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Public service innovation, defined as the adoption of new technology and methods of service delivery, is at the heart of public management research. Scholars have long studied public and private sector innovation as distinctive phenomena, arguing that private sector innovation aims to increase firms' competitive advantage, while public sector innovation purports to improve governance and performance. The public-private dichotomy overlooks the complex way how organizations interact with each other for service delivery. Public services are increasingly delivered through the web of collaborative networks, in which organizations compete and cooperate simultaneously. This Element explores how coopetition, namely the simultaneous presence of competition and collaboration, shapes innovation in the health care sector. Analyzing panel data of 4,000+ American hospitals from 2008 to 2017, this Element finds evidence that coopetition catalyzes the technology and service process innovation and offers practical implications on managing innovation in competitive environments.
To explore the experiences of patients living with diabetic lower extremity amputation (DLEA) and its post-amputation wound in primary care.
DLEA, including both minor and major amputation, is a life-altering condition that brings numerous challenges to an individual’s life. Post-amputation physical wound healing is complicated and challenging because of wound dehiscence and prolonged healing times. Understanding patients’ experiences after DLEA with a post-amputation wound will enable healthcare professionals to develop interventions to assist patients in physical healing and psychosocial recovery.
This study employs a qualitative design using interpretative phenomenological analysis (IPA). A purposive maximum variation sample of nine patients who had had lower extremity amputations and post-amputation wound attributed to diabetes in the previous 12 months was recruited from a primary care setting in Singapore. Semi-structured audio recorded one-to-one interviews with a duration of 45–60 min each were conducted between September 2018 and January 2019. The interviews were transcribed verbatim and analysed using IPA.
The essential meaning of the phenomenon ‘the lived experiences for patients with DLEA and post-amputated wound’ can be interpreted as ‘struggling for “normality”’ which encompasses four domains of sense making: physical loss disrupted normality, emotional impact aggravated the disrupted normality, social challenges further provoked the disrupted normality, and attempt to regain normality. The study highlights the complex physical and psychosocial transition facing patients after DLEA before post-amputation wound closure. In primary care, an amputation, whether minor or major, is a life-altering experience that requires physical healing, emotional recovery, and social adaptation to regain normality. Patients living with DLEA and a post-amputation wound may benefit from an interdisciplinary team care model to assist them with physical and psychosocial adjustment and resume normality.
Political scientists have long been interested in studying the elective office-holding of disadvantaged groups. However, this line of research primarily focuses on the representation of ethnic minorities in the U.S. Congress and identifies three types of determinants of minority candidates' electoral success: the demographic and political make-up of constituents, candidates' personal traits, and macro-level electoral rules. Much less attention is given to minority candidates' electoral success in statehouses. In this paper, we ask: what factors promote the electoral success of minority candidates in state legislatures? Beyond voter characteristics and electoral rules, we attribute minority candidates' electoral success to the social capital possessed by their in-group constituents. We theorize that social capital manifested as civic engagement and social connectedness, can become political capital for minority candidates. Using the Current Population Surveys Civic Engagement Supplement, we validate state-level measures of social capital by race and ethnicity. Linking group social capital to state legislative election outcomes, we find the stock of minority social capital contributes to the electoral success of minority candidates, while white social capital decreases minority candidates' electoral success. Key findings suggest social capital is a form of political capital for disadvantaged groups with private benefits for in-group candidates.
Acute haemorrhagic conjunctivitis is a highly contagious eye disease, the prediction of acute haemorrhagic conjunctivitis is very important to prevent and grasp its development trend. We use the exponential smoothing model and the seasonal autoregressive integrated moving average (SARIMA) model to analyse and predict. The monthly incidence data from 2004 to 2017 were used to fit two models, the actual incidence of acute haemorrhagic conjunctivitis in 2018 was used to validate the model. Finally, the prediction effect of exponential smoothing is best, the mean square error and the mean absolute percentage error were 0.0152 and 0.1871, respectively. In addition, the incidence of acute haemorrhagic conjunctivitis in Chongqing had a seasonal trend characteristic, with the peak period from June to September each year.
Existing data on folate status and hepatocellular carcinoma (HCC) prognosis are scarce. We prospectively examined whether serum folate concentrations at diagnosis were associated with liver cancer-specific survival (LCSS) and overall survival (OS) among 982 patients with newly diagnosed, previously untreated HCC, who were enrolled in the Guangdong Liver Cancer Cohort (GLCC) study between September 2013 and February 2017. Serum folate concentrations were measured using chemiluminescent microparticle immunoassay. Cox proportional hazards models were performed to estimate hazard ratios (HR) and 95 % CI by sex-specific quartile of serum folate. Compared with patients in the third quartile of serum folate, patients in the lowest quartile had significantly inferior LCSS (HR = 1·48; 95 % CI 1·05, 2·09) and OS (HR = 1·43; 95 % CI 1·03, 1·99) after adjustment for non-clinical and clinical prognostic factors. The associations were not significantly modified by sex, age at diagnosis, alcohol drinking status and Barcelona Clinic Liver Cancer (BCLC) stage. However, there were statistically significant interactions on both multiplicative and additive scale between serum folate and C-reactive protein (CRP) levels or smoking status and the associations of lower serum folate with worse LCSS and OS were only evident among patients with CRP > 3·0 mg/l or current smokers. An inverse association with LCSS were also observed among patients with liver damage score ≥3. These results suggest that lower serum folate concentrations at diagnosis are independently associated with worse HCC survival, most prominently among patients with systemic inflammation and current smokers. A future trial of folate supplementation seems to be promising in HCC patients with lower folate status.
Suicide attempt is an important indicator of suicide and potential future mortality. However, the prevalence of suicide attempts has been inconsistent across studies. This meta-analysis aimed to examine the prevalence of suicide attempts in individuals with schizophrenia and associated correlates.
Relevant publications in Embase, PsycINFO, PubMed, Web of science and Cochrane were systematically searched. Data on the prevalence of suicide attempts in individuals with schizophrenia were pooled using a random-effects model.
Thirty-five studies with 16 747 individuals with schizophrenia were included. The pooled lifetime prevalence of suicide attempts was 26.8% (95% CI 22.1–31.9%; I2 = 97.0%), while the 1-year prevalence, 1-month prevalence and the prevalence of suicide attempts from illness onset were 3.0% (95% CI 2.3–3.7%; I2 = 95.6%), 2.7% (95% CI 2.1–3.4%; I2 = 78.5%) and 45.9% (95% CI 42.1–49.9%; I2 = 0), respectively. Earlier age of onset (Q = 4.38, p = 0.04), high-income countries (Q = 53.29, p < 0.001), North America and Europe and Central Asia (Q = 32.83, p < 0.001) were significantly associated with a higher prevalence of suicide attempts.
Suicide attempts are common in individuals with schizophrenia, especially those with an early age of onset and living in high-income countries and regions. Regular screening and effective preventive measures should be implemented as part of the clinical care.
Among 300 advanced cancer patients with potential urinary tract infection (UTI), 19 had symptomatic UTI. Among remaining patients (n = 281), 21% had asymptomatic bacteriuria or candiduria, and 14% received inappropriate therapy for 279 antimicrobial days. Bacteriuria or candiduria predicted antimicrobial therapy. At 10,000 to <100,000 CFU/mL, the incidence rate ratio [IRR] was 16.9 (95% confidence interval [CI], 6.0–47.2), and at ≥100,000 CFU/mL, the IRR was 27.9 (95% CI, 10.9–71.2).
In this work, corrosion-resistant fluoridated Ca–Mg–P composite coatings were prepared on magnesium alloys via a hydrothermal assisted sol–gel process. All these coatings derived from Coating Sols with different F− concentrations are composed of fluoridated hydroxyapatite, magnesium hydroxide, and dittmarite. When F− concentration of Coating Sol is 0.03 M, the coating exhibited uniform and dense surface, and its thickness reached 32 μm, thus possessing a high charge transfer resistance of 312 ± 12.69 kΩ cm2 in simulated body fluid (SBF). Immersion test in SBF showed that this coating could quickly induce the formation of the mineralized layer, implying relatively high bioactivity. After 49 days of immersion, the original composite coating and newly formed mineralized layer reached 60 μm in thickness, providing effective long-term protection for magnesium alloys. These attractive results indicate that this fluoridated Ca–Mg–P composite coating is a promising protective coating on biodegradable magnesium and magnesium alloy implants for orthopaedic applications.
The acquisition of signals is a precondition for tracking and solution calculation in software-based Global Navigation Satellite System (GNSS) receivers. The Parallel Code phase Acquisition (PCA) algorithm can simultaneously obtain the correlation results at every sampling point. However, if the number of sampling points that needs processing is large, this method will lead to a heavy computational load. Thus, we improve the process of the PCA algorithm and propose a novel algorithm that divides the signals into K (K is a constant) parts to achieve correlation and obtains the correlation results with a fusion algorithm. This algorithm can simultaneously obtain the correlation results for sampling points at an interval of K points. If the K value is selected appropriately, the computational load can be decreased by about 50%. Also, the Receiver Operating Characteristic (ROC) curves show that under a certain probability of false alarm, the detection probability of the proposed algorithms is 5% lower than that of the PCA algorithm. Therefore, the proposed algorithm can speed up the acquisition process with a slight decrease in detection probability.
Although many studies worldwide have focused on the relationship between vitamin D and insulin resistance, results remain controversial. Furthermore, concentrations of serum 25-hydroxyvitamin D (25(OH)D) in the Chinese population are unclear. We aimed to investigate vitamin D status and its correlation with insulin resistance among a Chinese adult population.
Serum 25(OH)D, fasting blood glucose, fasting insulin, glycated Hb (HbA1c) and other metabolic parameters were assessed. Neck circumference, waist circumference, hip circumference, weight and height were also measured. Lifestyle factors including smoking and drinking status were obtained. Diabetes mellitus was diagnosed by HbA1c according to the 2010 American Diabetes Association criteria.
Of 7200 residents included, 6597 individuals were ultimately analysed.
We enrolled 2813 males (mean age 52·7 (sd 13·5) years) and 3784 females (52·3 (sd 13·5) years); mean serum 25(OH)D concentration was 43·1 (sd 11·6) and 39·6 (sd 9·8) nmol/l, respectively. Additionally, 83·3 % of participants were 25(OH)D deficient. A significant difference in 25(OH)D was observed between males and females in winter and spring (P<0·001). Furthermore, 25(OH)D concentrations were inversely associated with the homeostasis model assessment of insulin resistance (HOMA-IR) in the overweight and pre-diabetic populations. After adjusting for several variables, 25(OH)D was significantly associated with HOMA-IR in winter. When 25(OH)D values were categorized into quartiles, HOMA-IR was significantly associated with decreasing 25(OH)D.
The majority of the Chinese population was vitamin D deficient and this deficiency was negatively associated with insulin resistance, particularly in the overweight and pre-diabetic populations. Moreover, these associations might be more evident in the winter.
Nitrogen is an essential element for biological activity, and nitrogen isotopic compositions of geological samples record information about both marine biological processes and environmental evolution. However, only a few studies of N isotopes in the early Cambrian have been published. In this study, we analysed nitrogen isotopic compositions, as well as trace elements and sulphur isotopic compositions of cherts, black shales, carbonaceous shales and argillaceous carbonates from the Daotuo drill core in Songtao County, NE Guizhou Province, China, to reconstruct the marine redox environment of both deep and surface seawater in the study area of the Yangtze shelf margin in the early Cambrian. The Mo–U covariation pattern of the studied samples indicates that the Yangtze shelf margin area was weakly restricted and connected to the open ocean through shallow water flows. Mo and U concentrations, δ15Nbulk and δ34Spy values of the studied samples from the Yangtze shelf margin area suggest ferruginous but not sulphidic seawater and low marine sulphate concentration (relatively deep chemocline) in the Cambrian Fortunian and early Stage 2; sulphidic conditions (shallow chemocline and anoxic photic zone) in the upper Cambrian Stage 2 and lower Stage 3; and the depression of sulphidic seawater in the middle and upper Cambrian Stage 3. Furthermore, the decreasing δ15N values indicate shrinking of the marine nitrate reservoir during the middle and upper Stage 3, which reflects a falling oxygenation level in this period. The environmental evolution was probably controlled by the changing biological activity through its feedback on the local marine environment.
The purpose of the present study was to do a psychometric evaluation of the somatic and psychological health report (SPHERE) among Chinese adolescents. Our participants were 116 twins (50 females). Psychometric evaluation indicated that the reliability and validity of this scale were good. The internal consistencies and split-half reliabilities of all subscales were above 0.80. Furthermore, the item-total correlations were acceptable for all the subscales (all the values were higher than 0.20). The present findings suggest that the SPHERE can be well used to measure Chinese adolescents’ somatic and psychological health.
In this article, we use data from the American states from 1996 to 2008 to explore the effects of immigration on income inequality. Empirical evidence from both static and dynamic models shows that the foreign-born population has a strong positive effect on state-level income inequality, even when we control for a range of federal and state political and economic contextual variables. We also find that the positive relationship between immigration and state income inequality is driven primarily by low-skill immigrants (rather than high-skill immigrants), and we provide some evidence that high-skill immigrants lower income inequality for some segments of the income distribution. We conclude that immigration—particularly low-skilled immigration—has an important effect on income inequality in the American states.
Recent studies have suggested an association between vitamin D and non-alcoholic fatty liver disease (NAFLD); however, some results are subject to debate. This study was carried out to evaluate the correlation between NAFLD and vitamin D in men and women in East China. The data were obtained from a cross-sectional study that focused on the health and metabolic status of adults in sixteen areas of East China. According to ultrasonic assessments, the patients were divided into normal and NAFLD groups. Demographic characteristics and biochemical measurements were obtained. Binary logistic regression analysis was used to explore the association. In total, 5066 subjects were enrolled, and 2193 (43·3 %) were diagnosed with NAFLD; 84·56 % of the subjects showed vitamin D deficiency. Subjects with high vitamin D levels had a lower prevalence of NAFLD, particularly male subjects. Within the highest quartile of vitamin D levels, the prevalence of NAFLD was 40·8 %, whereas the lowest quartile of vitamin D levels showed a prevalence of 62·2 %, which was unchanged in women across the vitamin D levels. Binary logistic analysis showed that decreased vitamin D levels were associated with an increased risk of NAFLD (OR 1·54; 95 % CI 1·26, 1·88). This study suggests that vitamin D levels are significantly associated with NAFLD and that vitamin D acts as an independent factor for NAFLD prevalence, particularly in males in East China. Vitamin D interventional treatment might be a new target for controlling NAFLD; elucidating the mechanism requires further research.
The Centers for Disease Control and Prevention (CDC) has developed an approach to ventilator-associated events (VAE) surveillance. Using these methods, this study was performed to investigate VAE incidences and to test whether VAEs are associated with poorer outcomes in China.
A 4-month, prospective multicenter surveillance study between April and July 2013.
Our study included 15 adult intensive care units (ICUs) of 15 hospitals in China.
Patients admitted to ICUs during the study period
Patients on mechanical ventilation (MV) were monitored for VAEs: ventilator-associated conditions (VACs), infection-related ventilator-associated complications (IVACs), and possible or probable ventilator-associated pneumonia (VAP). Patients with and without VACs were compared with regard to duration of MV, ICU length of stay (LOS), overall hospital LOS, and mortality rate.
During the study period, 2,356 of the 5,256 patients admitted to ICUs received MV for 8,438 ventilator days. Of these patients, 636 were on MV >2 days. VACs were identified in 94 cases (4.0%; 11.1 cases per 1,000 ventilator days), including 31 patients with IVACs and 16 with possible VAP but none with probable VAP. Compared with patients without VACs, patients with VACs had longer ICU LOS (by 6.2 days), longer duration on MV (by 7.7 days), and higher hospital mortality rate (50.0% vs 27.3%). The mortality rate attributable to VACs was 11.7%. Compared with those with VACs alone, patients with IVACs had longer duration on MV and increased ICU LOS but no higher mortality rates.
In China, surveillance of VACs and IVACs is able to identify MV patients with poorer outcomes. However, surveillance of possible and probable VAP can be problematic.
Infect. Control Hosp. Epidemiol. 2015;36(12):1388–1395
The question of how the American political process shapes inequality remains unsettled. While recent studies break ground by linking inequality to political institutions, much of this work focuses on national-level income inequality. The literature is lacking in its examination of inequality in other issue areas at the subnational level. This research explores how partisanship in government affects subnational-level inequality in health care coverage in the context of racial diversity. Using a new Gini-coefficient measure of inequality in health insurance coverage, we find a negative relationship between the seat share of Democratic representatives and inequality in health care coverage but only in states with racially diverse populations. Moreover, Democratic-controlled state legislatures mitigate the negative impact of racial diversity on inequality in health care coverage. These results highlight the importance of examining the partisan foundation of health care inequality in the context of racial diversity.
Objectives: This study sought to evaluate left ventricular, right ventricular, and left atrial mechanics and their interactions in patients with congenital scoliosis without clinical heart failure. Methods: A total of 23 patients with a median age of 14 years and a median Cobb’s angle of 61° were studied. Ventricular and atrial myocardial deformation was measured using speckle tracking echocardiography. The results of the patients were compared with 22 controls. Results: Compared with controls, the patients had a significantly greater annular a velocity (p=0.04) and lower e/a ratio (p=0.03); the left ventricular deformation significantly decreased in radial global (p=0.04) and segmental systolic strain and early diastolic strain rate (p=0.03); the left atrial deformation showed a significantly lower positive strain (p=0.02), greater negative strain (p=0.01), and active contractile strain rate (p=0.01). For the patients, the Cobb’s angle was negatively correlated with the left ventricular global radial systolic strain (r=−0.65, p=0.001), left atrial positive strain (r=−0.68, p<0.001), and the left atrial negative strain was positively correlated with the left ventricular circumferential late diastolic strain rate (r=0.46, p=0.01). The left atrial conduit strain rate was positively correlated with the left ventricular circumferential early diastolic strain rate (r=0.42, p=0.03). The left atrial active contractile strain rate was positively correlated with the left ventricular longitudinal late diastolic strain rate (r=−0.4, p=0.03). Conclusions: Impaired left ventricular and altered left atrial mechanics occur relatively early in patients with congenital scoliosis, and are correlated with the severity of their scoliosis. Our findings provide evidence of preclinical heart dysfunction in patients with this disorder.
Au nanoparticles (Au NPs) have attracted much interest owing to their unique optical properties. In this paper, a facile process has been successfully developed to synthesize the SiO2/Au hybrid microspheres with a diameter of 200 nm via the galvanic replacement of SiO2/Ag hybrid microspheres and chlorauric acid (HAuCl4) solution. The as-prepared products were investigated by x-ray diffraction (XRD), field-emission scanning electron microscopy (FESEM, JEOL-6700F), and transmission electron microscopy (TEM, JEOL 3010), respectively. As expected, the as-prepared SiO2/Au hybrid microspheres show strong chemical stability and superior catalytic reduction of 4-nitrophenol (4-NP) to 4-aminophenol (4-AP). The SiO2/Au hybrid microspheres would be found widely used in wastewater treatment, catalytic reaction, bacteriostatic and bactericidal applications.
Severe fever with thrombocytopenia syndrome virus (SFTSV) has been prevalent for some time in China and it was first identified in 2010. However, the seroprevalence of SFTSV in the general population in southeastern China and risk factors associated with the infection are currently unclear. Blood samples were collected from seven counties across Zhejiang province and tested for the presence of SFTSV-specific IgG antibodies by ELISA. A total of 1380 blood samples were collected of which 5·51% were seropositive for SFTSV with seroprevalence varying significantly between sites. Seroprevalence of SFTSV in people who were family members of the patient, lived in the same village as the patient, or lived in a different village than the patient varied significantly. There was significant difference in seroprevalence between participants who bred domestic animals and participants who did not. Domestic animals are probably potential reservoir hosts and contact with domestic animals may be a transmission route of SFTSV.
Patterned porous films prepared by the breath figure method have received considerable interests because of the potential applications. This paper reports a top–down method to fabricate functional patterned films. Cross-linked polystyrene microspheres were synthesized by a two-stage dispersion polymerization using divinylbenzene (DVB) and ethylene glycol dimethacrylate (EGDMA) as cross-linkers, which provide free vinyl groups on the microspheres surface. The amounts of residual vinyl groups were determined by potentiometric titration. Glucose was then bound to the microspheres via thiol–ene reaction, which was confirmed by x-ray photoelectron spectroscopy and water contact angle measurements. Results indicate that vinyl groups of EGDMA show relatively higher reactivity than that of DVB. Microspheres with glucose were assembled into the pores of honeycomb films prepared by the breath figure method, forming functional arrays for recognizing a lectin, Con A. This top–down method is useful in preparing patterned films with various functional moieties, which may act as a platform, such as, for investigating carbohydrate–lectin interactions and for sensing.