Impact of mobile health technology adoption on service quality and patient satisfaction

Long registration time, long waiting time, long medication-taking time and short consultation time, also called "three long, one short", are urgent management problems to be solved in Chinese hospitals. To this end, many hospitals have begun to actively invest in the establishment of mobile health applications (Apps), for the purpose of improving the medical environment and optimizing the clinical processes, such as making appointment, registration, consultation, payment, diagnosis and treatment, medication-taking, waiting time, and ultimately improving the quality of hospital services and patient satisfaction. This dissertation research aims at empirically examining the mechanisms through which patients’ uses of mobile health Apps affect their perceptions of hospital service quality and their satisfaction. The study is conducted in Shenzhen Eye Hospital in China. First, based on literature review and expert interviews, a research model was developed regarding the relationships among four variables: Mobile Health Technology Use (MHTU), Clinical Process Change (CPC), Service Quality (SQ), and Patient Satisfaction (PS). Five hypotheses about the relationship among the variables were proposed and tested. Based on existing measures in the literature and field interviews, a survey instrument was developed and tested using a pilot sample. The survey was then administered to randomly selected patients in the hospital over a period of three weeks. The research model and hypotheses were tested using SPSS statistical software. Results reported in the study include descriptive analysis of patient demographic information and medical information, exploratory factor analysis, reliability and validity analysis, correlation and regression analysis. The study results suggest that the use of mobile health Apps directly and significantly affects patient satisfaction, but it has no direct impact on the hospital service quality. Instead, it affects hospital service quality through the role of intermediate variables of perceived changes of clinical process by patients. Physician-patient Interaction is an important factor that positively affects the quality of hospital service. Convenience is one of the important dimensions for patients to perceive the quality of service in Chinese hospitals, and it has a positive and significant impact on patient satisfaction. The above findings suggest that hospital managers should not only pay attention to the management of system usage, but also to organizational factors that affect the results of system usage, such as the perceived changes of clinical process by patients. When evaluating the quality of hospital service, especially in the face of large-scale hospitals with large outpatient service, Convenience dimension should be considered. In addition, managers should pay attention to enhancing the initiative of physician-patient interaction, as it is an important factor affecting patients' perception of hospital service quality.O longo tempo de registo, o longo tempo de espera, o longo tempo de toma de medicamentos e o curto tempo de consulta, também chamados "três longos, um curto", são problemas de gestão urgentes a resolver nos hospitais Chineses. Para tal, muitos hospitais começaram a investir ativamente no estabelecimento de aplicações (Apps) móveis de saúde, com o objetivo de melhorar o ambiente médico e otimizar os processos clínicos, como agendamento, registo, consulta, pagamento, diagnóstico e tratamento, tomada de medicamentos, tempo de espera e, por fim, melhorar a qualidade dos serviços hospitalares e a satisfação dos pacientes. A investigação desta dissertação visa examinar empiricamente os mecanismos através dos quais o uso de Apps móveis de saúde pelos pacientes afeta as suas percepções sobre a qualidade do serviço hospitalar e a sua satisfação. O estudo é realizado no Shenzhen Eye Hospital, na China. Primeiramente, com base na revisão da literatura e em entrevistas com especialistas, foi desenvolvido um modelo de pesquisa sobre as relações entre quatro variáveis: Uso de Tecnologia Móvel em Saúde (MHTU), Mudança de Processos Clínicos (CPC), Qualidade de Serviço (SQ) e Satisfação do Paciente (PS). Cinco hipóteses sobre a relação entre as variáveis foram propostas e testadas. Com base nas medidas existentes na literatura e nas entrevistas de campo, foi desenvolvido e testado um questionário utilizando uma amostra piloto. O questionário foi então administrado a pacientes selecionados aleatoriamente no hospital durante um período de três semanas. O modelo de pesquisa e as hipóteses foram testados utilizando o software estatístico SPSS. Os resultados relatados no estudo incluem análise descritiva das informações demográficas e informações médicas dos pacientes, análise fatorial exploratória, análise de confiabilidade e validade, análise de correlação e regressão. Os resultados do estudo sugerem que o uso de Apps móveis de saúde afeta direta e significativamente a satisfação do paciente, mas não tem impacto direto na qualidade do serviço hospitalar. Em vez disso, afeta a qualidade do serviço hospitalar através do papel de variáveis intermediárias das alterações percebidas pelo paciente no processo clínico. A interação médico-paciente é um fator importante que afeta positivamente a qualidade do serviço hospitalar. A conveniência é uma das dimensões importantes para que os pacientes percebam a qualidade do serviço nos hospitais Chineses, tendo um impacto positivo e significativo na satisfação dos pacientes. Os resultados acima sugerem que os gestores hospitalares devem prestar atenção não apenas à gestão do uso do sistema, mas também aos fatores organizacionais que afetam os resultados do uso do sistema, como as mudanças percebidas pelos pacientes no processo clínico. Ao avaliar a qualidade do serviço hospitalar, especialmente no caso de hospitais de grande dimensão com um elevado número de atendimentos em ambulatório, a dimensão conveniência deve ser considerada. Além disso, os gestores devem estar atentos para potencializar a iniciativa de interação médico-paciente, pois este é um fator importante que afeta a percepção dos pacientes sobre a qualidade do serviço hospitalar

Improved Linear Approximations of SNOW-V and SNOW-Vi

Abstract. in this paper, we improve the results of linear approximation of SNOW-V and SNOW-Vi.We optimized the automatic search program by replacing the S-box part with accurate characterizations of the Walsh spectral of S-boxes, which results in a series of trails with higher correlations. On the basis of existing results, we investigate the common features of linear approximation trails with high correlation, and search for more trails by exhausting free masks. By summing up the correlations of trails with the same input and output masks, we get closer to the real correlation. As a result, we get a linear approximation with a correlation -2^{-47.76},which results in a correlation attack on SNOW-V and SNOW-Vi with a time complexity 2^{246:53}, data complexity 2^{237.5} and memory complexity 2^{238.77}

A MIQCP-Based Automatic Search Algorithm for Differential-Linear Trails of ARX Ciphers(Long Paper)

Differential-linear (DL) cryptanalysis has undergone remarkable advancements since it was first proposed by Langford and Hellman \cite{langford1994differential} in 1994. At CRYPTO 2022, Niu et al. studied the (rotational) DL cryptanalysis of $n$-bit modulo additions with 2 inputs, i.e., $\boxplus_2$, and presented a technique for evaluating the (rotational) DL correlation of ARX ciphers. However, the problem of how to automatically search for good DL trails on ARX with solvers was left open, which is the focus of this work. In this paper, we solve this open problem through some techniques to reduce complexity and a transformation technique from matrix multiplication chain to Mixed Integer Quadratically-Constrained Programs (MIQCP). First, the computational complexity of the DL correlation of $\boxplus_2$ is reduced to approximately one-eighth of the state of art, which can be computed by a $2\times2$ matrix multiplication chain of the same length as before. Some methods to further reduce complexity in special cases have been studied. Additionally, we present how to compute the extended (rotational) DL correlations of $\boxplus_k$ for $k\ge 2$, where two output linear masks of the cipher pairs can be different. Second, to ensure that the existing solver Gurobi\footnote{The solver used in this paper is Gurobi, and some ready-made functions in Gurobi are also used, such as LOG\_2 and ABS. The source code is available at \url{https://}. } can compute DL correlations of $\boxplus_2$, we propose a method to transform an arbitrary matrix multiplication chain into a MIQCP, which forms the foundation of our automatic search of DL trails in ARX ciphers. Third, in ARX ciphers, we use a single DL trail under some explicit conditions to give a good estimate of the correlation, which avoids the exhaustion of intermediate differences. We then derive an automatic method for evaluating the DL correlations of ARX, which we apply to Alzette and some versions of SPECK. Experimentally verified results confirm the validity of our method, with the predicted correlations being close to the experimental ones. To the best of our knowledge, this method finds the best DL distinguishers for these ARX primitives currently. Furthermore, we presented the lowest time-complexity attacks against 12-14 rounds of SPECK32 to date

A Correlation Attack on Full SNOW-V and SNOW-Vi

In this paper, a method for searching correlations between the binary stream of Linear Feedback Shift Register (LFSR) and the keystream of SNOW-V and SNOW-Vi is presented based on the technique of approximation to composite functions. With the aid of the linear relationship between the four taps of LFSR input into Finite State Machine (FSM) at three consecutive clocks, we present an automatic search model based on the SAT/SMT technique and search out a series of linear approximation trails with high correlation. By exhausting the intermediate masks, we find a binary linear approximation with a correlation $-2^{-47.76}$. Using such approximation, we propose a correlation attack on SNOW-V with an expected time complexity $2^{246.53}$, a memory complexity $2^{238.77}$ and $2^{237.5}$ keystream words generated by the same key and Initial Vector (IV). For SNOW-Vi, we provide a binary linear approximation with the same correlation and mount a correlation attack with the same complexity as that of SNOW-V. To the best of our knowledge, this is the first known attack on full SNOW-V and SNOW-Vi, which is better than the exhaustive key search with respect to time complexity. The results indicate that neither SNOW-V nor SNOW-Vi can guarantee the 256-bit security level if we ignore the design constraint that the maximum length of keystream for a single pair of key and IV is less than $2^{64}$

Identification and Characterization of Paramyosin from Cyst Wall of Metacercariae Implicated Protective Efficacy against Clonorchis sinensis Infection

Human clonorchiasis has been increasingly prevalent in recent years and results in a threat to the public health in epidemic regions, motivating current strategies of vaccines to combat Clonorchis sinensis (C. sinensis). In this study, we identified C. sinensis paramyosin (CsPmy) from the cyst wall proteins of metacercariae by proteomic approaches and characterized the expressed recombinant pET-26b-CsPmy protein (101 kDa). Bioinformatics analysis indicated that full-length sequences of paramyosin are conserved in helminthes and numerous B-cell/T-cell epitopes were predicted in amino acid sequence of CsPmy. Western blot analysis showed that CsPmy was expressed at four life stages of C. sinensis, both cyst wall proteins and soluble tegumental components could be probed by anti-CsPmy serum. Moreover, immunolocalization results revealed that CsPmy was specifically localized at cyst wall and excretory bladder of metacercaria, as well as the tegument, oral sucker and vitellarium of adult worm. Both immunoblot and immunolocalization results demonstrated that CsPmy was highly expressed at the stage of adult worm, metacercariae and cercaria, which could be supported by real-time PCR analysis. Both recombinant protein and nucleic acid of CsPmy showed strong immunogenicity in rats and induced combined Th1/Th2 immune responses, which were reflected by continuous high level of antibody titers and increased level of IgG1/IgG2a subtypes in serum. In vaccine trials, comparing with control groups, both CsPmy protein and DNA vaccine exhibited protective effect with significant worm reduction rate of 54.3% (p<0.05) and 36.1% (p<0.05), respectively. In consistence with immune responses in sera, elevated level of cytokines IFN-γ and IL-4 in splenocytes suggested that CsPmy could induce combined cellular immunity and humoral immunity in host. Taken together, CsPmy could be a promising vaccine candidate in the prevention of C. sinensis regarding its high immunogenicity and surface localization