Using sound Clinical Paths and Diagnosis-related Groups(DRGs)-based payment reform to bring benefits to patientcare: A case study of leukemia therapy

China has been undertaking a profound reform on health care.Although more than 1.16 billion people have been covered by rural and urban medical insurance to date,the level of reimbursement from insurance is very limited,especially for critical diseases such as leukemia.This places heavy economic burdens on patients.Under these circumstances,systems innovation is imperative for the efficient utilization of limited funding.In this respect,certain valuable experience from other countries may prove helpful.The prospective payment system of Diagnosis-related Groups(DRGs),Clinical Paths,and the Comparative Effectiveness Analysis adopted by the National Institute of Health and Clinical Excellence(NICE,UK),can befine tools to reduce medical costs and improve quality of services.Treatments of acute promyelocytic leukemia at Rui-Jin Hospital,and childhood acute lymphoblastic leukemia at Shanghai Children’s Medical Center,can be taken as suitable models to illustrate the crucial role of Clinical Paths in guaranteeing clinical and cost effectiveness of medical services for critical diseases,and to satisfactorily justify the feasibility of DRGs in China.

Introducing hydroxyl groups to tailor the d-band center of Ir atom through side anchoring for boosted ORR and HER

Tuning the coordination atoms of central metal is an effective means to improve the electrocatalytic activity of atomic catalysts.Herein,iridium(Ir) is proposed to be asymmetrically anchored by sp-N and pyridinic N of hydrogen-substituted graphdiyne(HsGDY),and coordinated with OH as an Ir atomic catalyst(Ir_(1)-N-HsGDY).The electron structures,especially the d-band center of Ir atom,are optimized by these specific coordination atoms.Thus,the as-synthesized Ir_(1)-N-HsGDY exhibits excellent electrocatalytic performances for oxygen reduction and hydrogen evolution reactions in both acidic and alkaline media.Benefiting from the unique structure of HsGDY,IrN_(2)(OH)_(3) has been developed and demonstrated to act as the active site in these electrochemical reactions.All those indicate the fresh role of the sp-N in graphdiyne in producing a new anchor way and contributing to promote the electrocatalytic activity,showing a new strategy to design novel electrochemical catalysts.

A Novel On-Site-Real-Time Method for Identifying Characteristic Parameters Using Ultrasonic Echo Groups and Neural Network

On-site and real-time non-destructive measurement of elastic constants for materials of a component in a in-service structure is a challenge due to structural complexities,such as ambiguous boundary,variable thickness,nonuniform material properties.This work develops for the first time a method that uses ultrasound echo groups and artificial neural network(ANN)for reliable on-site real-time identification of material parameters.The use of echo groups allows the use of lower frequencies,and hence more accommodative to structural complexity.To train the ANNs,a numerical model is established that is capable of computing the waveform of ultrasonic echo groups for any given set of material properties of a given structure.The waveform of an ultrasonic echo groups at an interest location on the surface the structure with material parameters varying in a predefined range are then computed using the numerical model.This results in a set of dataset for training the ANN model.Once the ANN is trained,the material parameters can be identified simultaneously using the actual measured echo waveform as input to the ANN.Intensive tests have been conducted both numerically and experimentally to evaluate the effectiveness and accuracy of the currently proposed method.The results show that the maximum identification error of numerical example is less than 2%,and the maximum identification error of experimental test is less than 7%.Compared with currently prevailing methods and equipment,the proposefy the density and thickness,in addition to the elastic constants.Moreover,the reliability and accuracy of inverse prediction is significantly improved.Thus,it has broad applications and enables real-time field measurements,which has not been fulfilled by any other available methods or equipment.

How Group Leaders Build Stable Community Buying Groups:A Perspective Based on the Differential Mode of Association

Since 2016,community group buying has grown significantly in China,largely driven by its efficient logistics,supply chains,low prices,and convenience.This model has been further popularized during the COVID-19 pandemic due to its effectiveness in meeting daily needs while minimizing human-to-human contact.A key component of this business model is the“group leaders”-influential individuals within a community responsible for managing group buying activities,which include order collection,supplier liaison,and goods distribution.Their primary task is to form and sustain a reliable community group buying consortium,a task that demands excellent organizational and interpersonal skills.This paper examines this phenomenon using the lens of the differential mode of association,a theoretical model explaining interpersonal relationships in traditional Chinese society.The research indicates that group leaders,through regular interaction with consumers,are able to alter their social network position,increase their influence,understand consumer needs,provide satisfying services,and enhance trust,thereby transforming consumers into loyal group buying participants.This transformation not only brings stability to group buying activities but also reinforces the community influence of group leaders,thus fostering the growth of community group buying.

Combined Promoting Effects of Specific Organic Functional Groups and Alumina Surface Characteristics for the Design of a Highly Efficient NiMo/Al_(2)O_(3) Hydrodesulfurization Catalyst

To prepare a highly efficient NiMo/Al_(2)O_(3) hydrodesulfurization catalyst,the combined effects of specific organic functional groups and alumina surface characteristics were investigated.First,the correlation between the surface characteristics of four different alumina and the existing Mo species states was established.It was found that the Mo equilibrium adsorption capacity can be used as a specific descriptor to quantitatively evaluate the changes in surface characteristics of different alumina.A lower Mo equilibrium adsorption capacity for alumina means weaker metal-support interaction and the loaded Mo species are easier to transform into MoS2.However,the Mo-O-Al bonds still exist at the metal-support interface.The introduction of cationic surfactant hecadecyl trimethyl ammonium bromide(CTAB)can further improve Mo species dispersion through electrostatic attraction with Mo anions and interaction of its alkyl chain with the alumina surface;meanwhile,the introduction of ethylenediamine tetraacetic acid(EDTA)can complex with Ni ions to enhance the Ni-promoting effect on Mo.Therefore,the NiMo catalyst designed using alumina with lower Mo equilibrium adsorption capacity and the simultaneous addition of EDTA and CTAB exhibits the highest hydrodesulfurization activity for 4,6-dimethyl dibenzothiophene because of its proper metal-support interaction and more well-dispersed Ni-Mo-S active phases.

Research on diagnosis-related group grouping of inpatient medical expenditure in colorectal cancer patients based on a decision tree model

BACKGROUND In 2018,the diagnosis-related groups prospective payment system(DRGs-PPS)was introduced in a trial operation in Beijing according to the requirements of medical and health reform.The implementation of the system requires that more than 300 disease types pay through the DRGs-PPS for medical insurance.Colorectal cancer(CRC),as a common malignant tumor with high prevalence in recent years,was among the 300 disease types.AIM To investigate the composition and factors related to inpatient medical expenditure in CRC patients based on disease DRGs,and to provide a basis for the rational economic control of hospitalization expenses for the diagnosis and treatment of CRC.METHODS The basic material and cost data for 1026 CRC inpatients in a Grade-A tertiary hospital in Beijing during 2014-2018 were collected using the medical record system.A variance analysis of the composition of medical expenditure was carried out,and a multivariate linear regression model was used to select influencing factors with the greatest statistical significance.A decision tree model based on the exhaustiveχ^2 automatic interaction detector(E-CHAID)algorithm for DRG grouping was built by setting chosen factors as separation nodes,and the payment standard of each diagnostic group and upper limit cost were calculated.The correctness and rationality of the data were re-evaluated and verified by clinical practice.RESULTS The average hospital stay of the 1026 CRC patients investigated was 18.5 d,and the average hospitalization cost was 57872.4 RMB yuan.Factors including age,gender,length of hospital stay,diagnosis and treatment,as well as clinical operations had significant influence on inpatient expenditure(P<0.05).By adopting age,diagnosis,treatment,and surgery as the grouping nodes,a decision tree model based on the E-CHAID algorithm was established,and the CRC patients were divided into 12 DRG cost groups.Among these 12 groups,the number of patients aged≤67 years,and underwent surgery and chemotherapy or radiotherapy was largest;while patients aged>67 years,and underwent surgery and chemotherapy or radiotherapy had the highest medical cost.In addition,the standard cost and upper limit cost in the 12 groups were calculated and re-evaluated.CONCLUSION It is important to strengthen the control over the use of drugs and management of the hospitalization process,surgery,diagnosis and treatment to reduce the economic burden on patients.Tailored adjustments to medical payment standards should be made according to the characteristics and treatment of disease types to improve the comprehensiveness and practicability of the DRGs-PPS.

金融机构ESG投资的“漂绿”与“反漂绿”——基于DWSGroup的案例分析

深化绿色金融发展、助力经济绿色发展,是实现“双碳”目标的重要途径,特别是在ESG理念盛行的今天,金融机构的ESG投资行为因其深远影响而颇受投资者青睐,但层出不穷的“漂绿”现象也牢牢制约着绿色金融的发展,制约着ESG投资的发展。西方国家作为绿色金融发展先驱,从信息披露、制度监管、实践探索等方面对“漂绿”现象进行了研究和治理。本文在学习其先进经验的基础上,基于舞弊三角理论对DWSGroup案例进行分析,从压力、机会和自我合理化因素角度对金融机构ESG投资“漂绿”行为的动因进行分析,并据此提出我国“反漂绿”体系框架,以期为绿色金融的平稳发展和“双碳”目标的实现作出贡献。

MXene terminating groups=O,–F or–OH,–F or=O,–OH,–F,or=O,–OH,–Cl?

MXenes are a novel family of two-dimensional(2D)materials that are fast gaining popularity due to their versatile characteristics.The surfaces of these materials are often functionalized by negatively charged terminal groups,such as=O,OH,and F during their synthesis,and it has been hypothesized that regulating the surface terminators enables to control the material characteristics.However,there is still a large gap between computational and experimental investigations regarding comprehending the surface functional groups.Surfaces with mixed terminations are consistently synthesized in experiments,although pure terminated surfaces are predicted by computational research.Here we summarized the nature of chemical bonding in transition metal carbide materials(MXenes)by1H and19F nuclear magnetic resonance(NMR),Raman,X-ray absorption near edge structure(XANES),extended X-ray absorption fine structure(EXAFS),ultraviolet photoelectron spectroscopy(UPS),X-ray photoelectron spectroscopy(XPS)/scanning transmission electron microscopy(STEM),and thermogravimetric analysis-mass spectrometry(TGA-MS)characterizations.Previous literature reveals that=O,–OH,–F,and–Cl are typical MXene surface terminators.However,recent comparative investigations on the valence band intensity distribution in MXenes reveal that the–OH cannot be considered an intrinsic termination species in MXenes.The surface terminals(=O,–OH,–F,and–Cl)of several MXenes,particularly V2CTxand Ti3C2Tx,will be identified and quantified here.We have also discussed different etching approaches for the synthesis of MXene,the dependence of MXene conductivity on MXene terminating groups,and the emission of various gaseous products that evolved during its chemical transformations.This paper provides significance,especially in the field of energy conversion and storage materials,where the intercalation process is crucial.

Investigation into Protective Groups for Anilino Functionality upon Oxone-Mediated Oxidative Esterification

In the course of organic synthesis, particularly for multi-step synthesis or natural product total synthesis, the selection of appropriate protective groups for the intended functionality is crucial in order to achieve chemoselective synthetic goals. The development of many useful protective groups has been reported based on the functionality of the anilino group. Herein, we discuss our study of various protective groups and the processes we used to establish compatibility with anilino functionality via the implementation of Oxone-mediated oxidative esterification in methanol. The results and the details of our experiments are reported herein.

Functional groups and seasonal diversity of crustacean zooplankton in adjacent waters of Haizhou Bay,South Yellow Sea

Zooplankton are important linkages in the food web and can respond nonlinearly to environmental changes.Marine organisms thrive from spring to summer.Thus,it is crucial to understand how ecological functions of zooplankton communities may shift under seasonal environmental changes during this period.Samples were collected from May to August(May,June-Ⅰ,June-Ⅱ,July-Ⅰ,July-Ⅱ,and August)in 2018 in Haizhou Bay,Jiangsu,East China for zooplankton and environmental variables.Crustaceans accounted for 75 out of 134 zooplankton taxa and 91.8%of total zooplankton abundance.The average abundance of crustacean varied between 2824.6±635.4 inds./m3 in July-Ⅱand 6502.7±1008.8 inds./m3 in June-Ⅱ.Multivariate analyses results showed that the dissimilarity of community increased gradually in the time series.Body length,feeding type,trophic group,and reproduction mode were used to investigate crustacean community functions.Trait-based functional groups contained species with similar ecological roles.Functional diversity fused the differences of species and trait.The proportion of large-sized species(2-5 mm)decreased with the increasing proportion of medium-sized species(1-2 mm).The proportion of current feeders increased with the drop in the proportion of mixed feeders.Parthenogenesis species increased with decreasing free spawners,and omnivores-carnivores increased with decreasing omnivoresherbivores.Generalized additive models suggested that temperature was the main driver of variations in crustacean zooplankton function.Seven identified functional groups varied with increasing temperature.Omnivorous-herbivorous copepods declined(90.0%-68.0%),whereas the parthenogenetic cladocerans increased(0-24.1%).The small egg-brooding ambush copepods fluctuated(6.5%-9.3%)with increasing water temperature.The other functional groups changed slightly.Functional diversity also varied according to temperature changes.The community structure and ecological function of crustacean zooplankton community showed gradual changes with increasing temperature from spring to summer.

Partial Groups, Simplicial K(G, 1)’s and Kan Complexes

In our paper Simplicial K(G, 1)’s we constructed a sub-complex of the nerve of a group G determined by a partial group structure, and we proved, under a generalized associativity condition called regularity, that the sub-complex realizes as a K(G, 1). This type of sub-complex appears naturally in several topological and algebraic contexts. In this note we prove that regularity of a partial group implies that the Kan extension condition is satisfied on its nerve in dimensions greater than one, and in dimension one a weaker version of the extension condition holds.

States of graphene oxide and surface functional groups amid adsorption of dyes and heavy metal ions

Water pollution regarding dyes and heavy metal ions is crucial facing the world.How to effectively separate these contaminants from water has been a key issue.Graphene oxide(GO)promises the greenwater world as a long-lasting spotlight adsorbent material and therefore,harnessing GO has been the research hotspot for over a decade.The state of GO as well as its surface functional groups plays an important role in adsorption.And the way of preparation and structural modification matters to the performance of GO.In this review,the significance of the state of existence of stock GO and surface functional groups is explored in terms of preparation,structural modification,and adsorption.Besides,various adsorbates for GO adsorption are also involved,the discussion of which is rarely established elsewhere.

Interpersonal Perception in Virtual Groups: Examining Homophily, Identification and Individual Attraction Using Social Relations Model in Network

With the penetration of the Internet, virtual groups have become more and more popular. The reliability and accuracy of interpersonal perception in the virtual environment is an intriguing issue. Using the Social relations model (SRM) [1], this paper investigates interpersonal perception in virtual groups from a multilevel perspective. In particular, it examines the following three areas: homophily, identification, and individual attraction, and explores how much of these directional and dyadic relational evaluations can be attributed to the effect of the actor, the partner, and the relationship.

ASL Recognition by the Layered Learning Model Using Clustered Groups

American Sign Language(ASL)images can be used as a communication tool by determining numbers and letters using the shape of the fingers.Particularly,ASL can have an key role in communication for hearing-impaired persons and conveying information to other persons,because sign language is their only channel of expression.Representative ASL recognition methods primarily adopt images,sensors,and pose-based recognition techniques,and employ various gestures together with hand-shapes.This study briefly reviews these attempts at ASL recognition and provides an improved ASL classification model that attempts to develop a deep learning method with meta-layers.In the proposed model,the collected ASL images were clustered based on similarities in shape,and clustered group classification was first performed,followed by reclassification within the group.The experiments were conducted with various groups using different learning layers to improve the accuracy of individual image recognition.After selecting the optimized group,we proposed a meta-layered learning model with the highest recognition rate using a deep learning method of image processing.The proposed model exhibited an improved performance compared with the general classification model.

Eff ects of stand condition and root density on fi ne-root dynamics across root functional groups in a subtropical montane forest

Fine roots play key roles in belowground C cycling in terrestrial ecosystems.Based on their distinct functions,fi ne roots are either absorptive fi ne roots(AFRs)or transport fi ne roots(TFRs).However,the function-based fi ne root dynamics of trees and their responses to forest stand properties remain unclear.Here,we studied the dynamics of AFRs and TFRs and their responses to stand conditions and root density in a subtropical montane mixed forest based on a 2-a root window experiment.Mean(±SE)annual production,mortality,and turnover rate of AFRs were 7.87±0.17 m m^(−2)a^(−1),8.13±0.20 m m^(−2)a^(−1)and 2.96±0.24 a^(−1),respectively,compared with 7.09±0.17 m m^(−2)a^(−1),4.59±0.17 m m^(−2)a^(−1),and 2.01±0.22 a^(−1),respectively,for TFRs.The production and mortality of fi ne roots were signifi cantly higher in high root-density sites than in low-root density sites,whereas the turnover of fi ne roots was faster in the low root-density sites.Furthermore,root density had a larger positive eff ect than other environmental factors on TFR production but had no obvious impact on AFR production.Tree species diversity had an apparent positive eff ect on AFR production and was the crucial driver of AFR production,probably due to a complementary eff ect,but had no evident impact on TFR.Both tree density and tree species diversity were positively correlated with the mortality of AFRs and negatively related to the turnover of TFRs,suggesting that higher root density caused stronger competition for rooting space and that plants tend to reduce maintenance costs by decreasing TFR turnover.These fi ndings illustrated the importance of root functional groups in understanding root dynamics and their responses to changes in environmental conditions.

Effects of non-liquefiable crust layer and superstructure mass on the response of 2×2 pile groups to liquefaction-induced lateral spreading

In this research,two shake table experiments were conducted to study the effects of non-liquefiable crust layer and superstructure mass on the responses of two sets of 22 pile groups to liquefactioninduced lateral spreading.In this regard,an inclined base layer overlain by a very loose liquefiable layer was constructed in both models;while only in one model,a non-liquefiable crust layer was built.A lumped mass,being representative of a superstructure,was attached to the cap of one pile group in both models.The models were fully instrumented with various sensors,including acceleration,displacement,and pore water pressure transducers.Also,the piles were instrumented with pair strain gauges to measure pure bending moments induced by cyclic and monotonic loadings associated with ground shaking and lateral spreading,respectively.The results showed that the existence of the non-liquefiable crust layer increases both the maximum and residual soil displacements at the free field and also the maximum bending moments in the piles.The results of the experiments indicated that the crust layer induces a high kinematic lateral soil pressure and force on the piles which are not present in the crustless case.The crust layer increases the pile cap displacement before liquefaction,albeit decreases it after liquefaction,due to the elastic rebound of the piles in the liquefiable layer.The crust layer postpones both liquefaction triggering and dissipation of excess pore water pressure.The existence of the superstructure mass on the pile caps decreases the acceleration amplitude of the pile caps,while increases their maximum displacement.

Efficient Expressive Attribute-Based Encryption with Keyword Search over Prime-Order Groups

Attribute-based encryption with keyword search(ABEKS)is a novel cryptographic paradigm that can be used to implementfine-grained access control and retrieve ciphertexts without disclosing the sensitive information.It is a perfect combination of attribute-based encryption(ABE)and public key encryption with keyword search(PEKS).Nevertheless,most of the existing ABEKS schemes have limited search capabilities and only support single or simple conjunctive keyword search.Due to the weak search capability and inaccurate search results,it is difficult to apply these schemes to practical applications.In this paper,an effi-cient expressive ABEKS(EABEKS)scheme supporting unbounded keyword uni-verse over prime-order groups is designed,which supplies the expressive keyword search function supporting the logical connectives of“AND”and“OR”.The proposed scheme not only leads to low computation and communica-tion costs,but also supports unbounded keyword universe.In the standard model,the scheme is proven to be secure under the chosen keyword attack and the cho-sen plaintext attack.The comparison analysis and experimental results show that it has better performance than the existing EABEKS schemes in the storage,com-putation and communication costs.

Stabilizing Buried Interface via Synergistic Effect of Fluorine and Sulfonyl Functional Groups Toward Efficient and Stable Perovskite Solar Cells

The interfacial defects and energy barrier are main reasons for interfacial nonradiative recombination.In addition,poor perovskite crystallization and incomplete conversion of PbI_(2) to perovskite restrict further enhancement of the photovoltaic performance of the devices using sequential deposition.Herein,a buried interface stabilization strategy that relies on the synergy of fluorine(F)and sulfonyl(S=O)functional groups is proposed.A series of potassium salts containing halide and non-halogen anions are employed to modify SnO_(2)/perovskite buried interface.Multiple chemical bonds including hydrogen bond,coordination bond and ionic bond are realized,which strengthens interfacial contact and defect passivation effect.The chemical interaction between modification molecules and perovskite along with SnO_(2) heightens incessantly as the number of S=O and F augments.The chemical interaction strength between modifiers and perovskite as well as SnO_(2) gradually increases with the increase in the number of S=O and F.The defect passivation effect is positively correlated with the chemical interaction strength.The crystallization kinetics is regulated through the compromise between chemical interaction strength and wettability of substrates.Compared with Cl−,all non-halogen anions perform better in crystallization optimization,energy band regulation and defect passivation.The device with potassium bis(fluorosulfonyl)imide achieves a tempting efficiency of 24.17%.

Dynamical Properties of Additive Cellular Automata over Finite Abelian Groups

Some dynamical properties were discussed for additive cellular automata(CA)over finite abelian groups.These properties include surjection,ergodicity,sensitivity to initial conditions and positive expansivity.Some necessary and sufficient conditions of determining ergodicity and sensitivity of the above additive CA were presented,respectively.A necessary condition for the positive expansivity of the above additive CA was given.The positive expansivity was proved to be preserved under the shift mappings for the general CA.The discussion was mainly based on the structure theorem of the finite abelian groups and the matrix associated with the global rule of the additive CA over the finite abelian p-groups.

A Study on the Chess Culture of Ethnic Minority Groups in Gansu Province

As a region inhabited by large populations of ethnic minority groups, Gansu province boasts rich ethnic cultural resources which reflect traditional culture and intangible cultural heritage that had taken shape thousands of years ago. Among these are various ethnic folk chess games. They are time-honored with many types such as the “Fang” chess of the Hui ethnic group, the “Jiu” chess of the Tibetans, the “King and Ministers” chess, the Mongolian chess, the Mongolian military chess, etc. These games embody distinctive ethnic and regional characteristics, as well as the cultural elements of a particular ethnic minority group. It is of great significance, therefore, to study the ethnic chess by collecting, documenting and comparing different types of related chess. The paper explores ways to standardize, protect and promote them scientifically in joint efforts, and draws a conclusion that examining their significance in the present era and the ethnic characteristics is the key to understanding the profound culture behind the chess.