Practice Standards in International Medical Departments of Public Academic Hospitals in China: Cross-Sectional Study.

BACKGROUND: Improving health care in cities with a diverse, international population is crucial for ensuring health equity, particularly for foreigners facing challenges due to cultural and language barriers. This situation is especially relevant in China, a major destination for expatriates and travelers, where optimizing health care services and incorporating international standards in the public sector are vital. Achieving this involves understanding the operational details, cultural and linguistic nuances, and advancing medical digitalization. A strategic approach focusing on cultural competence and awareness of health care systems is essential for effectively navigating health care for foreigners and expatriates in China. OBJECTIVE: The aim of this study was to perform an in-depth analysis of the subjective and objective experiences of local and international patients in public hospitals in China to provide a basis for enhancing the medical experience of all patients. METHODS: A structured questionnaire was provided to patients at an international outpatient service of a top-tier university hospital in China. Qualitative analysis of the survey responses was performed to methodically categorize and analyze medical treatment, focusing on patient demand and satisfaction across four main category elements ("high demand, high satisfaction"; "high demand, low satisfaction"; "low demand, high satisfaction"; and "low demand, low satisfaction"), enabling a detailed cross-sectional analysis to identify areas for improvement. RESULTS: Elements falling under "high demand, high satisfaction" for both Chinese and international patients were primarily in the realms of medical quality and treatment processes. In contrast, elements identified as "high demand, low satisfaction" were significantly different between the two patient groups. CONCLUSIONS: The findings highlight the importance of systematic, objective research in advancing the quality of international health care services within China's leading academic medical centers. Key to this improvement is rigorous quality control involving both patients and providers. This study highlights the necessity of certifying such centers and emphasizes the role of digital platforms in disseminating information about medical services. This strategy is expected to cater to diverse patient needs, enhancing the overall patient experience. Furthermore, by developing comprehensive diagnosis and treatment services and highlighting the superior quality and costs associated with international health care, these efforts aim to foster a sense of belonging among international patients and increase the attractiveness of China's medical services for this demographic.

Correction: Practice Standards in International Medical Departments of Public Academic Hospitals in China: Cross-Sectional Study.

[This corrects the article DOI: 10.2196/53898.].

Spontaneous mainstream anammox in a full-scale wastewater treatment plant with hybrid sludge retention time in a temperate zone of China.

Spontaneous anammox bacteria enrichment at mainstream conditions was reported in a full-scale Wastewater Treatment Plant (WWTP) in a temperate zone of China. The mainstream anammox was observed after WWTP process retrofit, which constructed a hybrid sludge retention time (SRT) system by providing moving carriers in the anaerobic/anoxic tank and was initially designed to enhance the denitrification process in a conventional anaerobic/anoxic/oxic process. The hybrid SRT system achieved 86.0 ± 4.6% total nitrogen (TN) removal via combined mainstream anammox and conventional denitrification. Autotrophic denitrification via mainstream anammox was confirmed by various shreds of evidence including high-throughput sequencing, specific anammox activity test, and 15 N isotopic tracing. Long-term anammox bacteria existence in the biofilm of the carrier in anoxic zones was detected in a much higher relative abundance compared with other spots. The contribution of anammox activity to TN removal was estimated at around 20%-30%. The reasons leading to spontaneous anammox enrichment were mainly attributed to the carriers for slow-growing bacteria growth and dissolved oxygen gradient in the anoxic tank (caused by intermittent aeration) for nitrite production. The insights of this full-scale case study provide important perspectives for future mainstream anammox application, and also the design of an energy-neutral WWTP process. PRACTITIONER POINTS: Spontaneous mainstream anammox in a full-scale WWTP after its retrofit in a temperate zone of China was reported. Anammox bacteria enrichment and long-term stability on moving carriers at mainstream conditions was achieved by modified hybrid SRT system. The hybrid SRT system achieve stable nitrogen removal even in cold winter and high BOD/N situation by combining mainstream anammox with conventional denitrification. Long term full-scale operation demonstrated excellent nitrogen removal with about 20%-30% contribution of mainstream anammox. This full-scale case study provided perspectives for future optimizing mainstream anammox application, and also energy-neutral WWTP process design.

Quantify the contribution of anammox for enhanced nitrogen removal through metagenomic analysis and mass balance in an anoxic moving bed biofilm reactor.

In this study, enhanced nitrogen removal through in situ enrichment of anammox bacteria was successfully obtained in a full-scale municipal wastewater treatment plant (WWTP). The WWTP was an anaerobic-anoxic-oxic (AAO) process and upgraded by adding moving carriers into the anoxic zone. Enhanced nitrogen removal was obtained during almost two years of operation. The significant nitrogen removal might be associated with the in situ enrichment of anammox bacteria on the adding carriers, as revealed by the comprehensive results of molecular analysis and 15N-stable isotope tracing tests. Quantitative PCR results indicated that anammox bacteria in the anoxic-carrier biofilms presented a higher abundance than flocculent sludge (16S rRNA: P < 0.005; HzsB: P < 0.042). The 16S rRNA amplicon sequencing showed significant differences in the phylum Planctomycetes (P < 0.001) between anoxic-carrier biofilms and flocculent sludge. And metagenomic sequencing analysis further revealed the anammox relative abundance in the anoxic-carrier biofilms was significantly higher than the reported level in the flocculent sludge of conventional WWTPs. In addition, 15N-stable isotope tracing tests showed that anammox could be combined with nitrate reduction by the anoxic-carrier biofilms. Thus, enriched anammox bacteria might contribute to nitrogen loss and lead to improvements in the nitrogen removal, which was also supported by the mass balance analysis of organic carbon, nitrogen, and phosphorus of the WWTP. Overall, this study suggests that anoxic-carrier biofilms might be a candidate to enhance nitrogen removal through partial anammox in municipal WWTPs.

[The study of noninvasive ventilator impeller based on ANSYS].

An impeller plays a significant role in the non-invasive ventilator. This paper shows a model of impeller for noninvasive ventilator established with the software Solidworks. The model was studied for feasibility based on ANSYS. Then stress and strain of the impeller were discussed under the external loads. The results of the analysis provided verification for the reliable design of impellers.

[Design of a noninvasive ventilator's turbine].

The design principles of a noninvasive ventilator's turbine are studied and discussed in this paper. The design is completed from its several aspects and in combination of related theories, using SolidWorks tools. Abundant experimental results prove that this design's technical specifications meet all the requirements.