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Objective:To analyze the salary characteristics of medical institutions and the influencing factors of personnel expenditure as found in the salary system reform of public hospitals in Sichuan province, for reference in furthering such reform in public hospitals.Methods:The data of personnel expenditure, business operation and medical services came from 96 medical institutions in 21 cities(prefectures)of Sichuan province from 2017 to 2020 by means of institutional survey. The average salary level and salary structure of medical staff were used to describe the salary characteristics, and the total salary was presented by the level of personnel expenditure. The measurement data was represented by M(IQR), the counting data was described by frequency and constituent ratio, and the influencing factors of personnel expenditure were analyzed by generalized linear mixed model. Results:From 2017 to 2020, the personnel expenditure of medical institutions increased by 13.04% annually. In 2020, the per capita salary level of medical staff was 151 900 yuan, while the basic salary and performance salary accounted for 16.20% and 54.60% of personnel expenditure respectively. The analysis results of the generalized linear mixed model showed that the average cost of patients per visit( β=0.596), the level of drugs and sanitary materials consumed per 100 yuan medical income( β=0.286), the number of medical visits( β=0.328), and the years [(2018, 2019, 2020) β=0.025, 0.052, 0.066] were positively correlated to personnel expenditure, while the average length of stay( β=-0.693), the proportion of medical service income( β=-0.392), and the balance rate of income and expenditure( β=-0.062)were negatively correlated to personnel expenditure( P<0.05). The proportion of fiscal subsidy revenue, regional GDP and asset-liability ratio were not the influencing factors of personnel expenditure( P> 0.05). Conclusions:In the reform of the salary system of the province, its salary level of medical institutions has surpassed the current wage ceiling of these institutions. As the salary distribution was mainly made based on the workload, the " baton" role of the salary system reform has begun to pay off. However, the basic guarantee role of compensation has not yet been fully leveraged.Further reform is needed in upgrading refined management, and timely dynamic adjustment of personnel expenditure in combination with the hospital's financial performance and cost analysis, and reasonably optimizing the level of medical staff compensation.
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Objective To evaluate the impact of water pollutants, water levels and meteorological factors on the Oncomelania hupensis density in Eastern Dongting Lake regions, so as to provide insights into schistosomiasis control. Methods O. hupensis snails were surveyed using a systematic sampling method in snail-infested marshlands in Eastern Dongting Lake regions from 2007 to 2014, and data pertaining to water pollutants, water levels and meteorological factors were collected. The duration of submergence and the date of the start of submergence were calculated. The snail density and its influencing factors were descriptively analyzed, and a linear mixed model was generated to examine the impacts of variables on the snail density. In addition, smooth curves were fitted to investigate the relationship between snail density and variables. Results The snail density appeared a fluctuation in Eastern Dongting Lake regions during the period from 2007 to 2014, with the highest density on October, 2010 (52.79 snails/0.1 m2) and the lowest density on January 2009 (2.15 snails/0.1 m2). Linear mixed-model analysis showed that permanganate index, total phosphorus and the date of the start of submergence affected the snail density (t = 6.386, −2.920 and −3.892, all P values < 0.01). Smooth curve analysis revealed that the associations of the snail density with the permanganate index and total phosphorus appeared an approximately quadratic curve. After the end of April, the earlier date of the start of submergence resulted in a higher snail density. Conclusion Permenganate index, total phosphorus and the date of the start of submergence affect the O. hupensis snail density in Eastern Dongting Lake regions.
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Objective To describe the genetic structure of populations in different areas of China,and explore the effects of different strategies to control the confounding factors of the genetic structure in cohort studies.Methods By using the genome-wide association study (GWAS) on data of 4 500 samples from 10 areas of the China Kadoorie Biobank (CKB),we performed principal components analysis to extract the fast and second principal components of the samples for the component two-dimensional diagram generation,and then compared them with the source of sample area to analyze the characteristics of genetic structure of the samples from different areas of China.Based on the CKB cohort data,a simulation data set with cluster sample characteristics such as genetic structure differences and extensive kinship was generated;and the effects of different analysis strategies including traditional analysis scheme and mixed linear model on the inflation factor (λ) were evaluated.Results There were significant genetic structure differences in different areas of China.Distribution of the principal components of the population genetic structure was basically consistent with the geographical distribution of the project area.The first principal component corresponds to the latitude of different areas,and the second principal component corresponds to the longitude of different areas.The generated simulation data showed high false positive rate (λ =1.16),even if the principal components of the genetic structure was adjusted or the area specific subgroup analysis was performed,λ could not be effectively controlled (λ ＞ 1.05);while,by using a mixed linear model adjusting for the kinship matrix,λ was effectively controlled regardless of whether the genetic structure principal component was further adjusted (λ =0.99).Conclusions There were large differences in genetic structure among populations in different areas of China.In molecular epidemiology studies,bias caused by population genetic structure needs to be carefully treated.For large cohort data with complex genetic structure and extensive kinship,it is necessary to use a mixed linear model for association analysis.
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Objective To describe the genetic structure of populations in different areas of China,and explore the effects of different strategies to control the confounding factors of the genetic structure in cohort studies.Methods By using the genome-wide association study (GWAS) on data of 4 500 samples from 10 areas of the China Kadoorie Biobank (CKB),we performed principal components analysis to extract the fast and second principal components of the samples for the component two-dimensional diagram generation,and then compared them with the source of sample area to analyze the characteristics of genetic structure of the samples from different areas of China.Based on the CKB cohort data,a simulation data set with cluster sample characteristics such as genetic structure differences and extensive kinship was generated;and the effects of different analysis strategies including traditional analysis scheme and mixed linear model on the inflation factor (λ) were evaluated.Results There were significant genetic structure differences in different areas of China.Distribution of the principal components of the population genetic structure was basically consistent with the geographical distribution of the project area.The first principal component corresponds to the latitude of different areas,and the second principal component corresponds to the longitude of different areas.The generated simulation data showed high false positive rate (λ =1.16),even if the principal components of the genetic structure was adjusted or the area specific subgroup analysis was performed,λ could not be effectively controlled (λ ＞ 1.05);while,by using a mixed linear model adjusting for the kinship matrix,λ was effectively controlled regardless of whether the genetic structure principal component was further adjusted (λ =0.99).Conclusions There were large differences in genetic structure among populations in different areas of China.In molecular epidemiology studies,bias caused by population genetic structure needs to be carefully treated.For large cohort data with complex genetic structure and extensive kinship,it is necessary to use a mixed linear model for association analysis.
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PURPOSE: To investigate the changes in intraocular pressure (IOP) and associated systemic factors over 7 years in a healthy Korean population. METHODS: This longitudinal study included healthy subjects with no history of ocular disease and who had been receiving health examinations seven years apart at the Konkuk University Medical Center, Healthcare Center. The participants completed lifestyle questionnaires and underwent general health examinations (blood pressure, height and weight, and blood biochemical tests) and ocular examinations including noncontact tonometry and fundus photography. Subjects with abnormal fundus photography findings and ocular hypertension were excluded. Changes in IOP and systemic factors over 7 years were analyzed. RESULTS: Of 524 possible subjects, 469 were enrolled (55 subjects were excluded: 50 due to abnormal fundus photography and 5 for missing data). The left eye was analyzed in all patients. In all subjects, initial IOP (mean 14.50 ± 3.14 mmHg) was not significantly different from final IOP (14.72 ± 3.38 mmHg) (paired t-test, p = 0.074). In male patients, the final IOP was significantly higher than the initial IOP (paired t-test, p = 0.035). Lifestyle questionnaire variables were associated with a final IOP that was significantly higher than the initial IOP (smokers, alcohol drinkers and less exercisers, paired t-test; p = 0.014, 0.010 and 0.024, respectively). A linear mixed-effects model analysis showed that the change in IOP was negatively associated with age, but this was not statistically significant. Changes in systolic blood pressure (SBP), body mass index (BMI), total cholesterol (T.Chol) and low density lipoprotein (LDL) were positively correlated with change in IOP. CONCLUSIONS: A linear mixed-model analysis showed IOP decreased with age but this was not statistically significant. Changes in SBP, BMI, T.Chol and LDL were significantly positively correlated with change in IOP.
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Humans , Male , Academic Medical Centers , Blood Pressure , Body Mass Index , Cholesterol , Delivery of Health Care , Healthy Volunteers , Intraocular Pressure , Life Style , Lipoproteins , Longitudinal Studies , Manometry , Ocular Hypertension , PhotographyABSTRACT
BACKGROUND: External quality assessment (EQA) uses a standard deviation index (SDI), based on a peer group, to evaluate laboratory performance. However, evaluations using peer group SDIs often have limited applicability, because they are not statistically valid unless the number of institutions in the same peer group is large. The present study proposes a statistical model for simultaneously evaluating the performance of all participating institutions, as well as the performance of instruments on the market. METHODS: By assuming that proficiency test results were affected by the manufacturer, the instrument, and the institution, the effects of those factors were estimated using a linear mixed model. We used these effect estimates to calculate manufacturer, instrument, and institution SDIs. Using simulation, we evaluated the false positive rates and efficiencies of the proposed linear mixed model. RESULTS: Simulations showed that the linear mixed model empirical type I error rates preserved the nominal significance level. This model was also more statistically efficient than the peer group SDI. Rates of unacceptability were lower when using institution SDI than they were when using peer group SDI. Additional outliers that could not be evaluated using the current system were detected by the institution SDI statistic. The instrument SDI statistic detected outliers among different instrument groups. CONCLUSIONS: Institution and instrument SDIs are robust and efficient tools for EQA, and they can replace the currently used system of peer group SDI.
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Laboratory Proficiency Testing , Models, Statistical , Peer GroupABSTRACT
O presente trabalho objetivou estimar parâmetros, correlações e ganhos genéticos para caracteres de crescimento e forma, em um teste de progênies deEucalyptus camaldulensisna região centro-oeste do Brasil. Aos três anos de idade, as progênies foram avaliadas quanto aos caracteres: altura total (ALTT), altura comercial (ALTC), diâmetro à altura do peito (DAP) e forma de fuste (FF). A análise de deviance detectou diferenças significativas para os caracteres ALTC, DAP e FF. As estimativas das herdabilidades individuais foram de baixa magnitude para ALTT (0,10) e DAP (0,16), porém, ALTC (0,18) e FF (0,25) apresentaram valores de média a alta magnitude. Os coeficientes de variação genética individual (CVgi%) variaram de 8,59% para FF a 15,91% para ALTC. As correlações fenotípicas e genéticas preditas foram positivas e de alta magnitude entre ALTT e ALTC (0,80 e 0,82, respectivamente) e ALTT e DAP (0,85 e 0,86, respectivamente), indicando que a seleção indireta pode ser utilizada para essas associações. A seleção individual se mostrou superior, quando comparada à seleção entre e dentro. Os valores encontrados indicaram perspectivas de progressos genéticos com seleção baseada nos caracteres avaliados.
This study aimed to estimate parameters, correlations and genetic gain for growth and shape traits in a progeny trial using Eucalyptus camaldulensisin Central Brazil. When it was three years old, progenies were evaluated for the following traits: total height (ALTT), commercial height (ALTC), diameter at breast height (DAP) and stem form (FF). Deviance analysis detected significant differences for ALTC, DAP and FF. Estimates of individual heritability showed low magnitude for ALTT (0.10) and DAP (0.16). However, ALTC (0.18) and FF (0.25), showed median to high magnitude values. Individual genetic variation coefficients (CVgi%), ranged from 8.59% (FF) to 15.91% (ALTC). Predicted phenotypic and genetic correlations were positive and of high magnitude between ALTT and ALTC (0.80 and 0.82) as well as between ALTT and DAP (0.85 and 0.86), indicating that indirect selection can be used for these associations. Individual selection showed to be superior when compared to selection between and within. Found values indicated perspectives of genetic progress with selection based on the evaluated characters.
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Objetivou-se com este trabalho comparar modelos de predição de plantas sobreviventes de Eucalyptus grandis. Utilizaram-se os seguintes modelos: modelo linear misto com os dados transformados, utilizando-se as transformações angular e BOX-COX; modelo linear generalizado misto com distribuição binomial e funções de ligação logística, probit e complemento log-log; modelo linear generalizado misto com distribuição Poisson e função de ligação logarítmica. Os dados são provenientes de um experimento em blocos ao acaso, para avaliação de progênies maternas de Eucalyptus grandis, aos 5 anos de idade, em que a variável resposta são plantas sobreviventes. Para comparação dos efeitos entre os modelos foram estimadas as correlações de Spearman e aplicado o teste de permutação de Fisher. Foi possível concluir que, o modelo linear generalizado misto com distribuição Poisson e função de ligação logarítmica se ajustou mal aos dados e que as estimativas para os efeitos fixos e predição para os efeitos aleatórios, não se diferenciaram entre os demais modelos estudados.
The objective of this work was to compare models for prediction of the survival of plants of Eucalyptus grandis. The following models were used: linear mixed model with the transformed data, by utilizing the angular transformations and BOX-COX; generalized linear mixed model with binomial distribution and logistic functions, probit and complement log-log links; generalized linear mixed model with Poisson distribution and logarithmic link function. The data came from a randomized block experiment for evaluation of Eucalyptus grandis maternal progenies at five years old, in which the variable response are surviving plants. For comparison of the effects among the models the correlations of Spearman were estimated and the test of permutation of Fisher was applied. It was possible to conclude that: the generalized linear mixed model with Poisson distribution and logarithmic link function misadjusted to the data; the estimates for the fixed effects and prediction for the random effects did not differ among the to other studied models.