Compreendendo mudanças no comportamento de risco moral médico em resposta a reforma governamental de cuidados à saúde

Doctor moral hazard has a significant effect on the doctor-patient relationship, increases the cost of healthcare, and introduces medical risks. It is a global concern. Doctor moral hazard behaviour is evolving in response to China’s healthcare reform program which was inaugurated in 2009.A scientific understanding of doctor behaviour would facilitate the prevention and control of doctor moral hazard behaviour. This study used the principles and methodology of Glaser and Strauss’s grounded theory. Theoretical and snowball samplings were used to identify 60 subjects. Semi-structured in-depth interviews were conducted with each subject. Themes were identified through substantial (open) coding and theoretical coding. Six types of doctor moral hazard behaviour were extracted from the data. A behavioural model was described and diagrammed to provide a conceptual framework of current doctor moral hazard behaviour. The conceptual model of doctor moral hazard behaviour can be used in several ways to correct or prevent undesirable actions. Rules governing hospital procedures can be strengthened and enforced by supervision and punishment; the asymmetry of information between doctor and patient can be reduced; patient participation in treatment decisions can be increased; the effectiveness of medical ethics education can be improved.Para un médico, el riesgo moral tiene un efecto significativo en la relación médico-paciente, incrementa el costo de la atención de salud e introduce riesgos en la salud. Se trata de una preocupación global. El riesgo moral del comportamiento médico ha evolucionado en respuesta al programa de reforma de atención de salud del gobierno de China, inaugurado en 2009. Un entendimiento científico del comportamiento de los médicos facilitaría la prevención y el control del riesgo moral. El presente estudio usa los principios y metodología de la teoría fundamentada de Glaser y Strauss. Se usaron muestras teóricas y multiplicativas para identificar 60 sujetos y realizar entrevistas semiestructuradas en profundidad. Los temas se identificaron mediante codificación sustancial abierta y teórica. De los datos se extrajeron seis tipos de riesgo moral del comportamiento médico. Se describió y diagramó un modelo de comportamiento para proporcionar una estructura conceptual del riesgo moral del comportamiento médico actual. El modelo conceptual de riesgo moral del comportamiento médico puede usarse de varias maneras para corregir o prevenir acciones no deseadas. Las normas procedimentales de los hospitales pueden fortalecerse y exigirse mediante supervisión y castigo; se puede reducir la asimetría de la información que se da entre el médico y el paciente, incrementar la participación del pacieRisco moral médico tem um efeito significativo na relação médico-paciente, aumenta o custo dos cuidados à saúde e introduz riscos médicos. É uma preocupação global. Comportamento de risco moral médico vem se desenvolvendo em resposta ao programa de reforma de cuidados à saúde da China, que se iniciou em 2009. Uma compreensão científica do comportamento médico facilitaria a prevenção e controle do comportamento de risco moral médico. Este estudo utilizou os princípios da metodologia da Teoria Fundamentada de Glaser e Strauss. Amostragem teóricas e por bola de neve foram utilizadas para identificar 60 participantes. Entrevistas detalhadas semi-estruturadas foram realizadas com cada participante. Temas foram identificados através de codificação (aberta) substancial e codificação teórica. Seis tipos de comportamento de risco moral médico foram obtidos dos dados. Um modelo comportamental foi descrito e diagramado de forma a fornecer um enquadre conceitual do comportamento de risco moral médico. O modelo conceitual de comportamento de risco moral médico pode ser utilizado de diversas formas para corrigir ou prevenir ações indesejáveis. Regras que governam procedimentos em hospitais podem ser fortalecidas e reforçadas por supervisão e punição; a assimetria de informações entre médicos e pacientes pode ser reduzida; a participação dos pacientes nas decisões sobre tratamento pode ser aumentada; e a efetividade da educação ética médica pode ser melhorada

A New Structure Bipolar Plate for Vanadium Flow Battery

A pattern bipolar plate (BP) is designed to decrease the electrical contact resistance between the BP and carbon felt electrode (CFE) by increasing the BP's specific surface area through hot pressing the spherical crown pattern on the surface of the BP, and the carbon felt is pressed into the pattern by the stack tightening force. The contact area growth rate is 18.3% of a single cell which has 48cm2 active area. The areal specific resistance (ASR) of conventional BP and pattern BP is 1309 mΩ·cm2 and 946 mΩ·cm2 at 20% electrode compression ratio, the pattern plate is 27% lower than the conventional plate. In the single battery charge/discharge cycle test, battery assembled with the pattern BP shows a 1% higher EE than the conventional BP

Unveiling the Tapestry of Automated Essay Scoring: A Comprehensive Investigation of Accuracy, Fairness, and Generalizability

Automatic Essay Scoring (AES) is a well-established educational pursuit that employs machine learning to evaluate student-authored essays. While much effort has been made in this area, current research primarily focuses on either (i) boosting the predictive accuracy of an AES model for a specific prompt (i.e., developing prompt-specific models), which often heavily relies on the use of the labeled data from the same target prompt; or (ii) assessing the applicability of AES models developed on non-target prompts to the intended target prompt (i.e., developing the AES models in a cross-prompt setting). Given the inherent bias in machine learning and its potential impact on marginalized groups, it is imperative to investigate whether such bias exists in current AES methods and, if identified, how it intervenes with an AES model's accuracy and generalizability. Thus, our study aimed to uncover the intricate relationship between an AES model's accuracy, fairness, and generalizability, contributing practical insights for developing effective AES models in real-world education. To this end, we meticulously selected nine prominent AES methods and evaluated their performance using seven metrics on an open-sourced dataset, which contains over 25,000 essays and various demographic information about students such as gender, English language learner status, and economic status. Through extensive evaluations, we demonstrated that: (1) prompt-specific models tend to outperform their cross-prompt counterparts in terms of predictive accuracy; (2) prompt-specific models frequently exhibit a greater bias towards students of different economic statuses compared to cross-prompt models; (3) in the pursuit of generalizability, traditional machine learning models coupled with carefully engineered features hold greater potential for achieving both high accuracy and fairness than complex neural network models

Positive impact of a tower inlet cover on natural draft dry cooling towers under crosswind conditions

This study proposes a tower inlet cover to improve the performance of the small natural draft dry cooling tower (NDDCT) under crosswind conditions. CFD analyses are performed on a small NDDCT with tower inlet covers of different lengths, and the CFD model is validated against experimental results. The air temperature, air pressure, air flow and heat flux fields are presented, and the thermal performance for each heat exchanger and the NDDCT are obtained using CFD simulations. The CFD simulation results show that the high-pressure zone around the tower side wall, formed by the crosswind, causes the decrease in air flow through the tower and the deterioration in tower performance with a crosswind. The tower inlet cover can improve the tower performance in crosswinds by increasing the air flow of the heat exchangers. Tower inlet covers with lengths of 1.5 m, 3 m and 4.5 m improve the tower heat load by 40–65%, 70–130% and 85–230%, respectively, when the crosswind increases from 4 m/s to 12 m/s

Solid-phase extraction of polar organophosphorous pesticides from aqueous samples with oxidized carbon nanotubes

The development of new sorbents, which are able to trap polar compounds, is a growing research field in solid-phase extraction (SPE). In this study, multi-walled carbon nanotubes (MWCNTs) and single-walled carbon nanotubes (SWCNTs) were oxidized in air at 600 degrees C and 500 degrees C, respectively, for 2 h. MWCNTs, SWCNTs, air oxidized MWCNTs (OMWCNTs) and SWCNTs (OSWCNTs) (200 mg of each) were packed in SPE cartridges. The four cartridges obtained, together with a commercial Oasis HLB cartridge, were used to extract six polar organophosphorous pesticides (OPPs), i. e., dichlorvos, methamidophos, acephate, omethoate, monocrotophos and dimethoate, from an aqueous sample. The results showed that the oxidation process significantly enhanced the adsorption abilities of both SWCNTs and MWCNTs for polar OPPs. A comparative study indicated that OSWCNTs were more effective than Oasis HLB for the extraction of methamidophos and acephate and as effective as Oasis HLB for the other four OPPs from aqueous samples. When 100 mL of a natural sample was spiked with OPPs and extracted with OSWCNTs, the recoveries of five of the six polar OPPs ( methamidophos excepted) ranged from 79.1 to 101.9%. The detection limits of the method based on OSWCNTs was found to be 0.07-0.12 mu g L-1.National Natural Science Foundation of China [20607017]; Natural Science Foundation of Fujian Province of China [D0610018

Greenhouse gas emissions (CO2–CH4–N2O) along a large reservoir‐downstream river continuum: The role of seasonal hypoxia

Recent studies suggest that hypolimnetic respiration may be responsible for greenhouse gas (GHG) emissions from deep reservoirs. Currently, quantitative evaluation of aerobic vs. anaerobic processes and priming (enhanced processing of organic matter due to the addition of labile carbon) in regulating GHG production and emissions across the reservoir-downstream continuum remains largely unknown. High-resolution, annual time-series observations in a large, subtropical reservoir (Shuikou) experiencing seasonal hypoxia in southeast China indicate that aerobic hypolimnetic CO2 production dominated in most periods of the stratified spring/summer with higher rates at higher temperatures. In addition, anaerobic production of hypolimnetic CO2 occurred in the late stratified spring/summer period, which stimulated hypolimnetic production of CH4 and N2O. Incubation experiments showed that priming in spring enhanced both aerobic and anaerobic production of excess GHGs. A late spring flood event generated the highest daily efflux of CO2 through the flushing of GHG-enriched hypolimnion waters. Turbine degassing contributed 59%, 93%, and 63% of annual CO2, CH4, and N2O effluxes, respectively. Moreover, annual downstream GHG emissions were similar to those in the transition/lacustrine zone of the Shuikou reservoir. Diurnal variation observations revealed net CO2 emissions even during algal bloom seasons. The reservoir-downstream river continuum was a year-round source of GHGs (218.5 ± 18.9 Gg CO2-equivalent yr−1; CO2 contributed 91%). However, the loss of oxygen also leads to increased production and storage of recalcitrant dissolved organic carbon (RDOC). Thus, identifying mechanisms controlling both GHG emissions and RDOC production is crucial to constrain the carbon neutrality issue of hydroelectric reservoirs in the context of climate change mitigation strategies

Unlocking the potential of nanoscale sulfur in sustainable agriculture

The global population is growing rapidly, which poses a significant challenge to food security. Innovation in agricultural technologies is necessary to achieve sustainable development in agriculture and combat food insecurity. Nanotechnology has emerged as a promising tool in agriculture; compared to conventional agricultural chemicals, demonstrated benefits include increased efficiency of delivery and utilization of both nutrients and pesticides, as well as nanoscale-specific stimulation of stress tolerance pathways. Among the many studied nanomaterials, nano-sulfur has demonstrated superior effects at enhancing plant resilience to pathogens and abiotic stresses, as well as improving plant growth and nutritional quality of edible tissues. A number of published studies have investigated the physiological effects (growth promotion, disease resistance) of single or several sulfur and sulfide compounds on crop species. However, there is no systematic analysis of this literature, including the effects and specific mechanisms of various sulfur forms in agricultural applications. In this review, we will discuss the effects of sulfur (including nano-sulfur) on crop species, the underlying mechanisms of action for their transport and transformation in the soil-plant system, and evaluate their suitability in sustainable agricultural development. Additionally, we discuss the current challenges and knowledge gaps for nanoscale sulfur use in agriculture, and describe future research directions to advance our understanding of the sustainable use of this material at the scale of individual fields

Unlocking the potential of nanoscale sulfur in sustainable agriculture

The global population is growing rapidly, which poses a significant challenge to food security. Innovation in agricultural technologies is necessary to achieve sustainable development in agriculture and combat food insecurity. Nanotechnology has emerged as a promising tool in agriculture; compared to conventional agricultural chemicals, demonstrated benefits include increased efficiency of delivery and utilization of both nutrients and pesticides, as well as nanoscale-specific stimulation of stress tolerance pathways. Among the many studied nanomaterials, nano-sulfur has demonstrated superior effects at enhancing plant resilience to pathogens and abiotic stresses, as well as improving plant growth and nutritional quality of edible tissues. A number of published studies have investigated the physiological effects (growth promotion, disease resistance) of single or several sulfur and sulfide compounds on crop species. However, there is no systematic analysis of this literature, including the effects and specific mechanisms of various sulfur forms in agricultural applications. In this review, we will discuss the effects of sulfur (including nano-sulfur) on crop species, the underlying mechanisms of action for their transport and transformation in the soil-plant system, and evaluate their suitability in sustainable agricultural development. Additionally, we discuss the current challenges and knowledge gaps for nanoscale sulfur use in agriculture, and describe future research directions to advance our understanding of the sustainable use of this material at the scale of individual fields

Grounded theory research on the factors that lead to doctor moral hazard

Moral hazard clearly exists among doctors, and it has a dramatic impact on doctor-patient relationships, medical costs and medical risks. This study explored the factors that lead to doctor moral hazard, as well as the interrelationships and internal regularity of these factors. This study takes doctor moral hazard as the research content and the inducing factors as the core theme, conducting grounded theory research on the causes of doctor moral hazard. Scientific understanding of doctor behavior would facilitate the prevention and control of doctor moral hazard behavior. This study used the principles and methodology of Glaser and Strauss’s grounded theory. Theoretical and snowball samplings were used to identify 24 subjects. Semi-structured in depth interviews were conducted with each subject. Themes were identified through substantial (open) coding and theoretical coding. The factors that lead to doctor moral hazard were categorized into five dimensions, i.e. motivation, opportunity, self rationalization, exposure and punishment. These five factors influence each other, forming the inducing mechanism of doctor moral hazard. This will provide useful theoretical support and method guidance for the follow-up prevention and control of moral hazard for doctors