Physician disruptive behaviors: Five year progress report

Disruptive behaviors in health care can have a significant adverse effect on staff interactions that can negatively impact staff satisfaction, staff performance, and patient outcomes of care. As referenced in a previously published article, the Obstetrics and Gynecology specialty is one of the service areas where these behaviors occur more frequently. Despite growing evidence of the ill effects of these types ofbehaviors many organizations are still having a difficult time in addressing these issues in an effective manner. Gaining a better understanding of the nature, causes, and impact of these behaviors is crucial to finding the right remedies for solution. Nobody intentionally starts the day planning to be disruptive, it's just that things get in the way. A combination of deep seated factors related to age and gender preferences, culture and ethnicity, life experiences, and other events that help shape values, attitudes and personalities, and more external factors related to training, environmental pressures, stress and burnout, and other personal issues all contribute to the mix. Given the complexities of today's health care environment, each person needs to recognize the importance of being held accountable for appropriate actions and behaviors that affect work relationships and care coordination that impact patient care. Early recognition, early intervention, and taking a pro-active supportive approach to improve individual behaviors will result in better relationships, less disruption, more satisfaction, and better outcomes of care.

Double-null divertor configuration discharge and disruptive heat flux simulation using TSC on EAST

The tokamak simulation code （TSC） is employed to simulate the complete evolution of a disruptive discharge in the experimental advanced superconducting tokamak. The multiplication factor of the anomalous transport coefficient was adjusted to model the major disruptive discharge with double-null divertor configuration based on shot 61 916. The real-time feed-back control system for the plasma displacement was employed. Modeling results of the evolution of the poloidal field coil currents, the plasma current, the major radius, the plasma configuration all show agreement with experimental measurements. Results from the simulation show that during disruption, heat flux about 8 MW m-2 flows to the upper divertor target plate and about 6 MW m-2 flows to the lower divertor target plate. Computations predict that different amounts of heat fluxes on the divertor target plate could result by adjusting the multiplication factor of the anomalous transport coefficient. This shows that TSC has high flexibility and predictability.

The Strategy of Industrial Clusters to Deal with Disruptive Innovation

Disruptive innovation may be a fatal threat to industrial clusters, or it may be a major development opportunity. The key lies in how industrial clusters respond to disruptive innovation. The main obstacles to the development of disruptive innovation in industrial clusters are lock-in and cluster inertia, which originate from the negative effects of cluster system isomorphism. In order to break through the development barriers, industrial clusters need to adopt a targeted overall response strategy, including adopting bottom-up local subversive innovation policies, introducing external knowledge, encouraging spin-off entrepreneurial enterprises, and encouraging alliances and cooperation between incumbent enterprises and entrepreneurial enterprises, etc.

Balancing resilience and efficiency in supply chains: Roles of disruptive technologies under Industry 4.0

In the Industry 4.0 era,disruptive technologies such as big data analytics,blockchain,Internet-of-Things,and additive manufacturing have become major forces driving supply chain transformation.Under such circumstances,particular attention should be attached to balancing resilience and efficiency of the supply chain,especially in the presence of more turbulence.In this study,we first summarize the conflicts between supply chain efficiency and supply chain resilience regarding practices and objectives.Then,we discuss the positive effects of disruptive technologies in improving resilience and efficiency.Afterwards,we propose a research agenda that covers both the influence mechanism and trade-off mechanism of these technologies in terms of resilience and efficiency.

Disruptive technologies for advancing supply chain resilience

Disruptive technologies provide a new paradigm for supply chain risk management and bring opportunities and challenges for the improvement of supply chain resilience(SCRes).This study summarizes the application cases of some disruptive technologies in the SCRes and analyzes the benefits and damages brought by disruptive technologies to the SCRes.The results show that disruptive technologies can provide the supply chain with flexibility,visibility,agility,and other capabilities at various stages of risk management.Hence,technology advancements greatly increase the level of the SCRes.Although disruptive technologies undermine the construction of SCRes,these damages can be eliminated through technology iteration or other disruptive technologies.Furthermore,disruptive technologies will provide better stability for the SCRes.The study also makes several suggestions for the use of disruptive technologies in the construction of the SCRes.

Research Progress of Minimally Destructive Medicine Applied to Multimorbidity

Objective:To review the research status and progress of minimally disruptive medicine(MDM)with a view and to provide a theoretical basis for reducing the treatment burden of patients with multimorbidity.Methods:"Minimal Destructive Medicine"was used as searching term in HowNet Database and Wanfang Database,and"Minimally Disruptive Medicine"was used as searching term in PubMed database.The literature was reviewed for a review of the concepts of minimally destructive medicine(MDM),four basic principles,care models,and tools and strategies for clinical implementation.Results:MDM was developed for the coexistence burden of chronic diseases.It had formed a detailed and detailed application of basic principles and care models.The tools and strategies developed by MDM have been applied in clinical practice with good Results.Conclusion:MDM has a positive effect on reducing the burden of treatment for the multimorbidity and it is worthy of further research and promotion.

The Mechanism of Cortico-Striato-Thalamo-Cortical Neurocircuitry in Response Inhibition and Emotional Responding in Attention Deficit Hyperactivity Disorder with Comorbid Disruptive Behavior Disorder

The neurocircuitries that constitute the corticostriato-thalamo-cortical（CSTC） circuit provide a framework for bridging gaps between neuroscience and executive function in attention deficit hyperactivity disorder（ADHD）, but it has been difficult to identify the mechanisms for regulating emotional problems from the understanding of ADHD comorbidity with disruptive behavior disorders（DBD）. Research based on ＂cool＇＇ and ＂hot＇＇executive functional theory and the dual pathway models,which are thought of as applied response inhibition and delay aversion, respectively, within the neuropsychological view of ADHD, has shed light on emotional responding before and after decontextualized stimuli, while CSTC circuit-related domains have been suggested to explain the different emotional symptoms of ADHD with or without comorbid DBD. This review discusses the role of abnormal connections in each CSTC circuit, especially in the emotion circuit, which may be responsible for targeted executive dysfunction at the neuroscience level. Thus, the two major domains – abstract thinking（cool） and emotional trait（hot） – trigger the mechanism of onset of ADHD.

Adaptive Process for SMART Community Governance under Persistent Disruptive Risks

This article addresses the increasing need for participatory approaches to disaster reduction at the community level. Based on the author's 30-year engagement in the mountainous community Chizu Town, Tottori Prefecture, Japan, a unique participatory approach called ‘‘Zeroto-One Movement'' has been strategically studied. The study areas are found to have adaptively increased their coping capacity. Their unique participatory process is shown to be an adaptive process for SMART community governance under persistent disruptive risks—‘‘S'' represents small-sized and survivability-minded, ‘‘M'' modestscale and multiple-stakeholder involved, ‘‘A'' anticipatory and adaptive, ‘‘R'' risk-concerned and responsive, and ‘‘T''is transformative. Finally, the Case Station-Field Campus scheme is proposed to serve as a platform for studying the adaptive processes over a long period of time.

Commercialization of disruptive innovations:Literature review and proposal for a process framework

The challenges of disruptive innovations have gained significant attention from both academics and practitioners,commercialization being one of the most critical phases.At the same time,however,it is the less studied area of disruptive innovation.Therefore,this article examined scholarly papers on the commercialization of disruptive innovations through a multidisciplinary systematic literature review.It resulted in the analysis of 64 high-quality peer-reviewed academic articles.The analysis highlighted the commercialization models and main constructs that are affecting the commercialization process:market orientation,market learning,user’s involvement,market configuration,adoption networks and stakeholders,and innovation transference.The study evidences how commercialization has evolved from a later stage in innovation to influence even the early phases of innovation,characterized in turn by exploration,learning and ecosystem creation activities.Additionally,the analysis led to a proposition that established an integrated commercialization model for high uncertainty innovations.The model has three phases:1)Concept/value proposition validation,2)Business model validation&Market creation,and 3)Creating sales in the majority market.Lastly,the article contributes to a better understanding of commercialization processes in high uncertainty innovations,bridging also the academic-practitioner divide.

Effect of wall-disruption on nutrient composition and in vitro digestion of camellia and lotus bee pollens

The nutrient digestion,absorption and biological activity of bee pollen may be limited due to the complex pollen wall.Here,the effect of superfine grinding technology on the release of nutrients from bee pollen were investigated,and their antioxidant activities and in vitro digestion were explored in this study.Results showed that the content of nutrients in bee pollen increased after wall disruption.Among them,fat content increased by 22.55%-8.31%,protein content increased by 0.54%-4.91%,starch content increased by 36.31%-48.64%,soluble sugar content increased by 20.57%-29.67%,total phenolic acid content increased by 11.73%-86.98%and total flavonoids content increased by 14.29%-24.79%.At the same time,the antioxidant activity increased by 14.84%-46.00%.Furthermore,the active components such as phenolic compounds in the wall-disruption bee pollen were more readily to be released during the in vitro digestion,and easier to be absorbed because of their higher bioaccessibility.Antioxidant activities during in vitro digestion were also improved in walldisruption bee pollen.These findings provide evidence that bee pollen wall disruption was suggested,thus,it is more conducive to exerting the value of bee pollen in functional foods.

Design of pH-responsive antimicrobial peptide melittin analog-camptothecin conjugates for tumor therapy

Melittin,a classical antimicrobial peptide,is a highly potent antitumor agent.However,its significant toxicity seriously hampers its application in tumor therapy.In this study,we developed novel melittin analogs with pH-responsive,cell-penetrating and membranelytic activities by replacing arginine and lysine with histidine.After conjugation with camptothecin(CPT),CPT-AAM-1 and CPT-AAM-2 were capable of killing tumor cells by releasing CPT at low concentrations and disrupting cell membranes at high concentrations under acidic conditions.Notably,we found that the C-terminus of the melittin analogs was more suitable for drug conjugation than the N-terminus.CPT-AAM-1 significantly suppressed melanoma growth in vivo with relatively low toxicity.Collectively,the present study demonstrates that the development of antitumor drugs based on pH-responsive antimicrobial peptide-drug conjugates is a promising strategy.

CALD1 facilitates epithelial-mesenchymal transition progression in gastric cancer cells by modulating the PI3K-Akt pathway

BACKGROUND CALD1 has been discovered to be abnormally expressed in a variety of malignant tumors,including gastric cancer(GC),and is associated with tumor progression and immune infiltration;however,the roles and mechanisms of CALD1 in epithe-lial-mesenchymal transition(EMT)in GC are unknown.AIM To investigate the role and mechanism of CALD1 in GC progression,invasion,and migration.METHODS In this study,the relationship between CALD1 and GC,as well as the possible network regulatory mechanisms of CALD1,was investigated by bioinformatics and validated by experiments.CALD1-siRNA was synthesized and used to trans-fect GC cells.Cell activity was measured using the CCK-8 method,cell migration and invasive ability were measured using wound healing assay and Transwell assay,and the expression levels of relevant genes and proteins in each group of cells were measured using qRT-PCR and Western blot.A GC cell xenograft model RESULTS Bioinformatics results showed that CALD1 was highly expressed in GC tissues,and CALD1 was significantly higher in EMT-type GC tissues than in tissues of other types of GC.The prognosis of patients with high expression of CALD1 was worse than that of patients with low expression,and a prognostic model was constructed and evaluated.The experimental results were consistent with the results of the bioinformatics analysis.The expression level of CALD1 in GC cell lines was all higher than that in gastric epithelial cell line GES-1,with the strongest expression found in AGS and MKN45 cells.Cell activity was significantly reduced after CALD1-siRNA trans-fection of AGS and MKN45 cells.The ability of AGS and MKN45 cells to migrate and invade was reduced after CALD1-siRNA transfection,and the related mRNA and protein expression was altered.According to bioinfor-matics findings in GC samples,the CALD1 gene was significantly associated with the expression of members of the PI3K-AKT-mTOR signaling pathway as well as the EMT signaling pathway,and was closely related to the PI3K-Akt signaling pathway.Experimental validation revealed that upregulation of CALD1 increased the expression of PI3K,p-AKT,and p-mTOR,members of the PI3K-Akt pathway,while decreasing the expression of PTEN;PI3K-Akt inhibitor treatment decreased the expression of PI3K,p-AKT,and p-mTOR in cells overexpressing CALD1(still higher than that in the normal group),but increased the expression of PTEN(still lower than that in the normal group).CCK-8 results revealed that the effect of CALD1 on tumor cell activity was decreased by the addition of the inhibitor.Scratch and Transwell experiments showed that the effect of CALD1 on tumor cell migration and invasion was weakened by the addition of the PI3K-Akt inhibitor.The mRNA and protein levels of EMT-related genes in AGS and MKN45 cells were greatly altered by the overexpression of CALD1,whereas the effect of overex-pression of CALD1 was significantly weakened by the addition of the PI3K-Akt inhibitor.Animal experiments showed that tumour growth was slow after inhibition of CALD1,and the expression of some PI3K-Akt and EMT pathway proteins was altered.CONCLUSION Increased expression of CALD1 is a key factor in the progression,invasion,and metastasis of GC,which may be associated with regulating the PI3K-Akt pathway to promote EMT.

Disruptive changes and the post-library era: Toward supply-side structure reform of knowledge services

In view of predictions of the replacement of library work by automation,this paper analyzes the trends towards digital,data-centered and computable knowledge.It puts forwards that the information era is moving towards data era and computing era.We need to reexamine library services,to redefine knowledge discovery,expression,literacy and services,and to promote the supply-side reform of knowledge services.We can define the library from the perspective of service mechanisms based on knowledge and its utilization,reposition library scenarios from the perspective of services embedded and merged into users’workflows,absorb vitality and play the library’s role in knowledge-intensive activities such as scientific research,technological innovation,teaching,production and management.

Research on disruptive design pre-identification in the preliminary design phase of aero engine flow pass multidisciplinary optimization

In aero engine design, determining whether the preliminary design will have disruptive effects on the detailed design is the key to multidisciplinary design optimization in the preliminary design stage. In order to adapt to the non-orthogonal parameter value range caused by the selfconstrained parametric modeling method, a non-orthogonal space mapping method that maps the optimal Latin hypercube sampling points of the traditional orthogonal design space to the non-orthogonal design space is proposed. Based on the logical regression method in machine learning field, a kind of feasible domain boundary identification method is employed to identify whether the sample spatial response meets the relevant criteria. The method proposed in this paper is used to identify and analyze the key technologies of the high-pressure turbine mortise joint structure. It is found that the preliminary design of the aero engine may lead to the failure to obtain a mortise joint structure meeting the design requirements in the detailed design stage. The mortise joint structure needs to be pre-optimized in the preliminary design stage.

A hybrid method for product low-end disruptive innovation

Product innovation is often a process for improving existing products.Low-end disruptive innovation(LDI)enables a product to meet the most price-sensitive customers in the low-end market.The existing LDI methods are mainly based on unnecessary characteristics of disruptive innovations.Thus,they cannot easily identify and respond to the LDI design needs.This study proposes a hybrid method for the product LDI in two levels of the product design based on the summarized definition and essential characteristics of LDI.Feasible areas of the product LDI are determined using a hybrid relational function model to identify the maturity of dominant technologies.The technologies are identified through the technical search and evaluation of the feasible area for innovation to form an initial LDI scheme.Then,the product function is optimized using the trimming concept of theory of inventive problem solving based on the characteristics of LDI.The final LDI scheme is formed and evaluated based on the essential characteristics of the product LDI.The feasibility of the proposed method is verified in the design of a new dropping pill machine.

The pattern of cortical thickness underlying disruptive behaviors in Alzheimer’s disease

Background Disruptive behaviors,including agitation,disinhibition,irritability,and aberrant motor behaviors,are commonly observed in patients with Alzheimer’s disease(AD).However,the neuroanatomical basis of these disruptive behaviors is not fully understood.Objective To confirm the differences in cortical thickness and surface area between AD patients and healthy controls and to further investigate the features of cortical thickness and surface area associated with disruptive behaviors in patients with AD.Methods One hundred seventy-four participants(125 AD patients and 49 healthy controls)were recruited frommemory clinics at the Peking University Institute of Sixth Hospital.Disruptive behaviors,including agitation/aggression,disinhibition,irritability/lability,and aberrant motor activity subdomain scores,were evaluated using the Neuropsychiatry Inventory.Both whole-brain vertex-based and region-of-interest-based cortical thickness and surface area analyses were automatically conducted with the CIVET pipeline based on structural magnetic resonance images.Both group-based statistical comparisons and brain-behavior association analyses were performed using general linear models,with age,sex,and education level as covariables.Results Compared with healthy controls,the AD patients exhibited widespread reduced cortical thickness,with the most significant thinning located in the medial and lateral temporal and parietal cortex,and smaller surface areas in the left fusiform and left inferior temporal gyrus.High total scores of disruptive behaviors were significantly associated with cortical thinning in several regions that are involved in sensorimotor processing,language,and expression functions.The total score of disruptive behaviors did not show significant associations with surface areas.ConclusionWe highlight that disruptive behaviors in patientswith AD are selectively associated with cortical thickness abnormalities in sensory,motor,and language regions,which provides insights into neuroanatomical substrates underlying disruptive behaviors.These findings could lead to sensory,motor,and communication interventions for alleviating disruptive behaviors in patients with AD.

Cyberattack Ramifications, The Hidden Cost of a Security Breach

In this in-depth exploration, I delve into the complex implications and costs of cybersecurity breaches. Venturing beyond just the immediate repercussions, the research unearths both the overt and concealed long-term consequences that businesses encounter. This study integrates findings from various research, including quantitative reports, drawing upon real-world incidents faced by both small and large enterprises. This investigation emphasizes the profound intangible costs, such as trade name devaluation and potential damage to brand reputation, which can persist long after the breach. By collating insights from industry experts and a myriad of research, the study provides a comprehensive perspective on the profound, multi-dimensional impacts of cybersecurity incidents. The overarching aim is to underscore the often-underestimated scope and depth of these breaches, emphasizing the entire timeline post-incident and the urgent need for fortified preventative and reactive measures in the digital domain.

Emerging roles of astrocytes in blood-brain barrier disruption upon amyloid-beta insults in Alzheimer's disease

Blood-brain barrier disruption occurs in the early stages of Alzheimer’s disease.Recent studies indicate a link between blood-brain barrier dysfunction and cognitive decline and might accelerate Alzheimer’s disease progression.Astrocytes are the most abundant glial cells in the central nervous system with important roles in the structural and functional maintenance of the blood-brain barrier.For example,astrocytic cove rage around endothelial cells with perivascular endfeet and secretion of homeostatic soluble factors are two major underlying mechanisms of astrocytic physiological functions.Astrocyte activation is often observed in Alzheimer’s disease patients,with astrocytes expressing a high level of glial fibrillary acid protein detected around amyloid-beta plaque with the elevated phagocytic ability for amyloid-beta.Structural alte rations in Alzheimer’s disease astrocytes including swollen endfeet,somata shrinkage and possess loss contribute to disruption in vascular integrity at capillary and arte rioles levels.In addition,Alzheimer’s disease astrocytes are skewed into proinflammatory and oxidative profiles with increased secretions of vasoactive mediators inducing endothelial junction disruption and immune cell infiltration.In this review,we summarize the findings of existing literature on the relevance of astrocyte alte ration in response to amyloid pathology in the context of blood-brain barrier dysfunction.First,we briefly describe the physiological roles of astrocytes in blood-brain barrier maintenance.Then,we review the clinical evidence of astrocyte pathology in Alzheimer’s disease patients and the preclinical evidence in animal and cellular models.We further discuss the structural changes of blood-brain barrier that correlates with Alzheimer’s disease astrocyte.Finally,we evaluate the roles of soluble factors secreted by Alzheimer’s disease astrocytes,providing potential molecular mechanisms underlying blood-brain barrier modulation.We conclude with a perspective on investigating the therapeutic potential of targeting astrocytes for blood-brain barrier protection in Alzheimer’s disease.

The advance of magnetic diagnostics system in support of EAST long-pulsed operation

In EAST long-pulsed discharge(hundreds of seconds),electric magnetic diagnosis(EMD)is very important,since EMD not only monitors tokamak security status but also provides accurate measurement accuracy for reconstruction of the plasma boundary.To avoid current measurement drift,a fiber optic current sensor,based on the Faraday effect,is developed and used for poloidal and plasma current feedback control for the first time,relative current measurement accuracy is within 0.5%.To ensure plasma boundary control accuracy,a detailed set of magnetic measurement calibration methods is developed before the plasma discharge.The maximum relative error is less than 1%,the corresponding control accuracy is within 1 cm.To minimize integrator drift error,a long-pulse integrator test is essential,the corresponding drift error needs to be subtracted in plasma control system.Besides,the saddle coil and Mirnov coil not only help to detect MHD issues,but are also utilized for plasma disruption prediction during the long-pulse discharge.

Drift surface solver for runaway electron current dominant equilibria during the current quench

Runaway electron current generated during the current quench phase of tokamak disruptions could result in severe damage to future high performance devices.To control and mitigate such runaway electron current,it is important to accurately describe the runaway electron current dominated equilibrium,based on which further stability analysis could be carried out.In this paper,we derive a Grad-Shafranov-like equation solving for the axisymmetric drift surfaces of the runaway electrons instead of the magnetic flux surfaces for the simple case that all runaway electrons share the same parallel momentum.This new equilibrium equation is then numerically solved with simple rectangular wall with ITER-like and MAST-like geometry parameters.The deviation between the drift surfaces and the flux surfaces is readily obtained,and runaway electrons are found to be well confined even in regions with open field lines.The change of the runaway electron parallel momentum is found to result in a horizontal current center displacement without any changes in the total current or the external field.The runaway current density profile is found to affect the susceptibility of such displacement,with flatter profiles result in more displacement by the same momentum change.With up-down asymmetry in the external poloidal field,such displacement is accompanied by a vertical displacement of runaway electron current.It is found that this effect is more pronounced in smaller,compact device and weaker poloidal field cases.The above results demonstrate the dynamics of current center displacement caused by the momentum space change in the runaway electrons,and pave a way for more sophisticated runaway current equilibrium theory in the future with more realistic consideration on the runaway electron momentum distribution.This new equilibrium theory also provides foundation for future stability analysis of the runaway electron current.