Implementation and Outcome of Taiwan Diagnosis-Related Group (DRG) Payment System

The diagnosis-related groups (DRGs) payment system was established in the 1960s. Details of DRG-based payment system vary by country. The Diagnosis-Related Group payments system in Taiwan (Tw-DRG) was established in 2009 in order to contain medical costs and enhance medical efficiency under a universal coverage, single-payment insurance system: National Health Insurance (NHI). This capstone reviews the study literature about the history of DRGs payment system establishment, processes of medical reform, as well as the implementation and outcomes of Tw-DRGS. According to the studies reviewed there were changes of medical behaviors after the implementation of Tw-DRGs which included an increase of medical efficiency and an slightly declining intensity of care which are indicated by the number of order for medication, diagnosis and treatment during hospitalization. No significant change was found in patient health outcomes. The financial impacts on different levels of hospitals, departments or specific clinical items varied. Generally, the profitability was negatively impacted. Another potential problem noted concerns the disease severity and explanatory power of Tw-DRGs. Higher illness severity was related to more medical resource utilization. Due to the lower explanatory power of Tw-DRGs, there exists a lack of accounting for illness severity could lead to cost shifting or patient dumping

Effect of Metal Ions and Temperature on Stability of Thiamine Determined by HPLC

Thiamine degradation occurs during storage and transportation for short and long periods due to the exposure to several factors, such as heat, oxidation-reduction reactions, and alkali. In this study, the effects of four metal ions (i.e., Cu+, Cu2+, Fe2+, and Fe3+) on thiamine stability in aqueous solutions at three temperatures (i.e., 25, 40, and 55°C) for the storage time of 7 days were discussed. Thiamine degradation was found to follow the first-order kinetic reaction, and the degradation rate could also be estimated. The factors in influencing thiamine stability included pH values, temperatures, and chemical properties of metal chlorides. High-performance liquid chromatography (HPLC) equipped with an Eclipse XDB C18 column (4.6 mm x 150 mm, 5μm) was used to analyze thiamine contents. The method was operated in a gradient elution program, which comprised solvents A (0.1M ammonium acetate was adjusted to pH = 5.8 by 0.1% acetic acid) and solvent B (acetonitrile in HPLC grade) at the flow rate of 1 mL min-1 up to 5 mins. The column was maintained at 30°C, and the UV detector was set at a wavelength of 254 nm. The pH values of the samples were also monitored during the entire storage time. At 25°C, the highest loss of thiamine (64.00%) was in 50 mg L-1 of CuCl solution, while the lowest loss of thiamine (78.34%) was in 50 mg L-1 of FeCl3 solution. At 40°C, the highest loss of thiamine (59.76%) was in 50 mg L-1 of FeCl2 solution, while the lowest loss of thiamine (91.48%) was in 50 mg L-1 of FeCl3 solution. At 55°C, the highest loss of thiamine (61.94%) was in 50 mg L-1 of CuCl solution, while the lowest loss of thiamine (95.98%) was in 50 mg L-1 of FeCl3 solution

Water Conservation Through Drought-Resilient Landscape Plants and Deficit Irrigation

Increases in urban population and inadequate rainfall result in imbalanced water budgets in urban and sub-urban regions. Water conservation becomes important in urban landscapes because of increased water demands. Modern landscape designs require drought-resistant plants to maintain urban landscape greenness during water scarcity. Irrigating plants at their irrigation requirements, which is the minimum irrigation rate that can achieve acceptable aesthetic quality, can also conserve water. However, the drought tolerance and irrigation requrements of most landscape plants have not been widely evaluated. Shepherdia ×utahensis ‘Torrey’ (‘Torrey’ buffaloberry) and Penstemon species (beardtongues) are low-water-use landscape plants, but their drought resistance mechanisms are largely unknown. Despite garden roses (Rosa ×hybrida L.) being widely used in residential landscapes, their responses to reduced irrigation frequency and irrigation requirements are unclear. The objectives of this research were to determine the plant growth, morphology, and physiology of ‘Torrey’ buffaloberry, four penstemon species, and five garden rose cultivars under drought stress resulting from reduced substrate water content or irrigation frequency. Shepherdia ×utahensis ‘Torrey’ and the four penstemons were grown using an automated irrigation system to preciously control their substrate volumetric water contents at their setpoints between 0.40 to 0.05 m3·m-3 in a greenhouse for 50 days, whereas the five rose cultivars were irrigated at three irrigation frequencies (high, medium, and low) in an open field, where the irrigation frequency at the high, medium, and low levels was controlled using 80%, 50%, and 20% reference evapotranspiration (ETO), respectively. Under reduced substrate moisture levels, S. ×utahensis promoted root growth, closed stomata, and increased leaf trichomes density to regulate canopy temperature. Penstemon species native to arid regions, such as P. barbatus (Cav.) Roth ‘Novapenblu’ (Rock Candy Blue® penstemon) and P. strictus Benth. (Rocky Mountain penstemon), showed greater leaf reflectance, a higher volume of root system, and cooler canopy temperatures than the mesic penstemon species, including P. digitalis Nutt. ex Sims ‘TNPENDB’ (Dakota™ Burgundy beardtongue) and P. ×mexicali Mitch. ‘P007S’ (Pikes Peak Purple® penstemon). Rose cultivars were able to partially close their stomata to reduce water loss when irrigation frequency dereased or air temperatures increased. ‘MEIRIFTDAY’ and ‘Meibenbino’ roses, which showed reductions in the dry weights of leaves and stems and exhibited unacceptable overall appearance, were less tolerant to reduced irrigation compared with ‘ChewPatout’, ‘Overedclimb’, and ‘Radbeauty’ roses when irrigation events decreased from eight to one time during the growing season. Our research showed that landscape plants might change their morphology and physiology to allow them to tolerate water deficit and leaf overheating under drought conditions. Using plants with drought resilience could maintain acceptable visual quality with reduced irrigation water

Chemoenzymatic Studies to Enhance the Chemical Space of Natural Products

Natural products provide some of the most potent anticancer agents and offer a template for new drug design or improvement with the advantage of an enormous chemical space. The overall goal of this thesis research is to enhance the chemical space of two natural products in order to generate novel drugs with better in vivo bioactivities than the original natural products. Polycarcin V (PV) is a gilvocarcin-type antitumor agent with similar structure and comparable bioactivity with the principle compound of this group, gilvocarcin V (GV). Modest modifications of the polyketide-derived tetracyclic core of GV had been accomplished, but the most challenging part was to modify the sugar moiety. In order to solve this problem, PV was used as an alternative lead-structure for modification because its sugar moiety offered the possibility of enzymatic O-methylation. We produced four PV derivatives with different methylation patterns for cytotoxicity assays and provided important structure-activity-relationship information. Mithramycin (MTM) is the most prominent member of the aureolic acid type anticancer agents. Previous work in our laboratory generated three MTM analogues, MTM SA, MTM SK, and MTM SDK by inactivating the mtmW gene. We developed new MTM analogues by coupling many natural and unnatural amino acids to the C-3 side chain of MTM SA via chemical semi-synthesis and successfully made some compounds with both improved bioactivity and in vivo tolerance than MTM. Some of them were consequently identified as promising lead-structures against Ewing’s sarcoma. The potential of selectively generating novel MTM analogues led us to focus on a key enzyme in the biosynthetic pathway of mithramycin, MtmC. This protein is a bifunctional enzyme involved in the biosynthesis of TDP-D-olivose and TDP-D-mycarose. We clarified its enzymatic mechanisms by X-ray diffraction of several crystal complexes of MtmC with its biologically relevant ligands. Two more important post-PKS tailoring enzymes involved in the biosynthesis of the MTM side chains, MtmW and MtmGIV, are currently under investigation. This would not only give us insight into this biosynthetic pathway but also pave the way to develop potentially useful MTM analogues by engineered enzymes

The role of the self in episodic memory: the effect of closeness to others

It has been shown that processing information in relation to oneself as opposed to others benefits episodic memory. The cognitive and neural mechanisms underlying this self-reference effect (SRE) are mostly unknown. This thesis addressed these mechanisms by investigating (1) the effect of closeness to others on the SRE and (2) the electrophysiological activities associated with encoding and retrieving information about oneself. Three behavioural and two electrophysiological experiments are reported. In Experiment 1, healthy adults judged the degree to which trait adjectives described themselves, a close other or a distant other. Recognition memory for the adjectives showed a significant SRE for the self over both close and distant others. In Experiment 2, a source memory paradigm to elucidate the type of memory involved in the SRE again showed a significant SRE for the self relative to a close and distant other. In Experiment 3, subjective ratings of self-esteem and Big-Five personality traits were acquired to assess individual differences in the SRE. No significant correlations were found. In Experiments 4 and 5, memory-related brain activity was analysed via event-related potentials (ERPs) and oscillations. Retrieving information about oneself was associated with the mid-frontal and left-parietal ERP old/new effects, whereas retrieving information regarding a close other was associated with a late negative-going effect. Additionally, encoding information about oneself did not affect oscillatory power, but encoding information about a close or distant other was respectively associated with decreases in beta and theta power. In combination, the thesis suggests that (1) closeness to others does not explain the SRE and (2) there are distinct brain activities associated with the encoding and retrieval of information about oneself and others. The self thus seems a psychologically and anatomically specialised affiliation that affects information processing over time

EVALUATING ARTIFICIAL INTELLIGENCE FOR OPERATIONS IN THE INFORMATION ENVIRONMENT

Recent advances in artificial intelligence (AI) portend a future of accelerated information cycles and intensified technology diffusion. As AI applications become increasingly prevalent and complex, Special Operations Forces (SOF) face the challenge of discerning which tools most effectively address operational needs and generate an advantage in the information environment. Yet, SOF currently lack an end user–focused evaluation framework that could assist information practitioners in determining the operational value of an AI tool. This thesis proposes a practitioner’s evaluation framework (PEF) to address the question of how SOF should evaluate AI technologies to conduct operations in the information environment (OIE). The PEF evaluates AI technologies through the perspective of the information practitioner who is familiar with the mission, the operational requirements, and OIE processes but has limited to no technical knowledge of AI. The PEF consists of a four-phased approach—prepare, design, conduct, recommend—that assesses nine evaluation domains: mission/task alignment; data; system/model performance; user experience; sustainability; scalability; affordability; ethical, legal, and policy considerations; and vendor assessment. By evaluating AI through a more structured, methodical approach, the PEF enables SOF to identify, assess, and prioritize AI-enabled tools for OIE.Outstanding ThesisMajor, United States ArmyApproved for public release. Distribution is unlimited

Ion-Molecule Reactions in Unsaturated Hydrocarbons: Allene, Propyne, Diacetylene, and Vinylacetylene

Ion-molecule reactions in allene, propyne, diacetylene, and vinylacetylene (1-buten-3-yne) have been studied at near-thermal energies by the technique of ion cyclotron resonance mass spectrometry. Rate coefficients and branching ratios are reported for the reactions of C_3H^+_n (n = 1-4) with allene and propyne and for the reactions of C_4H^+_n (n = 0-5) with diacetylene and vinylacetylene. Branching ratios are also given for the reactions of C_4H^+_n, C_5H_n, and C_6H^+_n with propyne and for reactions of C_6H^+_n with diacetylene and vinylacetylene. More than 90% of the reactive channels lead to product ions having a larger carbon skeleton than the reactant ion. Evidence for ions with the same m/e ratio having differing reactivities was obtained for C_3H^+_3, C_6H^+_7, and C_7H^+_7. Ion reaction sequences in allene and propyne were followed at higher pressures (l0^(-4) torr) to investigate secondary, tertiary, and higher order processes

Proteresis of Core-Shell Nanocrystals: Investigation through Theoretical Simulation and Experimental Analysis

A study of proteresis (inverted hysteresis) in core-shell nanocrystals is presented. A core-shell anisotropic energy (CSAE) model is established to describe the observed proteretic behavior in Ni/NiO core-shell nanocrystals. The magnetic compositions of core-shell nanocrystals can be selected for ferromagnetic, antiferromagnetic, or paramagnetic materials where the exchange intercoupling between them results in both a large effective anisotropic energy and intercoupling energy. Simulation of the magnetization of core-shell nanocrystals reveals the existence of an exchange in the intercoupling energy between the interface of the core and shell moments that, surprisingly, is tuneable in both hysteresis and proteresis. Observations have shown a distinct proteresis, which is related to the spin-flip and exchange intercoupling energy between Ni and NiO. Our approach shows that the processing-dependent technology plays an important role when the grain size decreases to the order of nanometers and when the magnets are reduced from the single domain to core-shell domain. Integrated studies of process-dependent, theoretical modeling and core-shell nanocrystal fabrication technology will lead to more encouraging development in the overunity industry

Amorphous silicon nanocone array solar cell

In the hydrogenated amorphous silicon [a-Si:H]-thin film solar cell, large amounts of traps reduce the carrier's lifetime that limit the photovoltaic performance, especially the power conversion efficiency. The nanowire structure is proposed to solve the low efficiency problem. In this work, we propose an amorphous silicon [a-Si]-solar cell with a nanocone array structure were implemented by reactive-ion etching through a polystyrene nanosphere template. The amorphous-Si nanocone exhibits absorption coefficient around 5 × 105/cm which is similar to the planar a-Si:H layer in our study. The nanostructure could provide the efficient carrier collection. Owing to the better carrier collection efficiency, efficiency of a-Si solar cell was increased from 1.43% to 1.77% by adding the nanocone structure which has 24% enhancement. Further passivation of the a-Si:H surface by hydrogen plasma treatment and an additional 10-nm intrinsic-a-Si:H layer, the efficiency could further increase to 2.2%, which is 54% enhanced as compared to the planar solar cell. The input-photon-to-current conversion efficiency spectrum indicates the efficient carrier collection from 300 to 800 nm of incident light

Regulatory fit across levels of abstraction

Previous research has shown that regulatory fit has different effects on cognitive processes, such as the ability to make abstractions, or identifying various levels of perceptual characteristics from the environment. In the current study, we measured perceived abstractions under different environments of regulatory fit and mismatch by having the participants identify conceptual abstractions of distance and size, such as “far” and “large” under different regulatory environments of either fit or mismatch. Results showed no effect in reaction time in making associations between the different abstractions under the different regulatory environments, which reveals that more studies is needed to provide further insight into the relationship of different regulatory mindsets and its influence on cognitive processes, such as making associations and abstractions across different categories of conceptual words and pictures.Psycholog