EEG-based auditory attention decoding with audiovisual speech for hearing-impaired listeners.

Auditory attention decoding (AAD) was used to determine the attended speaker during an auditory selective attention task. However, the auditory factors modulating AAD remained unclear for hearing-impaired (HI) listeners. In this study, scalp electroencephalogram (EEG) was recorded with an auditory selective attention paradigm, in which HI listeners were instructed to attend one of the two simultaneous speech streams with or without congruent visual input (articulation movements), and at a high or low target-to-masker ratio (TMR). Meanwhile, behavioral hearing tests (i.e. audiogram, speech reception threshold, temporal modulation transfer function) were used to assess listeners' individual auditory abilities. The results showed that both visual input and increasing TMR could significantly enhance the cortical tracking of the attended speech and AAD accuracy. Further analysis revealed that the audiovisual (AV) gain in attended speech cortical tracking was significantly correlated with listeners' auditory amplitude modulation (AM) sensitivity, and the TMR gain in attended speech cortical tracking was significantly correlated with listeners' hearing thresholds. Temporal response function analysis revealed that subjects with higher AM sensitivity demonstrated more AV gain over the right occipitotemporal and bilateral frontocentral scalp electrodes.

Categorical perception of lexical tones based on acoustic-electric stimulation.

The effect of low-frequency acoustic input on the categorical perception of lexical tones was investigated with simulated electric-acoustic hearing. A synthesized T1-T2 (flat-rising) tone continuum of Mandarin monosyllables /i/ was used, and they were manipulated as five conditions: unprocessed, low-frequency acoustic-only, electric-only, electric-acoustic stimulation, and bimodal stimulation. Results showed the performance under electric-only condition was the significantly lowest, and the difference of other pairwise comparisons between conditions was quite small. These findings suggest that the low-frequency acoustic input can shape the categorical perception, and the combinations of acoustic and electric hearing within or across ears have no significant effect.

Estimation for Runway Friction Coefficient Based on Multi-Sensor Information Fusion and Model Correlation.

Friction is a crucial factor affecting air accident occurrence on landing or taking off. Tire-runway friction directly contributes to aircraft stability on land. Therefore, an accurate friction estimation is a rising issue for all stakeholders. This paper summarizes the existing measurement methods, and a multi-sensor information fusion scheme is proposed to estimate the friction coefficient between the tire and the runway. Acoustic sensors, optical sensors, tread sensors, and other physical sensors form a sensor system that is used to measure friction-related parameters and fuse them through a neural network. So far, many attempts have been made to link the ground friction coefficient with the aircraft braking friction coefficient. The models that have been developed include the International Runway Friction Index (IRFI), Canada Runway Friction Index (CRFI), and other fitting models. Additionally, this paper attempts to correlate the output of the neural network (estimated friction coefficient) with the correlation model to predict the friction coefficient between the tire and the runway when the aircraft brakes. The sensor system proposed in this paper can be regarded as a mobile weather-runway-tire system, which can estimate the friction coefficient by integrating the runway surface conditions and the tire conditions, and fully consider their common effects. The role of the correlation model is to convert the ground friction coefficient to the grade of the aircraft braking friction coefficient and the information is finally reported to the pilots so that they can make better decisions.

Effect of co-combusted sludge in waste incinerator on heavy metals chemical speciation and environmental risk of horizontal flue ash.

Incineration of sludge in waste incinerators is a trend of sludge disposal, and the problem of heavy metal in horizontal flue ash is a concern. Horizontal flue ash in waste incinerator was collected before and after the sludge was co-combusted. XRF, SEM-DES, and ICP were used to characterize the effect of sludge on the distribution of heavy metals on different heated surfaces. Potential ecological risk index of all horizontal flue ash was higher than 600, indicating the high ecological risk. After adding sludge for co-combustion, heavy metals content in all ash sample increased. As for chemical speciation of heavy metals, the addition of sludge increased the content of mild acid-soluble fraction, reducible fraction and oxidizable fraction of heavy metals, while decreased that of the residual fraction. Environmental pollution and potential ecological risks of heavy metals were increased when sludge was co-combusted. The fitting relation between the heavy metals content of each speciation and the gas temperature and the sludge mixing amount was given, which could be used to predict the heavy metal content in horizontal flue ash.

The effect of F0 contour on the intelligibility of Mandarin Chinese for hearing-impaired listeners.

Dynamic F0 contour plays an important role in recognizing speech. The present work examined the effect of F0 contour on speech intelligibility for hearing-impaired listeners for Mandarin Chinese in quiet, in steady noise, and in two-talker competing speech. The intelligibility of two types of natural speech was measured: single-Tone speech with relatively flat F0 contours and multi-Tone speech with time-varying F0 contours. The speech rate and mean F0 of speech materials were carefully controlled to avoid effects other than F0 contour on the speech intelligibility. Results showed that intelligibility was significantly higher for speech with a flat F0 contour than that with a dynamic F0 contour at a low signal-to-masker ratio in both speech-spectrum noise and two-talker masker.

Can Primary Medical Institutions Lead to Worse Health Status for Patients with Noncommunicable Diseases Compared with High-Level Hospitals? A Follow-Up Observation Study in China.

The weak primary healthcare system in China brings challenges to the national strategy of primary medical institutions providing general health needs for patients with non-communicable diseases (NCDs). It is necessary to explore the potential discrepancies in health status for patients with NCDs if they go to primary medical institutions rather than high-level hospitals. Data was obtained from Surveillance of Health-seeking Behavior in Hubei Province. Respondents were investigated six times to collect information on health service utilization and health-related quality of life (HRQoL). Ninety-two hypertension patients who went to medical institutions of the same level were included. HRQoL was measured by the Chinese version of EQ-5D-3L. A multilevel growth curve model was applied to analyze whether provider level could influence HRQoL. The utility score and visual analogue scale (VAS) of patients varied insignificantly over six months (p > 0.05). A growth curve model showed that comorbidity was the only factor significantly influencing utility score (p = 0.019). Time and comorbidity were the only influencing factors of VAS (p < 0.05). Our findings indicated that the level of healthcare provider had no significant impact on the health status of patients with NCDs. As such, this study concludes that the primary healthcare system in China is qualified to be the health gatekeeper for NCDs patients.

Can unsuccessful treatment in primary medical institutions influence patients' choice? A retrospective cluster sample study from China.

OBJECTIVE: China has been attempting to control the patients' choice of high-level medical institutions through series measures of first point of contact at primary medical institutions, but the outcome is considered poor. We aim to analyse whether unsuccessful treatment in primary medical institutions can lead to the patients' choice of high-level medical institutions. DESIGN: A retrospective cluster sample study. SETTING: The study setting was in Macheng city, Hubei province. PARTICIPANTS: The respondents are township-county (TC) patients (patients who first went to township hospitals and then county hospitals within 30 days for the same disease) who experienced unsuccessful treatment in primary medical institutions. A total of 2090 TC patients were screened out based on the New Rural Cooperative Medical System database in 2013. MAIN OUTCOME MEASURES: The choice of patients between township hospitals (primary medical institutions) and county hospitals was observed. We compared TC patients' ratio of choosing county hospitals (RoCC) before TC experience with after TC experience. Thereafter, we compared RoCC of TC patients and non-TC patients (patients who did not experience TC) based on coarsened exact matching. RESULTS: The ratio of TC for outpatient in township hospitals is 0.68% and that of TC for inpatient in township hospitals is 3.37%. RoCC for TC disease increased from 20.8% to 35.5% (p<0.001), RoCC for other disease increased from 35% to 37.3% (p=0.01). TC patients had significantly higher RoCC than non-TC patients (p<0.001). CONCLUSIONS: Patients' choice of high-level medical institutions is highly associated with the experience of unsuccessful treatment in primary medical institutions. Moreover, people likely select high-level medical institutions thereafter regardless of conditions in rural China. Unsuccessful treatment in primary medical institutions is inevitable for patients. Thus, additional measures should be considered in lowering the potential risks for patients when treatments fail. TRIAL REGISTRATION NUMBER: ChiCTR-OOR-14005563.

Medical Service Quality, Efficiency and Cost Control Effectiveness of Upgraded Case Payment in Rural China: A Retrospective Study.

Background: As the principal means of reimbursing medical institutions, the effects of case payment still need to be evaluated due to special environments and short exploration periods, especially in rural China. Methods: Xi County was chosen as the intervention group, with 36,104, 48,316, and 59,087 inpatients from the years 2011 to 2013, respectively. Huaibin County acted as the control group, with 33,073, 48,122, and 51,325 inpatients, respectively, from the same period. The inpatients' information was collected from local insurance agencies. After controlling for age, gender, institution level, season fixed effects, disease severity, and compensation type, the generalised additive models (GAMs) and difference-in-differences approach (DID) were used to measure the changing trends and policy net effects from two levels (the whole county level and each institution level) and three dimensions (cost, quality and efficiency). Results: At the whole-county level, the cost-related indicators of the intervention group showed downward trends compared to the control group. Total spending, reimbursement fee and out-of-pocket expense declined by ¥346.59 (p < 0.001), ¥105.39 (p < 0.001) and ¥241.2 (p < 0.001), respectively (the symbol ¥ represents Chinese yuan). Actual compensation ratio, length of stay, and readmission rates exhibited ascending trends, with increases of 7% (p < 0.001), 2.18 days (p < 0.001), and 1.5% (p < 0.001), respectively. The intervention group at county level hospital had greater length of stay reduction (¥792.97 p < 0.001) and readmission rate growth (3.3% p < 0.001) and lower reimbursement fee reduction (¥150.16 p < 0.001) and length of stay growth (1.24 days p < 0.001) than those at the township level. Conclusions: Upgraded case payment is more reasonable and suitable for rural areas than simple quota payment or cap payment. It has successfully curbed the growth of medical expenses, improved the efficiency of medical insurance fund utilisation, and alleviated patients' economic burden of disease. However, no positive effects on service quality and efficiency were observed. The increase in readmission rate and potential hidden dangers for primary health care institutions should be given attention.

Exploring Medical Expenditure Clustering and the Determinants of High-Cost Populations from the Family Perspective: A Population-Based Retrospective Study from Rural China.

The costliest 5% of the population (identified as the "high-cost" population) accounts for 50% of healthcare spending. Understanding the high-cost population in rural China from the family perspective is essential for health insurers, governments, and families. Using the health insurance database, we tallied 202,482 families that generated medical expenditure in 2014. The Lorentz curve and the Gini coefficient were adopted to describe the medical expenditure clustering, and a logistic regression model was used to identify the determinants of high-cost families. Household medical expenditure showed an extremely uneven distribution, with a Gini coefficient of 0.76. High-cost families spent 54.0% of the total expenditure. The values for family size, average age, and distance from and arrival time to the county hospital of high-cost families were 4.05, 43.18 years, 29.67 km, and 45.09 min, respectively, which differed from the values of the remaining families (3.68, 42.46 years, 30.47 km, and 46.29 min, respectively). More high-cost families live in towns with low-capacity township hospitals and better traffic conditions than the remaining families (28.98% vs. 12.99%, and 71.19% vs. 69.6%, respectively). The logistic regression model indicated that family size, average age, children, time to county hospital, capacity of township hospital, traffic conditions, economic status, healthcare utilizations, and the utilization level were associated with high household medical expenditure. Primary care and health insurance policy should be improved to guide the behaviors of rural residents, reduce their economic burden, and minimize healthcare spending.

Determinants of patient choice for hospital readmission after township hospitalisation: a population-based retrospective study in China.

OBJECTIVE: The lack of coordinated and appropriate healthcare across sectors has produced more patients for county hospitals in China. This study examined differences in patient choice between township and county hospitals for readmission after a first township hospitalisation, and the determinants that influenced this choice. DESIGN: A retrospective study of readmissions across hospitals after a first admission in township hospital. A township-township (TT) inpatient group and a township-county (TC) inpatient group were compared. A two-level logistic regression model was used to examine the determinants of choice for hospital readmission. SETTING: Data were drawn from a population-based health utilisation database for Qianjiang District, China, from 1 January 2008 to 31 December 2013. PARTICIPANTS: This study focused on readmitted patients whose first admission was in a township hospital. Readmission cases were identified as the same diagnosis (International Classification of Diseases, Tenth Revision) in a subsequent hospitalisation within 30 days. In total, 6764 readmissions had first admissions in township hospitals. PRIMARY OUTCOME MEASURES: Patient choice for hospital readmission after a first township hospitalisation. RESULTS: The TT group accounted for 62.5% (4225) and the TC group for 37.5% (2539) of readmissions in 6 years, and the proportion of TC readmissions in total inpatients increased from 1.66% to 1.89%. Readmission rates varied among towns (p<0.001). Differences between the TC and TT groups included: length of stay (LOS) of first admission (6.96 days vs 9.23 days), average interval between admissions (6.03 days vs 14.95 days) and disease category. Admission year, age, travel time to county hospital, interval between admissions, first admission LOS and disease category were determinants of choice for hospital readmission. CONCLUSIONS: Patients whose first admission was in a township hospital were more likely to be readmitted to a county hospital. A combination of first LOS and interval between admissions may be an effective identification index for TC readmission. TRIAL REGISTRATION NUMBER: ChiCTR-OOR-14005563.

Medical expenditure clustering and determinants of the annual medical expenditures of residents: a population-based retrospective study from rural China.

OBJECTIVE: To identify the characteristics of high-cost (HC) patients and the determinants of the annual medical expenditures of Chinese rural residents. METHODS: Medical expenditure clustering was performed by Lorentz curve and Gini index. T and X2 tests were performed to identify the characteristics of the respondents, and a multilevel regression model examined the determinants of their annual medical expenditures. DESIGN: A cluster sampling study was performed to identify those residents who availed healthcare services and to assign them to HC (top 5%), moderate-cost (top 30%) and low-cost (others) groups based on their annual medical expenditures. SETTING: The annual healthcare utilisation was calculated by using data from the population-based database of the 2014 New Rural Cooperative Medical System. PARTICIPANTS: A total of 478 051 residents who availed healthcare services were recruited for the retrospective study in 2014. The annual medical expenditures of these residents were used as the research object. RESULTS: The total medical expenditures of Macheng city residents for the year 2014 have a Gini index of 0.81 and around 68.01% of these expenditures can be attributed to HC patients. Female residents (51.5%) and persons aged over 60 years (34.48%) who are suffering from diseases that are difficult to diagnose have a high tendency to accumulate high medical costs. The annual medical expenditures of people living in the same village or town tend to be approximated. Age, disease category, inpatient status, healthcare utilisation and utilisation level are identified as the determinants of annual medical expenditures. CONCLUSIONS: The medical expenditures of rural residents are clustered at a remarkably high level, and HC patients are suffering from high economic burden. Therefore, policy-makers must guide these patients in seeking appropriate healthcare services and improve their management of healthcare quality to reduce the unnecessary healthcare utilisation of these patients. TRIAL REGISTRATION NUMBER: ChiCTR-OOR-14005563.

Exploring the characteristics of the high-cost population from the family perspective: a cross-sectional study in Jiangsu Province, China.

BACKGROUND: Across a range of healthcare settings, 5% of the population accounts for half of healthcare spending: these patients are identified as a 'high-cost population'. Characterising high-cost users is essential for predicting potential high-cost patients and the development of appropriate interventions to improve the management and financing of these patients. OBJECTIVE: This cross-sectional study aimed to explore the characteristics of this high-cost population from a family perspective in China and provide suggestions for social health insurance policy development. METHODS: This study used data from the Fifth Health Service Investigation of Jiangsu Province (2013), and 12 600 families were enrolled for analysis. Households whose medical expenditures were among the top 5% were identified to be high-cost families. A t-test, a Χ2 test, and a binary logistic regression were used. RESULTS: High-cost families (n=631, 5%) accounted for 44.9% of the total medical expenditure of sampled families. High-cost families had 3.2 members and 1.2 chronic disease patients per household, which is significantly more than the 2.9 members and 0.7 people in the remaining families, respectively (p<0.05). Bi-weekly emergency department visits and annual hospitalisations preceding the household investigation of high-cost families were 1.19 and 0.98 per household, which is significantly more than the 0.68 and 0.17 of the remaining families, respectively (p<0.05). A binary logistic regression indicated that the number of family members (OR 1.152), the number of chronic disease patients (OR 1.508), bi-weekly emergency department visits (OR 1.218), and annual hospitalisations (OR 4.577) were associated with high costs. CONCLUSION: The 5% high-cost families in Jiangsu Province accounted for approximately half of medical expenditures. The effectiveness of Chinese Social Health Insurance in lowering high-cost families' risk of catastrophic health expenditure was modest. Policymakers need to ascertain the priority of lowering the burden of high-cost families' out-of-pocket expenses through improving the reimbursement proportion and reducing avoidable medical services.