Abstract: Background: Traditional chronic disease management did not pay attention to effects of geographic factors on the compliance of treatment regime, which resulted in geographic inequality in outcomes of chronic disease management. This study aims to examine the geographic distribution and clustering of quality indicators of diabetes care. Method: We first extracted address, demographic information and quality of care indicators (number of visits, complications, prescription and laboratory records) of patients with diabetes for 2014 from medical information system in a medical center in Tainan City, Taiwan, and the patients’ addresses were transformed into district- and village-level data. We then compared the differences of geographic distribution and clustering of quality of care indicators between districts and villages. Despite the descriptive results, rate ratios and 95% confidence intervals (CI) were estimated for indices of care in order to compare the quality of diabetes care among different areas. Results: A total of 23,588 patients with diabetes were extracted from the hospital data system; whereas 12,716 patients’ information and medical records were included to the following analysis. More than half of the subjects in this study were male and between 60-79 years old. Furthermore, the quality of diabetes care did indeed vary by geographical levels. Thru the smaller level, we could point out clustered areas more specifically. Fuguo Village (of Yongkang District) and Zhiyi Village (of Sinhua District) were found to be “hotspots” for nephropathy and cerebrovascular disease; while Wangliau Village and Erwang Village (of Yongkang District) would be “coldspots” for lowest proportion of ≥80% compliance to blood lipids examination. On the other hand, Yuping Village (in Anping District) was the area with the lowest proportion of ≥80% compliance to all laboratory examination. Conclusion: In spite of examining the geographic distribution, calculating rate ratios and their 95% CI could also be a useful and consistent method to test the association. This information is useful for health planners, diabetes case managers and other affiliate practitioners to organize care resources to the areas most needed.
Abstract: The central recirculation zone (CRZ) in a swirl
stabilized gas turbine combustor has a dominant effect on the fuel air
mixing process and flame stability. Most of state of the art swirlers
share one disadvantage; the fixed swirl number for the same swirler
configuration. Thus, in a mathematical sense, Reynolds number
becomes the sole parameter for controlling the flow characteristics
inside the combustor. As a result, at low load operation, the
generated swirl is more likely to become feeble affecting the flame
stabilization and mixing process. This paper introduces a new swirler
concept which overcomes the mentioned weakness of the modern
configurations. The new swirler introduces air tangentially and
axially to the combustor through tangential vanes and an axial vanes
respectively. Therefore, it provides different swirl numbers for the
same configuration by regulating the ratio between the axial and
tangential flow momenta. The swirler aerodynamic performance was
investigated using four CFD simulations in order to demonstrate the
impact of tangential to axial flow rate ratio on the CRZ. It was found
that the length of the CRZ is directly proportional to the tangential to
axial air flow rate ratio.