Medical expenditure and its inequity for people with disabilities: Evidence from the CHARLS 2018 data.

Introduction: Disabilities may raise heavy medical expenses and rich-poor inequalities. However, data is lacking for the Chinese older populations. This study aimed to measure socioeconomic inequalities in medical expenses amongst the Chinese adult 45 years or older, and explored the main determinants among different disability categories. Method: Data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) were used. Disabilities were divided into five categories: physical disabilities, intellectual disability, vision problems, hearing problems, and multiple disabilities. The two-part model was employed to identify the factors that are associated with medical expenditures. Socioeconomic inequalities were measured by the concentration index (CI), and the horizontal inequity index (HI) which adjusts for health needs. Decomposition analysis was further applied to evaluate the contribution of each determinant. Results: Two thousand four hundred nineteen people were included in this study. The CIs and HIs of the expenditure were both positive. Amongst the varied types of medical expenses, the highest CIs were found for self-treatment expenses (0.0262). Amongst the five categories of disabilities, the group with vision problem disability reported the highest CIs and HIs for outpatient expenses (CI = 0.0843, HI = 0.0751), self-treatment expenses (CI = 0.0958, HI = 0.1119), and total expenses (CI = 0.0622, HI = 0.0541). The group of intellectual disability reported the highest CI and HI (CI = 0.0707, HI = 0.0625). The decomposition analysis showed that income (80.32%), education (25.14%) and living in the rural areas (13.96%) were the main determinants of medical expenses for HI amongst all types of disabilities. Conclusion: For five types of disabilities, our data shows that medical expenses concentrated in the richer groups in China. Income, education, and rural areas factors were the main contributors to the economic-related inequalities. Health policies to improve the affordability of medical care are needed to decrease inequity of medical expenditures for people with disabilities.

Evaluation of the quality of contracted family doctor services based on patient perceptions and expectations: a follow-up analysis from the elderly with chronic diseases in rural Jiangsu, China.

INTRODUCTION: The policy focus of contracted family doctor services (CFDS) has been shifting to improve quality and efficiency in China. The study's objective was to establish a quality evaluation scale for CFDS based on the perceived service quality model and to assess the service quality from the perspective of patient perceptions and expectations. METHODS: Data were obtained from a 2-year follow-up survey of CFDS in Jiangsu, China. A total of 1264 elderly people with chronic diseases were tracked. The self-developed scale was designed based on the perceived service quality model. The product scale method was used to assign weighted values, the Wilcoxon signed-rank test was used to compare the differences over the 2 years, and pooled cross-sectional regression was conducted to evaluate the associated factors with the gap scores of service quality. RESULTS: There were significant differences between perceptions and expectations in each dimension in the 2 years (p<0.05), and the service quality gaps existed. Over the 2 years, Accessibility and Horizontal continuity were the first-ranked and second-ranked in expectations; the top three scores in perception were Horizontal continuity, Comprehensive service and Accessibility dimensions. The service quality gap in 2020 was smaller than that in 2019 (p<0.05). There were differences in the perception scores in the Vertical continuity, Technical and Economic dimensions and in the expectation scores in the Horizontal continuity, Vertical continuity and Technical dimensions between the 2 years (p<0.05). The factors that were significantly associated with each dimension score included the Jiangsu region, gender, age and education levels (p<0.05). CONCLUSION: The quality evaluation scale of CFDS has good reliability and validity. Policy efforts should be focused on accelerating the development of medical alliances, optimising medical insurance policies and improving the capacity of family doctor services to meet the needs of the elderly with chronic diseases.

High-efficiency adsorption of Cr(VI) and RhB by hierarchical porous carbon prepared from coal gangue.

Coal gangue (CG) is one of the largest industrial solid wastes in the world produced during the process of coal mining. The accumulation of CG is easy to cause ion leakage, which is harmful to the environment and human body. The recovery and utilization of CG are imminent. In the process, a hierarchical porous carbon (HPC) adsorbent with excellent adsorption property for Cr(VI) and rhodamine B (RhB), was prepared from CG by a two-step method and characterized by SEM, TEM, XRD, XPS, TPD and BET. The results revealed that the specific surface area of HPC is up to 2012.7 m2 g-1, and its adsorption capacities for Cr(VI) and RhB are reached 320.51 and 3086.42 mg g-1. The adsorption mechanism of RhB was the synergetic effect of physics and chemistry. While XPS results suggested that hierarchical porous carbons (HPCs) only have a chemisorption effect on Cr(VI). This study provided an idea for the preparation of HPCs from CG to remove inorganic and organic pollutants such as heavy metal Cr(VI) and RhB in water.

Study of Hepatic Vascular Dynamics Based on Symmetrical Pulsating Perfusion.

BACKGROUND The traditionally used perfusion method is constant flow. This study proposes a novel method called Symmetric Pulsating Flow (SPF) and verified that this method is applicable. MATERIAL AND METHODS The fluid dynamic behavior of perfusate in the vessel, the shear stress, and the vascular deformation were simulated based on the bi-directional fluid-structure interaction. The differences of the fluid dynamic behaviors and the mechanical characteristics of vascular wall were studied and compared between the 2 methods during the process of hepatic perfusion. The simulations and comparisons were carried out on 3 different vascular models. RESULTS Utilizing the constant flow perfusion, a double vortex clearly appeared at the rear end of the foreign matter and reflux retention can be caused by the double vortex. The reflux retention caused lower shear stress against the vascular wall and thus brought new accumulation of foreign matter. The SPF perfusion, however, prevented the double vortex, and avoided such reflux retention during the vascular perfusion. In addition, the SPF can clean the vascular wall better with a slower speed, which causes less injury to the vessel, and the pulsating effect can reduce the accumulation of new foreign matter. CONCLUSIONS The SPF perfusion can clean the vascular wall more thoroughly with less injury.

Enhanced Electrochemical Properties of Gel Polymer Electrolyte with Hybrid Copolymer of Organic Palygorskite and Methyl Methacrylate.

Gel polymer electrolyte (GPE) is widely considered as a promising safe lithium-ion battery material compared to conventional organic liquid electrolyte, which is linked to a greater risk of corrosive liquid leakage, spontaneous combustion, and explosion. GPE contains polymers, lithium salts, and liquid electrolyte, and inorganic nanoparticles are often used as fillers to improve electrochemical performance. However, such composite polymer electrolytes are usually prepared by means of blending, which can impact on the compatibility between the polymer and filler. In this study, the hybrid copolymer poly (organic palygorskite-co-methyl methacrylate) (poly(OPal-MMA)) is synthesized using organic palygorskite (OPal) and MMA as raw materials. The poly(OPal-MMA) gel electrolyte exhibits an ionic conductivity of 2.94 × 10-3 S/cm at 30 °C. The Li/poly(OPal-MMA) electrolyte/LiFePO4 cell shows a wide electrochemical window (approximately 4.7 V), high discharge capacity (146.36 mAh/g), and a low capacity-decay rate (0.02%/cycle).

Efficient Using Durian Shell Hydrolysate as Low-Cost Substrate for Bacterial Cellulose Production by Gluconacetobacter xylinus.

Durian is one important tropical fruit with high nutritional value, but its shell is usually useless and considered as waste. To explore the efficient and high-value utilization of this agricultural and food waste, in this study, durian shell was simply hydrolyzed by dilute sulfuric acid, and the durian shell hydrolysate after detoxification was used for bacterial cellulose (BC) production by Gluconacetobacter xylinus for the first time. BC was synthesized in static culture for 10 days and the highest BC yield (2.67 g/L) was obtained at the 8th day. The typical carbon sources in the substrate including glucose, xylose, formic acid, acetic acid, etc. can be utilized by G. xylinus. The highest chemical oxygen demand (COD) removal (16.40%) was obtained at the 8th day. The highest BC yield on COD consumption and the highest BC yield on sugar consumption were 93.51% and 22.98% (w/w), respectively, suggesting this is one efficient bioconversion for BC production. Durian shell hydrolysate showed small influence on the BC structure by comparison with the structure of BC generated in traditional Hestrin-Schramm medium detected by FE-SEM, FTIR, and XRD. Overall, this technology can both solve the issue of waste durian shell and produce valuable bio-polymer (BC).

Efficient bioconversion from acid hydrolysate of waste oleaginous yeast biomass after microbial oil extraction to bacterial cellulose by Komagataeibacter xylinus.

Biomass acid hydrolysate of oleaginous yeast Trichosporon cutaneum after microbial oil extraction was applied as substrate for bacterial cellulose (BC) production by Komagataeibacter xylinus (also named as Gluconacetobacter xylinus previously) for the first time. BC was synthesized in static culture for 10 days, and the maximum BC yield (2.9 g/L) was got at the 4th day of fermentation. Most carbon sources in the substrate (glucose, mannose, formic acid, acetic acid) can be utilized by K. xylinus. The highest chemical oxygen demand (COD) removal (40.7 ± 3.0%) was obtained at the 6th day of fermentation, and then the COD increased possibly due to the degradation of BC. The highest BC yield on COD consumption was 38.7 ± 4.0% (w/w), suggesting that this is one efficient bioconversion for BC production. The BC structure was affected little by the substrate by comparison with that generated in classical HS medium using field-emission scanning electron microscope (FE-SEM), Fourier transform infrared, and X-ray diffraction. Overall, this technology can both solve the issue of waste oleaginous yeast biomass and produce valuable biopolymer (BC).