An online inquiry service(OIS)is an innovative service designed to make medical re-sources more accessible,especially in remote areas.An OIS provides patients with an alternative method of consulting a physician.This ...An online inquiry service(OIS)is an innovative service designed to make medical re-sources more accessible,especially in remote areas.An OIS provides patients with an alternative method of consulting a physician.This study develops a game-theoretical queueing model to examine the impact of OISs on gatekeeping systems.In such sys-tems,patients are heterogeneous in terms of their travel costs.Here,we compare the performance of gatekeeping systems with and without an OIS.As such,we show that,owing to physicians’reduced diagnostic ability when working online,an OIS reduces pa-tients’travel costs,increases the flow of patients to specialists,increases the total waiting time in the system,and decreases the total health surplus of patients.Moreover,we demonstrate that when patients are not sensitive to delays,introducing an OIS always reduces their total cost.These findings are consistent with the intuition that patients are better off when more options are available.Interestingly,when patients are sensitive to delays,introducing an OIS may increase their total cost.This paradoxical result occurs when patients’sensitivity to delays is high,because those who consult a physician online impose negative externalities on the system by increasing the waiting cost in both the online and offline channels(which is proportional to patients’delay sensitivity).Finally,we numerically illustrate that the benefit of introducing an OIS is non-monotonic in the system parameters;thus,caution is required when designing policies to regulate OISs.展开更多
This paper is motivated by a concern in China's current medical practice in which patients can bypass the primary care and seek secondary care directly.We employ a queueing approach to examine two settings,i.e.the...This paper is motivated by a concern in China's current medical practice in which patients can bypass the primary care and seek secondary care directly.We employ a queueing approach to examine two settings,i.e.the gatekeeping and non-gatekeeping settings,in a service system consisting of two types of service provider-one with basic skills(C-H),e.g.community hospital,and the other with advanced skills(AAA-H),e.g.specialist hospital.Customers are heterogeneous with respect to service requirement.The C-H can only serve customers with a complexity level of service requirement lower than the cure threshold,while the AAA-H can serve all customers.We aim to analyze the social planner's capacity decision for the C-H in both settings and assess the relative merit of each setting with respect to total social welfare,i.e.the sum of customer benefits net of customer delay costs and service providers7 operating costs.Our findings show that when the C-H's capacity is exogenous,the gatekeeper setting is preferable if the capacity of the C-H is in the intermediate range because customers'self-selection behavior gives rise to negative externality.When the C-H's capacity is optimized by the social planner,the non-gatekeeping setting is preferable if the capacity of the AAA-H is large or the cure threshold is high,because customers'self-selection behavior as well as the investment in the C-H's capacity can result in a better distribution of demand among the two service providers.The gatekeeping setting is preferable if the cure threshold is low because it is economical for the social planner to invest in a large capacity in the C-H to serve all customers.We also show numerically the conditions under which the two settings can achieve the first-best solution.展开更多
The gatekeeper policy has been implemented for approximately ten years on a pilot population in China. It is necessary to assess the satisfaction of patients utilizing community health service（CHS） under the gatekee...The gatekeeper policy has been implemented for approximately ten years on a pilot population in China. It is necessary to assess the satisfaction of patients utilizing community health service（CHS） under the gatekeeper system. Our study showed that the cognition of gatekeeper policy was associated with four dimensions including doctor‐patient relationships, information and support, organization of care, and accessibility（P 〈 0.001）. One or more factors such as gender and self‐perceived health scores also affected their satisfaction. General practitioners must be prepared to focus on these aspects of information and support, organization of care, and accessibility as indicators of potential opportunities for improvement. Additionally, policymakers can improve patients＇ satisfaction with CHS by strengthening their awareness of the gatekeeper policy.展开更多
To investigate the RNA interference （RNAi） effect induced by vector-derived small interfering RNA （siRNA） targeting the three gatekeeper genes （Rad52, Ku70, Ku80） and screen the more effective target sites from ...To investigate the RNA interference （RNAi） effect induced by vector-derived small interfering RNA （siRNA） targeting the three gatekeeper genes （Rad52, Ku70, Ku80） and screen the more effective target sites from candidates for further research, by using siRNA design tools online, we selected 2 candidate sequences directed to every gatekeeper gene. According to the sequences, six vector-derived siRNAs （denoted psiRNA1-6） and one mocking psiRNA7 were constructed. Among them, psiRNA1 and psiRNA2 targeted Rad52, psiRNA3 and psiRNA4 to Ku70, psiRNA5 and psiRNA6 to Ku80. The mocking psiRNA7 was used as control. After sequence identification, the seven plasmids were lyansfected into HepG2 cell line. siRNA-induced silencing of gatekeeper genes was determined by using RT-PCR at RNA level and Western Blot at protein level. The results showed that the six plasmids specifically targeting the coding region of gatekeeper genes were successfully designed and constructed. To some extent, the ~ pPasmids could reduce the expression of target geffe Comparatively, the plasmid-derived siRNA psiRNA1, psiRNA4 and psiRNA5 were more effective than their counterparts. The results suggest that the gene silencing etticiency of siRNA is different, depending on their targeted region, and siRNA may provide us with practical tools for further study on the three gatekeeper genes, i.e. Rad52, Ku70, Ku80.展开更多
Ethical consulting is a critical professional activity that is very critical to the very survival of the corporate world and is thus likely to boom within the shortest possible time in the future. This predictive stat...Ethical consulting is a critical professional activity that is very critical to the very survival of the corporate world and is thus likely to boom within the shortest possible time in the future. This predictive statement is based on the consequential effect of the bankruptcy of Ertron and WorldCom and its aftermath legislature, Sarbanes-Oxley Act （Lander, 2004）. The main issues boarder on how ethics influence organizations＇ operations and to what extend these influences can be coded and managed to enhance objectivity and minimize fraud. The methodology applied in this paper was an exploratory approach under the qualitative design. It encapsulates a thorough review of literature on the subject matter and draws inferences to address the research objectives. It was found that ethical consulting was possible and consultants venturing into the area need to be strategically diversified to enable them to design and develop customized ethical codes for the heterogeneous clientele with appropriate supporting monitoring and compliance procedures.展开更多
Shishuoxinyu is a collection of anecdotal stories about the words and deeds of Wei and Jin characters. In this paper, we build a complex network with characters in Shishuoxinyu to analyze the scholarly connections in ...Shishuoxinyu is a collection of anecdotal stories about the words and deeds of Wei and Jin characters. In this paper, we build a complex network with characters in Shishuoxinyu to analyze the scholarly connections in the Wei-Jin and North-South dynasties. The ER random graph, WS small-world network, BA scale-free network, and experimental network are constructed for comparison. The network properties of the experimental network were analyzed using the average degree, average clustering coefficient, and average path length. Degree centrality, mesoscopic centrality, and proximity centrality were selected to understand the importance of the experimental network nodes, and it was found that the king guide had the highest importance in the whole experimental network. Then, through the observation of network degree distribution, this experimental network is considered as a scale-free network with robustness and vulnerability, which is in line with the political characteristics of the Wei-Jin and Northern Dynasties. Finally, ten larger-scale Shi clans are selected to construct a new network for inter-clan linkage analysis. This study helps to uncover the reasons for the rise and fall of the Shi clans during the Wei-Jin and North-South dynasties.展开更多
苹果发布新一代桌面操作系统Mac OS X MountainLion的预览版。这是对MacOXs操作系统进行的一次重大升级，它从iOS平台移植了大部分功能如通知中心、游戏中心等。其10个重点功能是：iCloud、集成了iMessage的Messages、Reminders提醒事项...苹果发布新一代桌面操作系统Mac OS X MountainLion的预览版。这是对MacOXs操作系统进行的一次重大升级，它从iOS平台移植了大部分功能如通知中心、游戏中心等。其10个重点功能是：iCloud、集成了iMessage的Messages、Reminders提醒事项、Notes备忘录、通知中心、游戏中心、分享功能、新浪微博、Twitter、AirPlay视频镜像输出和Gatekeeper安全功能。展开更多
基金This research is supported by the National Natural Science Foundation of China(NSFC:71731006,71801096,71925002,71971080,71601077,and 71571070)the Project funded by China Postdoctoral Science Foundation under 2019M650202+1 种基金the Project supported by GDHVPS(2017)the Fundamental Research Funds for the Central Universities,SCUT(x2gs/D2191820).
文摘An online inquiry service(OIS)is an innovative service designed to make medical re-sources more accessible,especially in remote areas.An OIS provides patients with an alternative method of consulting a physician.This study develops a game-theoretical queueing model to examine the impact of OISs on gatekeeping systems.In such sys-tems,patients are heterogeneous in terms of their travel costs.Here,we compare the performance of gatekeeping systems with and without an OIS.As such,we show that,owing to physicians’reduced diagnostic ability when working online,an OIS reduces pa-tients’travel costs,increases the flow of patients to specialists,increases the total waiting time in the system,and decreases the total health surplus of patients.Moreover,we demonstrate that when patients are not sensitive to delays,introducing an OIS always reduces their total cost.These findings are consistent with the intuition that patients are better off when more options are available.Interestingly,when patients are sensitive to delays,introducing an OIS may increase their total cost.This paradoxical result occurs when patients’sensitivity to delays is high,because those who consult a physician online impose negative externalities on the system by increasing the waiting cost in both the online and offline channels(which is proportional to patients’delay sensitivity).Finally,we numerically illustrate that the benefit of introducing an OIS is non-monotonic in the system parameters;thus,caution is required when designing policies to regulate OISs.
文摘This paper is motivated by a concern in China's current medical practice in which patients can bypass the primary care and seek secondary care directly.We employ a queueing approach to examine two settings,i.e.the gatekeeping and non-gatekeeping settings,in a service system consisting of two types of service provider-one with basic skills(C-H),e.g.community hospital,and the other with advanced skills(AAA-H),e.g.specialist hospital.Customers are heterogeneous with respect to service requirement.The C-H can only serve customers with a complexity level of service requirement lower than the cure threshold,while the AAA-H can serve all customers.We aim to analyze the social planner's capacity decision for the C-H in both settings and assess the relative merit of each setting with respect to total social welfare,i.e.the sum of customer benefits net of customer delay costs and service providers7 operating costs.Our findings show that when the C-H's capacity is exogenous,the gatekeeper setting is preferable if the capacity of the C-H is in the intermediate range because customers'self-selection behavior gives rise to negative externality.When the C-H's capacity is optimized by the social planner,the non-gatekeeping setting is preferable if the capacity of the AAA-H is large or the cure threshold is high,because customers'self-selection behavior as well as the investment in the C-H's capacity can result in a better distribution of demand among the two service providers.The gatekeeping setting is preferable if the cure threshold is low because it is economical for the social planner to invest in a large capacity in the C-H to serve all customers.We also show numerically the conditions under which the two settings can achieve the first-best solution.
基金supported by the National Natural Science Foundation of China.(NSFC,71373090,‘Study on the gatekeeper policy of CHS’)
文摘The gatekeeper policy has been implemented for approximately ten years on a pilot population in China. It is necessary to assess the satisfaction of patients utilizing community health service（CHS） under the gatekeeper system. Our study showed that the cognition of gatekeeper policy was associated with four dimensions including doctor‐patient relationships, information and support, organization of care, and accessibility（P 〈 0.001）. One or more factors such as gender and self‐perceived health scores also affected their satisfaction. General practitioners must be prepared to focus on these aspects of information and support, organization of care, and accessibility as indicators of potential opportunities for improvement. Additionally, policymakers can improve patients＇ satisfaction with CHS by strengthening their awareness of the gatekeeper policy.
文摘To investigate the RNA interference （RNAi） effect induced by vector-derived small interfering RNA （siRNA） targeting the three gatekeeper genes （Rad52, Ku70, Ku80） and screen the more effective target sites from candidates for further research, by using siRNA design tools online, we selected 2 candidate sequences directed to every gatekeeper gene. According to the sequences, six vector-derived siRNAs （denoted psiRNA1-6） and one mocking psiRNA7 were constructed. Among them, psiRNA1 and psiRNA2 targeted Rad52, psiRNA3 and psiRNA4 to Ku70, psiRNA5 and psiRNA6 to Ku80. The mocking psiRNA7 was used as control. After sequence identification, the seven plasmids were lyansfected into HepG2 cell line. siRNA-induced silencing of gatekeeper genes was determined by using RT-PCR at RNA level and Western Blot at protein level. The results showed that the six plasmids specifically targeting the coding region of gatekeeper genes were successfully designed and constructed. To some extent, the ~ pPasmids could reduce the expression of target geffe Comparatively, the plasmid-derived siRNA psiRNA1, psiRNA4 and psiRNA5 were more effective than their counterparts. The results suggest that the gene silencing etticiency of siRNA is different, depending on their targeted region, and siRNA may provide us with practical tools for further study on the three gatekeeper genes, i.e. Rad52, Ku70, Ku80.
文摘Ethical consulting is a critical professional activity that is very critical to the very survival of the corporate world and is thus likely to boom within the shortest possible time in the future. This predictive statement is based on the consequential effect of the bankruptcy of Ertron and WorldCom and its aftermath legislature, Sarbanes-Oxley Act （Lander, 2004）. The main issues boarder on how ethics influence organizations＇ operations and to what extend these influences can be coded and managed to enhance objectivity and minimize fraud. The methodology applied in this paper was an exploratory approach under the qualitative design. It encapsulates a thorough review of literature on the subject matter and draws inferences to address the research objectives. It was found that ethical consulting was possible and consultants venturing into the area need to be strategically diversified to enable them to design and develop customized ethical codes for the heterogeneous clientele with appropriate supporting monitoring and compliance procedures.
文摘Shishuoxinyu is a collection of anecdotal stories about the words and deeds of Wei and Jin characters. In this paper, we build a complex network with characters in Shishuoxinyu to analyze the scholarly connections in the Wei-Jin and North-South dynasties. The ER random graph, WS small-world network, BA scale-free network, and experimental network are constructed for comparison. The network properties of the experimental network were analyzed using the average degree, average clustering coefficient, and average path length. Degree centrality, mesoscopic centrality, and proximity centrality were selected to understand the importance of the experimental network nodes, and it was found that the king guide had the highest importance in the whole experimental network. Then, through the observation of network degree distribution, this experimental network is considered as a scale-free network with robustness and vulnerability, which is in line with the political characteristics of the Wei-Jin and Northern Dynasties. Finally, ten larger-scale Shi clans are selected to construct a new network for inter-clan linkage analysis. This study helps to uncover the reasons for the rise and fall of the Shi clans during the Wei-Jin and North-South dynasties.
文摘苹果发布新一代桌面操作系统Mac OS X MountainLion的预览版。这是对MacOXs操作系统进行的一次重大升级，它从iOS平台移植了大部分功能如通知中心、游戏中心等。其10个重点功能是：iCloud、集成了iMessage的Messages、Reminders提醒事项、Notes备忘录、通知中心、游戏中心、分享功能、新浪微博、Twitter、AirPlay视频镜像输出和Gatekeeper安全功能。
