Tension In The Chinese Doctor-Patient-Family Relationship: A Qualitative Study In Hunan Province, China

Problems facing the doctor-patient-family relationship (DPFR) in China, including violence against doctors, have received international attention. Possible contributors to tension in the medical relationship include systems-level challenges such as imbalances between provider and patient populations and a biased media. Yet, there has been limited empiric prior work examining how interpersonal dynamics, particularly communication, between patients, their family members, and providers contribute to satisfaction or tension. This study aims to identify actionable communication factors contributing to tension in the Chinese doctor-patient-family relationship among breast surgeons, surgical patients, and their family members in an urban, tertiary-level teaching in Hunan Province, China. We conducted a qualitative study between June and August 2015. We recruited a convenience sample of 29 participants, including 11 breast lumpectomy inpatients, 9 corresponding family members, and 9 surgeons. In-depth, semi-structured interviews were conducted perioperatively in Mandarin and English. Interviews were transcribed and translated into English. Transcripts were coded and thematic analysis was applied. We identified three emergent themes regarding tension: 1) Trust degradation occurred before and during the healthcare experience; 2) The healthcare-seeking experience for patients and family members was marked by unmet expectations for achieving a basic understanding as well as powerlessness; and 3) Societal pressures on doctors contributed to a state of learned helplessness. Findings from this study suggest that tension between doctors, patients, and family members is associated with both interpersonal and structural challenges with communication playing an important role. Reforms at all levels are needed to promote empowerment by providing a more patient-centered experience for patients and family members while ensuring the well-being and security of providers

Effect of Dietary Maillard Reaction Products on Insulin Sensitivity, Metabolic Inflammation and Intestinal Inflammation in Mice Fed the Total Western Diet

Maillard reaction products (MRPs) are generated when proteins or amino acids are heated with reducing sugars. In previous studies, baking whole diet pellets at a high temperature has been the most common way to promote MRP formation. However, baking diets also induces other chemical reactions besides MRP production, for example lipid oxidation. In this study, only casein and sugars were cooked to generate MRPs. Thus, a complementary experiment was conducted to determine how baking diet pellets affects lipid oxidation. Previous rodent studies showed MRPs either induced weight gain and or impaired glucose tolerance. On the other hand, dietary MRPs were shown to alleviate colitis induced by dextran sodium sulfate (DSS). The aim of this study was to elucidate the effects of dietary MRPs generated by a different treatment method in a different diet on weight gain, glucose metabolism and intestinal health in mice. Three groups of C57BL6/J mice (n=10/gp) were fed the Total Western Diet (TWD) with different levels of MRPs: MRP0, TWD with low level of MRPs; MRP1, TWD with medium level of MRPs, and MRP2, TWD with high level of MRPs. Mice receiving different levels of MRPs in their diet showed no significant difference in weight gain. Mice receiving 10 days of oral administration of dextran sodium sulfate (DSS) showed no significant difference in histology and colitis score of their colons. The results of the oral glucose tolerance test (OGTT) showed that the normalized area under the curve (AUC) of blood sugar during 120 minutes of MRP2 was significantly lower than that of MRP0 (p \u3c 0.05), indicating that increased intake of MRPs either promoted insulin secretion, increased insulin sensitivity in target tissues, or both. Alpha diversity of fecal microbiome showed significant differences at phylum level (p \u3c 0.01) and class level (p \u3c 0.01). Beta diversity of the cecal microbiome (p \u3c 0.004) and the fecal microbiome (p \u3c 0.001) showed significant differences at all taxonomic levels (OTU level, species, genus, family, order, class and phylum). Different levels of MRPs in the TWD induced significantly different taxonomic abundance of cecal microbiome at OTU level, species level and phylum level (p \u3c 0.05), and significantly different taxonomic abundance of fecal microbiome at all other taxonomic levels except Species level (p \u3c 0.05). Short chain fatty acids as microbial fermentation products were measured in the cecal and fecal contents using gas chromatography with flame ionization detection (GC-FID). Valeric acid, propionic acid and butyric acid in the cecal contents, along with propionic acid and valeric acid in the fecal contents were significantly different between the three groups (p \u3c 0.05). Baking diets to promote MRP formation was shown to significantly increase lipid oxidation. This suggests that the negative effects of MRPs on glucose metabolism shown in previous studies may be actually caused by ingestion of lipid oxidation products, rather than MRPs. In conclusion, ingestion of MRPs affected both glucose tolerance and the gut microflora. MRPs did not induce obesity in mice, nor did any of the mice show symptoms of colitis after receiving DSS for 10 days. Intake of MRPs decreased overall incremental blood glucose concentration during OGTT, indicating that it could reduce the risk of high blood glucose, which would be beneficial for health. High alpha diversity of gut microbiota is associated with healthy state according to previous human studies. Alpha diversity of fecal microbiome decreased with higher MRPs level in diet, and the significance of this observation is unclear. The microbiota composition and microbial fermentation products SCFAs in the hindgut of mice were changed by intake of MRPs. As SCFAs could play a role in the improvement of insulin sensitivity in mice, further studies should investigate possible mechanisms of this beneficial effect

Solving a class of zero-sum stopping game with regime switching

This paper studies a class of zero-sum stopping game in a regime switching model. A verification theorem as a sufficient criterion for Nash equilibriums is established based on a set of variational inequalities (VIs). Under an appropriate regularity condition for solutions to the VIs, a suitable system of algebraic equations is derived via the so-called smooth-fit principle. Explicit Nash equilibrium stopping rules of threshold-type for the two players and the corresponding value function of the game in closed form are obtained. Numerical experiments are reported to demonstrate the dependence of the threshold levels on various model parameters. A reduction to the case with no regime switching is also presented as a comparison

Plan integration for ecological resilience: examining factors associated with wetland alteration

A community’s resilience is strongly influenced by the growth management guidance provided by its network of plans. Wetland loss has been shown to amplify flood damage. This study explores the relationship between plan integration and wetland alteration, comparing the findings from Fort Lauderdale, Florida, and League City, Texas. Combining spatial analytics, a Plan Integration for Resilience Scorecard™ evaluation, and correlational statistics, we find that wetland loss is significantly associated with plan integration and development patterns and is less acute in League City than Fort Lauderdale. Integrating wetland protection policies throughout a network of plans helps build resilience to flood hazards

Point Normal Orientation and Surface Reconstruction by Incorporating Isovalue Constraints to Poisson Equation

Oriented normals are common pre-requisites for many geometric algorithms based on point clouds, such as Poisson surface reconstruction. However, it is not trivial to obtain a consistent orientation. In this work, we bridge orientation and reconstruction in implicit space and propose a novel approach to orient point clouds by incorporating isovalue constraints to the Poisson equation. Feeding a well-oriented point cloud into a reconstruction approach, the indicator function values of the sample points should be close to the isovalue. Based on this observation and the Poisson equation, we propose an optimization formulation that combines isovalue constraints with local consistency requirements for normals. We optimize normals and implicit functions simultaneously and solve for a globally consistent orientation. Owing to the sparsity of the linear system, an average laptop can be used to run our method within reasonable time. Experiments show that our method can achieve high performance in non-uniform and noisy data and manage varying sampling densities, artifacts, multiple connected components, and nested surfaces

Beneath Surface Similarity: Large Language Models Make Reasonable Scientific Analogies after Structure Abduction

The vital role of analogical reasoning in human cognition allows us to grasp novel concepts by linking them with familiar ones through shared relational structures. Despite the attention previous research has given to word analogies, this work suggests that Large Language Models (LLMs) often overlook the structures that underpin these analogies, raising questions about the efficacy of word analogies as a measure of analogical reasoning skills akin to human cognition. In response to this, our paper introduces a task of analogical structure abduction, grounded in cognitive psychology, designed to abduce structures that form an analogy between two systems. In support of this task, we establish a benchmark called SCAR, containing 400 scientific analogies from 13 distinct fields, tailored for evaluating analogical reasoning with structure abduction. The empirical evidence underlines the continued challenges faced by LLMs, including ChatGPT and GPT-4, in mastering this task, signifying the need for future exploration to enhance their abilities.Comment: Accepted to EMNLP 2023 (Findings

Exploring Straighter Trajectories of Flow Matching with Diffusion Guidance

Flow matching as a paradigm of generative model achieves notable success across various domains. However, existing methods use either multi-round training or knowledge within minibatches, posing challenges in finding a favorable coupling strategy for straight trajectories. To address this issue, we propose a novel approach, Straighter trajectories of Flow Matching (StraightFM). It straightens trajectories with the coupling strategy guided by diffusion model from entire distribution level. First, we propose a coupling strategy to straighten trajectories, creating couplings between image and noise samples under diffusion model guidance. Second, StraightFM also integrates real data to enhance training, employing a neural network to parameterize another coupling process from images to noise samples. StraightFM is jointly optimized with couplings from above two mutually complementary directions, resulting in straighter trajectories and enabling both one-step and few-step generation. Extensive experiments demonstrate that StraightFM yields high quality samples with fewer step. StraightFM generates visually appealing images with a lower FID among diffusion and traditional flow matching methods within 5 sampling steps when trained on pixel space. In the latent space (i.e., Latent Diffusion), StraightFM achieves a lower KID value compared to existing methods on the CelebA-HQ 256 dataset in fewer than 10 sampling steps