports of COVID-19 were retrieved from SCI, Embase, PubMed, CNKI, Wanfang and CBM in English and Chinese, respectively. Relative risks (RRs) were estimated in pairwise comparisons of SARs between different contact environments using the frequentist NMA framework, and the ranking of risks in these environments was calculated using the surface under the cumulative ranking curve (SUCRA). Subgroup analysis was performed by regions. Thirty-two studies with 68 260 participants were identified. Compared with meal or gathering, transportation (RR 10.55, 95% confidence interval (CI) 1.43–77.85), medical care (RR 11.68, 95% CI 1.58–86.61) and work or study places (RR 10.15, 95% CI 1.40–73.38) had lower risk ratios for SARs. Overall, the SUCRA rankings from the highest to the lowest were household (95.3%), meal or gathering (81.4%), public places (58.9%), daily conversation (50.1%), transportation (30.8%), medical care (18.2%) and work or study places (15.3%). Household SARs were significantly higher than other environments in the subgroup of mainland China and sensitive analysis without small sample studies (<100). In light of the risks, stratified personal protection and public health measures need to be in place accordingly, so as close contacts categorising and management.
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.
The scientific application of clinical evidence-based guidelines can reduce the variability of clinical practice, and standardize clinical diagnosis and treatment pathways. At present, many evidence-based guidelines on Chronic Obstructive Pulmonary Disease (COPD) prevention have been issued in countries around the world, but the procedures and evaluation strategies developed by different guidelines are not the same. This study aimed to evaluate the quality of published clinical practice guidelines (CPGs) relating to COPD using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument.
Databases were systematically searched PubMed, EMBASE, Wan Fang, and CNKI as well as guidelines websites on COPD prevention and treatment. The search period was from inception of the database up to May 2019. The inclusion criteria for this study are as follows: (i) published and in accordance with the definition of the practice guidelines; (ii)the main target population is COPD patients with the diagnostic criteria of the 2019 edition of the global initiative for COPD (GOLD), and the content of the guideline is related to the prevention and treatment practice of COPD; (ii) the same guide is included in the latest updated version; (iv) the published language is English or Chinese. Guidelines that met these inclusion criteria were evaluated for the quality of the AGREE II guidelines. Then, a descriptive analysis was made of the consensus that exists in the guidelines.
A total of fifteen guidelines/Consensuses Statements were included in the study. Two guidelines were assessed as recommended, eleven guidelines were assessed as recommended with modifications and two guidelines were not recommended. The mean scores of the included guidelines in the six domains (scope and purpose, personnel involved in guideline development, rigor of development, clarity, applicability, independence) were 90 percent, 72 percent, 49 percent, 96 percent, 60 percent, 69 percent, respectively. Thus, the study identified a consensus that disease risk factors and recommended interventions were mentioned in the guidelines, and that they comprehensively evaluated the quality of guideline reporting to provide reference for standardizing the development of practice guidelines for COPD in China.
The overall methodological quality of COPD CPGs should be improved. The key recommended areas for improvement include standardization of guideline report writing and synthesis of the latest and best evidence, to develop CPGs for COPD to improve the quality of clinical diagnosis and treatment for COPD.
Ankylosing spondylitis (AS) is a common disease that causes pain and affects productivity. Tumor necrosis factor-α (TNF-α) like adalimumab can bring better clinical efficacy and improve quality of life. Adalimumab is likely to be covered by health insurance. It is necessary to assess the impact of adalimumab for patients with AS on the medical insurance budget in China. Our research aims to give support evidence for policy-making.
From the perspective of medical insurance payers, a budget impact model was established to evaluate the impact of adalimumab for the treatment of adults with severe active AS that has responded inadequately to conventional therapy. The time horizon was 5 years (2020–2024). The cost of measurement included drug and treatment costs for adverse events. Scenario analysis was conducted to evaluate the results under different drug price reimbursement ratios and treatment ratios.
Based on the current price of adalimumab (CNY 3,160 [USD 446]/unit), under the reimbursement ratio of 70 percent, adalimumab will increase medical insurance expenditure by CNY 162 [USD 22] million, CNY 152 [USD 21] million, CNY 114 [USD 16] million, CNY 100 [USD 14] million and CNY 88.11 [USD 12] million in the next 1–5 years, respectively. The increased medical insurance expenditure accounts for 0.091, 0.085, 0.064, 0.056, and 0.049 percent of the annual medical insurance expenditure in the next 1–5 years, respectively, which is assumed to be equivalent to the expenditure in 2018 of CNY 1782.2 [USD 251] billion.
The budget impact of adalimumab for AS on medical insurance expenditure is limited, and including adalimumab in the medical insurance catalogue can reduce the burden on individuals, enrich treatment options, and satisfy clinical needs better.
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.
Spinal muscular atrophy (SMA) is a rare, life-threatening, and seriously debilitating neuromuscular disorder, which has a heavy burden on patients, caregivers and the health system. Technological advances have improved clinical effect, but have also increased the financial burden. There is limited information in the literature on the resource utilization and economic burden of SMA. Our research aims to summarize the current literature on resource use, cost and economic evaluations of treatments for SMA, to inform further research and policy decision making.
Databases, including PubMed, Embase, Cochrane Library and CRD Database, were searched from inception. Two reviewers undertook title and abstract screening followed by full-text screening, and any disagreement was resolved in consensus. Data extraction was conducted using a customized form. Included studies were summarized using narrative synthesis structured around general and economic characteristics. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered to where applicable.
We reviewed 552 abstracts and included twenty-six from 2015 to 2019. Four-fifths were published in the United States and Europe. Five full economic evaluations and one budget impact analysis compared nusinersen with AVXS-101 or best supportive care, and the remaining evaluated the economic burden of SMA. The most common outcomes were healthcare resource utilization and direct medical costs, only a few studies evaluated direct non-medical costs or indirect cost.
SMA patients have significant medical expenditures and high utilization of healthcare services, including nusinersen-treated patients. The results highlight the substantial burden of treatment for SMA, not only for patients but also for their caregivers. SMA represents a significant hidden cost that society should be made aware of, and that should be considered in the design, implementation and evaluation of support programs for people who suffer from this disease and their families, as well as in the economic evaluation of new treatments.
There is growing interest globally in using real-world data (RWD) and real-world evidence (RWE) for health technology assessment (HTA). Optimal collection, analysis, and use of RWD/RWE to inform HTA requires a conceptual framework to standardize processes and ensure consistency. However, such framework is currently lacking in Asia, a region that is likely to benefit from RWD/RWE for at least two reasons. First, there is often limited Asian representation in clinical trials unless specifically conducted in Asian populations, and RWD may help to fill the evidence gap. Second, in a few Asian health systems, reimbursement decisions are not made at market entry; thus, allowing RWD/RWE to be collected to give more certainty about the effectiveness of technologies in the local setting and inform their appropriate use. Furthermore, an alignment of RWD/RWE policies across Asia would equip decision makers with context-relevant evidence, and improve timely patient access to new technologies. Using data collected from eleven health systems in Asia, this paper provides a review of the current landscape of RWD/RWE in Asia to inform HTA and explores a way forward to align policies within the region. This paper concludes with a proposal to establish an international collaboration among academics and HTA agencies in the region: the REAL World Data In ASia for HEalth Technology Assessment in Reimbursement (REALISE) working group, which seeks to develop a non-binding guidance document on the use of RWD/RWE to inform HTA for decision making in Asia.
This cross-sectional study aimed to examine the associations between dietary fibre (DF) intake and depressive symptoms in a general adult population in Tianjin, China. A total of 24 306 participants (mean age 41 years; range 18–91 years) were enrolled. DF intake was assessed using a validated self-administered FFQ. Depressive symptoms were assessed using the Self-Rating Depression Scale. Associations between DF intake and depressive symptoms were estimated using logistic regression analysis. Socio-demographic, behavioural, health status and dietary factors were adjusted. In men, compared with participants in the lowest quartiles for total, soluble, vegetable and soya DF, OR for depressive symptoms in the highest were 0·83 (95 % CI 0·69, 0·99), 0·74 (95 % CI 0·63, 0·87), 0·79 (95 % CI 0·65, 0·96) and 0·69 (95 % CI 0·60, 0·81), respectively. In women, compared with participants in the lowest quartiles for vegetable and soya DF, the OR for depressive symptoms in the highest were 0·77 (95 % CI 0·64, 0·93) and 0·82 (95 % CI 0·70, 0·95), respectively. No association was found between total or soluble DF intake and depressive symptoms in women. No association was found between insoluble, cereal, fruit or tuber DF intake and depressive symptoms in men and women. Linear associations between DF intake and depressive symptoms were only detected for soya DF (men, β = –0·148, P < 0·0001; women, β = –0·069, P = 0·04). Results suggest that intake of soluble, vegetable and soya DF was inversely associated with depressive symptoms. These results should be confirmed through prospective and interventional studies.
LMNA mutations cause a variety of inherited diseases referred to as laminopathies which are associated with a wide spectrum of disease phenotypes, ranging from skeletal muscle disease, pre-mature ageing, metabolic disorders, and cardiac abnormalities. We present a case of a 14-year-old boy with dilated cardiomyopathy induced by the LMNA mutation (p. R429C) and described its electrocardiogram and imaging features.
Three fundamental questions have tasked philosophers and scientists across time: Where do we come from?”, “Why are we here?” and “Why do people do what they do?” Academics working within behavioral economics (i.e., the application of economic and psychological approaches to understand how individuals make economic decisions) and personality psychology (i.e., the study of relatively stable patterns of behavior and experience) have addressed the third question. Behavioral economists examine how certain incentive structures, frames or choice architectures nudge people’s choices (preferences). Similarly, personality psychologists explore how different traits interact with context to predict behavior. Both traditions have developed their own theoretical frameworks, analytic strategies and methods. Accordingly, personality psychologists and economists have much they can learn from each other with the aim of answering the third fundamental question and by doing so offer better and more nuanced answers about determinants of behavior (Borghans, Duckworth, Heckman & ter Weel, 2008; Cunha & Heckman, 2008; Ferguson, 2015; Ozer & Bennet-Martinez, 2006; Roberts, Kuneel, Shiner, Caspi & Goldberg, 2007). The aim of this chapter is to offer some suggestions that may guide this integration.
Brain structural connectome comprise of a minority of efficiently interconnected rich club nodes that are regarded as ‘high-order regions’. The remission of major depressive disorder (MDD) in response to selective serotonin reuptake inhibitor (SSRI) treatment could be investigated by the hierarchical structural connectomes’ alterations of subnetworks.
Fifty-five MDD patients who achieved remission underwent diffusion tensors imaging (DTI) scanning from 3 cohorts before and after 8-weeks antidepressant treatment. Five hierarchical subnetworks namely, rich, local, feeder, rich-feeder and feeder-local, were constructed according to the different combinations of connections and nodes as defined by rich club architecture. The critical treatment-related subnetwork pattern was explored by multivariate pattern analysis with support vector machine to differ the pre-/post-treatment patients. Then, relationships between graph metrics of discriminative subnetworks/ nodes and clinical variables were further explored.
The feeder-local subnetwork presented the most discriminative power in differing pre-/post- treatment patients, while the rich-feeder subnetwork had the highest discriminative power when comparing pre-treatment patients and controls. Furthermore, based on the feeder connection, which indicates the information transmission between the core and non-core architectures of brain networks, its topological measures were found to be significantly correlated with the reduction rate of 17-item Hamilton Rating Scale for Depression.
Although pathological lesion on MDD relied on abnormal core organization, disease remission was association with the compensation from non-core organization. These results suggested that the dysfunctions arising from hierarchical subnetworks are compensated by increased information interactions between core brain regions and functionally diverse regions.
Seed reserves play vital roles in seed germination and seedling growth and their variation may be related to various environment factors, plant traits and phylogenetic history. Here, the evolutionary correlation associated with seed mass and altitude and carbon (C), nitrogen (N) and phosphorus (P) allocation of seeds among 253 alpine herbaceous plants was tested. In this study, phylogeny had strong limitations on nutrient allocation of seeds across species, and species from younger phylogenetic groups tended to have higher N and P contents, which might be considered as the evolutionary selection of seed plants. Higher seed N and P content would help seedlings to gain more survival chance and stronger competitive capacity, and their progeny would be more likely to be preserved. When phylogeny was considered, altitude only had a significant positive effect on P content, but the negative effects on seed mass were all expressed. The independent effects of altitude and seed mass suggest that the nutrient allocation of seeds might be affected by both environment and plant traits. In addition, altitude and seed mass displayed partial overlapping effects on nutrient allocation of seeds. The negative effects of seed mass were affected slightly by altitude, whereas altitude only had a significant positive effect on P content when seed mass was controlled. Above all, seed P content showed obvious and general correlations with seed mass, altitude and age of clade, which indicated that higher seed P content might be an adaptive selection of species associated with growth and survival of progeny.
Since 2009, China has initiated a national program on free provision of essential public health services. The national program has expanded both in terms of service categories and funding, showing China's great commitment to universal health coverage. However, with slowdown of public input in the health sector, the government decided to prioritize interventions and optimize reimbursement packages. Researchers in the China National Health Development Research Center (CNHDRC)—the Chinese national health technology assessment (HTA) agency were asked to design the tools to facilitate the decision process.
With multi-criteria decision analysis (MCDA) method, the researchers analyzed value dimensions in public health issues, and built an evidence matrix for the priority-setting decisions. Supported by HTA tools, they appraised interventions and services through literature review and field studies, and projected budget impact of potential adjustment decisions based on cost analysis results. A deliberative process of key stakeholder groups was taken, and their views were counted in making the final recommendations.
Based on evidence review and scores of stakeholders’ judgment, two public health service interventions were recommended for removal, and another two for adjustment (one for merger, one for optimizing care pathway). Cost estimation and potential budgetary impact were also analyzed to support financial decisions.
HTA and MCDA are key tools for defining the value criteria, evidence framework, and deliberative process for the essential public health program. However, lack of cost-effectiveness evidence hinders fine-tuned decisions on resource allocation. Continual health economic evaluation needs to be conducted in the near future.
The hydrogen embrittlement of 12Cr2Mo1R(H) steel at different strain rates were investigated after hydrogen precharging for 4 h in a 0.5 M H2SO4 solution with 2 g/L ammonium thiocyanate. Results showed that the embrittlement index increased and gradually reached a relative stable value of about 20% at the strain rate of 5 × 10−5 s−1 with the decrease of strain rates. SEM images depicted small and deep flakes at high strain rates, while flakes grew larger at slow strain rates. Most hydrogen-induced cracks (HICs) were transgranular fracture through lath grain of bainitic ferrite. High strain field surrounds the crack tips, which makes the crack tips of two close and parallel cracks deflect toward each another and even form crack coalescence. The electron backscatter diffraction technique was used to investigate the effects of grain boundaries, recrystallization fraction, kernel average misorientation map, texture component, and coincidence site lattice boundaries on the HIC propagation. High densities of dislocations and strain concentrations were found around the cracks, where grains are highly sensitive to HIC.
The orientation of spheroidal particles dispersed in a fluid flow is known to influence the particles’ rotation mode. Rod-like and disk-like particles orient themselves differently and accordingly also rotate differently. In order to explore the role of the deterministic factors, i.e. mean shear and vorticity anisotropy, on the orientational behaviour of inertialess tracer spheroids, we adopted a purpose-made Couette–Poiseuille flow simulated numerically by Yang et al. (Intl J. Heat Fluid Flow, vol. 63, 2017, pp. 14–27). Typical wall turbulence with streamwise-oriented streaky structures caused by the locally high mean shear rate was observed only at one of the walls. The absence of mean shear at the other wall gave rise to an atypical turbulence field. Over a relatively wide and quasi-homogeneous core region, a modest mean shear rate made the vorticity field anisotropic. In spite of the mean shear, rod-like tracers were spinning and disk-like spheroids were tumbling, just as in homogeneous isotropic turbulence. We explained this phenomenon by the isotropic particle orientation and concluded that zero mean shear is not necessary for rod spinning and disk tumbling. The orientation and rotation of the Lagrangian tracer spheroids near the high shear wall were almost indistinguishable from the well-known behaviour in turbulent channel flows. Near the opposite wall, where the mean shear was negligibly small, disk-like particles aligned preferentially in the wall-normal direction and rotated similarly as in the presence of high shear. Rod-like particles, on the contrary, aligned more randomly and accordingly rotated similarly as in the core region. These observations revealed that the degree of particle orientation anisotropy has a major impact on the particle rotation mode, whereas mean shear, irrespective of the actual shear rate, only plays a secondary role in particle rotation. Deduction of the eigenvectors of the left Cauchy–Green tensor showed that the preferential orientation of the tracer spheroids was caused by the alignment of rods and disks with the strongest Lagrangian stretching and compression directions, respectively. Lagrangian stretching/compression determines the particle orientations and the particle orientation affects the particle rotation mode.
Paradoxical arguments and mixed empirical evidence coexist in the current literature concerning the relationship between team familiarity and team innovation. To resolve this contradiction, we apply habitual routines theory to propose that team familiarity and team innovation have an inverted U-shaped relationship. Using a data set of 68,933 R&D teams in the electrical engineering industry, our results support a nonlinear relationship between team familiarity and team innovation, and suggest that the best innovative performance is produced by moderately familiar teams. Furthermore, we find that external learning can moderate this curvilinear relationship. Theoretical contributions and future implications are discussed.
Protected areas, including nature reserves and management areas, are established for the conservation of biological diversity and protection of the associated natural and cultural resources. These objectives, however, are often in conflict with socio-economic development. We investigated the plant communities dominated by the dove tree Davidia involucrata in a nature reserve on Mount Jinfo, China, where people intensively manage large areas of bamboo stands. We found a significant lack of small-sized main stems of D. involucrata (0–25 cm diameter at breast height; height > 1.3 m) and newly emerging sprouts in the reserve. The height-class distribution showed a unimodal pattern, with most individuals (of both D. involucrata and co-occurring species) concentrated in the 16–28 m height-class, and few individuals in the shrub and sub-canopy layer (1.3–8 m). Existing practices to facilitate the spread of bamboo stands, and the need to develop a local market for bamboo shoots received little consideration when the nature reserve was established in 1979 to protect D. involucrata. To conserve D. involucrata on Mount Jinfo the appropriate authorities and local parties involved in bamboo harvesting need to focus on methods that are favourable to the life history of this and other tree species, and strategies for their regeneration. These methods will also benefit the conservation of other highly valued trees that share similar life-history characteristics with D. involucrata.
The Da Vinci surgical system is classified as a type “A” medical device in China; the procurement plan of which is regulated by the National Health and Family Planning Commission (NHFP). Between 2010 to 2015, there were thirty-four Da Vinci surgical robots purchased, and installed in thirty tertiary public hospitals across the country. In order to generate context-specific evidence and support further capital funding decisions, the NHFP commissioned a Health Technology Assessment (HTA) of Da Vinci surgical robots, with a focus on real use of the technology in those tertiary public hospitals.
Nine hospitals were selected to collect real word data between 2013 to 2015. Using a cross-sectional survey, data of all robotic surgical cases were collected and described. The unit costs of the robotic surgery were estimated from activity based costing. We also collected cases of prostatectomy (427 versus 421) and hysterectomy (247 versus 105) using the robotic system and laparoscope respectively, and then compared hospital fees and effectiveness during hospitalization. Simulation of the budget impact on health insurance in Shanghai City over the next 5 years was also performed.
A full HTA was conducted based on real data from nine public hospitals in the central and eastern region. Based on a systematic review methodology, we appraised evidence on safety, effectiveness and cost-effectiveness of the Da Vinci surgical robot. Data on technology use, clinical management, and pricing and payment were collected through a cross-sectional survey and interviews of hospital managers, surgeons and nurses. We designed a cohort study on cost-effectiveness of Da Vinci-assisted prostatectomy and hysterectomy, comparing Da Vinci-assisted and laparoscopic prostatectomy (427 vs 421) and Da Vinci-assisted and laparoscopic hysterectomy (247 versus 105). Ethics and inequity issues were discussed based on patient interviews. A budget impact analysis was performed based on scenario mapping of promoting Da Vinci-assisted prostatectomy in Shanghai City over a 5-year timeline.
Due to a lack of evidence on long-term clinical effectiveness and high impact on public finances, the Da Vinci robotic robot should not be procured in large numbers in China. For equipment purchasing the government should strengthen regulations and require the public hospitals to collect more evidence.
Much attention has been given to constructing Lie and Lie superalgebra for integrable systems in soliton theory, which often have significant scientific applications. However, this has mostly been confined to (1+1)-dimensional integrable systems, and there has been very little work on (2+1)-dimensional integrable systems. In this article, we construct a class of generalised Lie superalgebra that differs from more common Lie superalgebra to generate a (2+1)-dimensional super modified Korteweg-de Vries (mKdV) hierarchy, via a generalised Tu scheme based on the Lax pair method where the Hamiltonian structure derives from a generalised supertrace identity. We also obtain some solutions of the (2+1)-dimensional mKdV equation using the G′/G2 method.