BackgroundIt is globally agreed that a well-designed health system deliver timely and convenient access to health services for all patients. Many interventions aiming to reduce waiting times have been implemented in Chinese public tertiary hospitals to improve patients’ satisfaction. However, few were well-documented, and the effects were rarely measured with robust methods.MethodsWe conducted a longitudinal study of the length of waiting times in a public tertiary hospital in Southern China which developed comprehensive data collection systems. Around an average of 60,000 outpatients and 70,000 prescribed outpatients per month were targeted for the study during Oct 2014-February 2017. We analyzed longitudinal time series data using a segmented linear regression model to assess changes in levels and trends of waiting times before and after the introduction of waiting time reduction interventions. Pearson correlation analysis was conducted to indicate the strength of association between waiting times and patient satisfactions. The statistical significance level was set at 0.05.ResultsThe monthly average length of waiting time decreased 3.49 min (P = 0.003) for consultations and 8.70 min (P = 0.02) for filling prescriptions in the corresponding month when respective interventions were introduced. The trend shifted from baseline slight increasing to afterwards significant decreasing for filling prescriptions (P =0.003). There was a significant negative correlation between waiting time of filling prescriptions and outpatient satisfaction towards pharmacy services (r = −0.71, P = 0.004).ConclusionsThe interventions aimed at reducing waiting time and raising patient satisfaction in Fujian Provincial Hospital are effective. A long-lasting reduction effect on waiting time for filling prescriptions was observed because of carefully designed continuous efforts, rather than a one-time campaign, and with appropriate incentives implemented by a taskforce authorized by the hospital managers. This case provides a model of carrying out continuous quality improvement and optimizing management process with the support of relevant evidence.

Sand fly Phlebotomus chinensis is a primary vector of transmission of visceral leishmaniasis in China. The sand flies have adapted to various ecological niches in distinct ecosystems. Characterization of the microbial structure and function will greatly facilitate the understanding of the sand fly ecology, which would provide critical information for developing intervention strategy for sand fly control. In this study we compared the bacterial composition between two populations of Ph. chinensis from Henan and Sichuan, China. The phylotypes were taxonomically assigned to 29 genera of 19 families in 9 classes of 5 phyla. The core bacteria include Pseudomonas and enterobacteria, both are shared in the sand flies in the two regions. Interestingly, the endosymbionts Wolbachia and Rickettsia were detected only in Henan, while the Rickettsiella and Diplorickettsia only in Sichuan. The intracellular bacteria Rickettsia, Rickettsiella and Diplorickettsia were reported for the first time in sand flies. The influence of sex and feeding status on the microbial structure was also detected in the two populations. The findings suggest that the ecological diversity of sand fly in Sichuan and Henan may contribute to shaping the structure of associated microbiota. The structural classification paves the way to function characterization of the sand fly associated microbiome.

Understanding the response of the plant community to increasing nitrogen (N) deposition is helpful for improving pasture management in semi-arid areas. We implemented a 5-year N addition experiment in a Stipa krylovii steppe of Inner Mongolia, northern China. The aboveground biomass (AGB) and species richness were measured annually. Along with the N addition levels, the species richness declined significantly, and the species composition changed noticeably. However, the total AGB did not exhibit a noticeable increase. We found that compensatory effects of the AGB occurred not only between the grasses and the forbs but also among Gramineae species. The plant responses to N addition, from the community to species level, lessened in dry years compared to wet or normal years. The N addition intensified the reduction of community productivity in dry years. Our study indicated that the compensatory effects of the AGB among the species sustained the stability of grassland productivity. However, biodiversity loss resulting from increasing N deposition might lead the semi-arid grassland ecosystem to be unsustainable, especially in dry years.

Plant community structure responds strongly to anthropogenic disturbances, which greatly influence community stability. The changes in community structure, aboveground biomass (AGB), biodiversity and community stability associated with different management practices were studied with a three-year field investigation in a temperate steppe of Inner Mongolia, China. The species richness, Shannon-Wiener index, evenness, plant functional type abundance, AGB, temporal community stability, summed covariance, scaling coefficient and dominant species stability were compared among areas subjected to long-term reservation (R), long-term grazing (G), mowing since enclosure in 2008 (M) and grazing enclosure since 2008 (E). Site R had higher perennial grass abundance and lower species richness than sites G, M and E, although the AGB was not significantly different among the four sites. The species structure varied from a single dominant species at site R to multiple dominant species at sites G, M and E. The long-term reservation grassland had lower biodiversity but higher stability, whereas the enclosed grassland with/without mowing had higher biodiversity but lower stability. Different stability mechanisms, such as the compensatory dynamics, mean-variance scaling and dominant species stability were examined. Results showed that community stability was most closely related to the relative stability of the dominant species, which supports the biomass ratio hypothesis proposed by Grime.