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

Randomness invalidates criminal smart contracts

A smart contract enforces specific performance on anonymous users without centralization. It facilitates payment equity in commerce by providing irreversible transactions. Smart contracts are also used for illegal activities such as money laundering and ransomware. Such contracts include criminal smart contracts (CSCs), proposed in CCS’16, that can be efficiently implemented in existing scripting languages. This aggravates concerns about the dangers of CSCs. However, PublicLeaks, a CSC for leaking private data, is conditionally implemented as it is influenced by various factors. For example, PublicLeaks does not necessarily reach a desirable terminal state for a criminal leaking private information, and other possible terminal states may invalidate the CSC. In this study, we propose a CSC based on PublicLeaks by formulating random factors such as the donation ratio. Our contract forks into five terminal states, including a unique one in PublicLeaks due to randomness. We simulated the maximal probabilities of these terminal states and found that the desirable terminal state in PublicLeaks is reachable with low probabilities (lower than 25%). The terminal state where the criminal fails to leak private information is attained with relatively high probabilities (over 65%). Therefore, our simulations show that CSCs are not always as powerful as expected, and the risk posed by them can be mitigated

In vitro regeneration of ‘Feizixiao’ litchi (Litchi chinensis Sonn.)

A simple efficient in vitro plant regeneration system was developed by indirect somatic embryogenesis of ‘Feizixiao’ litchi (Litchi chinensis Sonn.). Pollen in the anther of monocytes was used to induce callus. Two auxins (naphthalene acetic acid [NAA] and 2,4-dichloriphenoxyacetic acid [2,4-D]), and two cytokines (kinetin [KT] and 6-benzyladenine [BA]) were tested to explore their influence on callus induction. MS medium supplemented with 2.22 μM BA, 2.69 μM NAA, 13.57 μM 2,4-D, and 0.4 g/L LH (lactalbumin hydrolysate) showed the highest callus induction frequency. The callus obtained from anther was subcultured in MS medium containing 4.52 μM 2,4-D to obtain synchronized friable embryogenic callus. Different developmental stages of SEs were obtained from the callus on MS medium containing 6% (w/v) sucrose and different PGRs (plant growth regulators). On MS medium containing 6% (w/v) sucrose and supplemented with 0.54 μM NAA, 23.23 μM KT, 0.4 g/L LH, 0.56 μM inositol, and 10% (w/v) CW (coconut water), a higher number of SEs (globular, heart, torpedo and cotyledonary embryos) was achieved than on other media. Plantlets were established onto half-strength MS medium containing 1.44 μM GA3 (gibberellic acid) followed by successful acclimatization in the greenhouse. With flow cytometry and chromosome counting, ploidy analysis of regenerated plants revealed that the regenerated plantlets were all diploid. This study is the first report on somatic embryogenesis of ‘Feizixiao litchi’, providing an opportunity to improve the cultivar by biotechnology methods.Keywords: litchi (Litchi chinensis Sonn.), anther culture, callus, regeneration, somatic embryogenesi

Research on Embedded Sensors for Concrete Health Monitoring Based on Ultrasonic Testing

In this article, embedded ultrasonic sensors were prepared using 1–3-type piezoelectric composite and piezoelectric ceramic as the piezoelectric elements, respectively. The frequency bandwidth of the novel embedded ultrasonic sensors was investigated. To obtain the relationship between the receiving ultrasonic velocity and compressive strength, as well as their response signals to crack damage, the sensors were fabricated and embedded into the cement mortar before testing. The results demonstrated that the piezoelectric composite sensor had wider frequency bandwidth than the piezoelectric ceramic sensor. The compressive strength and ultrasonic velocity had a positive linear relationship, with a correlation coefficient of 0.9216. The head wave amplitude of the receiving ultrasonic signal was sensitive to the changing crack damage and gradually decayed with the increasing degree of cement damage. Thus, the novel embedded ultrasonic sensors are suitable for concrete health monitoring via ultrasonic non-destructive testing

Dynamic Hydrogel-Metal-Organic Framework System Promotes Bone Regeneration in Periodontitis Through Controlled Drug Delivery

Periodontitis is a prevalent chronic inflammatory disease, which leads to gradual degradation of alveolar bone. The challenges persist in achieving effective alveolar bone repair due to the unique bacterial microenvironment\u27s impact on immune responses. This study explores a novel approach utilizing Metal-Organic Frameworks (MOFs) (comprising magnesium and gallic acid) for promoting bone regeneration in periodontitis, which focuses on the physiological roles of magnesium ions in bone repair and gallic acid\u27s antioxidant and immunomodulatory properties. However, the dynamic oral environment and irregular periodontal pockets pose challenges for sustained drug delivery. A smart responsive hydrogel system, integrating Carboxymethyl Chitosan (CMCS), Dextran (DEX) and 4-formylphenylboronic acid (4-FPBA) was designed to address this problem. The injectable self-healing hydrogel forms a dual-crosslinked network, incorporating the MOF and rendering its on-demand release sensitive to reactive oxygen species (ROS) levels and pH levels of periodontitis. We seek to analyze the hydrogel\u27s synergistic effects with MOFs in antibacterial functions, immunomodulation and promotion of bone regeneration in periodontitis. In vivo and in vitro experiment validated the system\u27s efficacy in inhibiting inflammation-related genes and proteins expression to foster periodontal bone regeneration. This dynamic hydrogel system with MOFs, shows promise as a potential therapeutic avenue for addressing the challenges in bone regeneration in periodontitis

Current Progress in CAR-T Cell Therapy for Solid Tumors

Cancer immunotherapy by chimeric antigen receptor-modified T (CAR-T) cells has shown exhilarative clinical efficacy for hematological malignancies. Recently two CAR-T cell based therapeutics, Kymriah (Tisagenlecleucel) and Yescarta (Axicabtagene ciloleucel) approved by US FDA (US Food and Drug Administration) are now used for treatment of B cell acute lymphoblastic leukemia (B-ALL) and diffuse large B-cell lymphoma (DLBCL) respectively in the US. Despite the progresses made in treating hematological malignancies, challenges still remain for use of CAR-T cell therapy to treat solid tumors. In this landscape, most studies have primarily focused on improving CAR-T cells and overcoming the unfavorable effects of tumor microenvironment on solid tumors. To further understand the current status and trend for developing CAR-T cell based therapies for various solid tumors, this review emphasizes on CAR-T techniques, current obstacles, and strategies for application, as well as necessary companion diagnostics for treatment of solid tumors with CAR-T cells

Fluent: Round-efficient Secure Aggregation for Private Federated Learning

Federated learning (FL) facilitates collaborative training of machine learning models among a large number of clients while safeguarding the privacy of their local datasets. However, FL remains susceptible to vulnerabilities such as privacy inference and inversion attacks. Single-server secure aggregation schemes were proposed to address these threats. Nonetheless, they encounter practical constraints due to their round and communication complexities. This work introduces Fluent, a round and communication-efficient secure aggregation scheme for private FL. Fluent has several improvements compared to state-of-the-art solutions like Bell et al. (CCS 2020) and Ma et al. (SP 2023): (1) it eliminates frequent handshakes and secret sharing operations by efficiently reusing the shares across multiple training iterations without leaking any private information; (2) it accomplishes both the consistency check and gradient unmasking in one logical step, thereby reducing another round of communication. With these innovations, Fluent achieves the fewest communication rounds (i.e., two in the collection phase) in the malicious server setting, in contrast to at least three rounds in existing schemes. This significantly minimizes the latency for geographically distributed clients; (3) Fluent also introduces Fluent-Dynamic with a participant selection algorithm and an alternative secret sharing scheme. This can facilitate dynamic client joining and enhance the system flexibility and scalability. We implemented Fluent and compared it with existing solutions. Experimental results show that Fluent improves the computational cost by at least 75% and communication overhead by at least 25% for normal clients. Fluent also reduces the communication overhead for the server at the expense of a marginal increase in computational cost

Lower-Elementary Level School Pupils' Developmental Trajectories of Chinese Verbal Vocabulary Knowledge and Influential Factors

149 elementary school pupils were selected as the subjects for this study, to whom five tracking assessments of their verbal vocabulary knowledge were given over a period of three years. In addition, a latent variable growth model was adopted to explore grades 1-3 elementary school pupil’s developmental trajectory for verbal Chinese vocabulary knowledge. The phonological awareness, homomorphic morpheme awareness, compound morpheme awareness and family socioeconomic status (SES) on the students’ verbal vocabulary knowledge were also investigated. The ndings are: 1, grades 1-3 elementary school pupils verbal Chinese vocabulary knowledge developmental trajectory shows a curvilinear form, of which linear development is trended in the first two years, and as of the third year the developmental rate doubles the previous two years, whereas individual di erences are remarkable in both the initial level and the growth rate; 2, awareness of phonetics, homomorphic morphemes and complex morphemes as well as the family socioeconomic status can be referred to for a positive forecast of the students’ initial level of verbal vocabulary knowledge; 3, only the awareness of homomorphic morphemes and the family socioeconomic status can be applied to a positive prediction of the students’ verbal vocabulary knowledge growth rate.

Development and Characterization of EST-SSR Markers From RNA-Seq Data in Phyllostachys violascens

Bamboo are woody grass species containing important economic and ecological values. Lei bamboo (Phyllostachys violascens) is a kind of shoot-producing bamboo species with the highest economic yield per unit area. However, identifying different varieties of Lei bamboo based on morphological characteristics is difficult. Microsatellites play an important role in plant identification and genetic diversity analysis and are superior to other molecular markers. In this study, we identified 18,356 expressed sequence tag-simple sequence repeat (EST-SSR) loci in Lei bamboo transcriptome data. A total of 11,264 primer pairs were successfully designed from unigenes of all EST-SSR loci, and 96 primer pairs were randomly selected and synthesized. A total of 54 primer pairs were used for classifying 16 Lei bamboo varieties and 10 different Phyllostachys species. The number of polymorphism alleles among the 54 primer pairs ranged from 3 to 12 for P. violascens varieties and 3 to 20 for Phyllostachys. The phylogenetic tree based on polymorphism alleles successfully distinguished 16 P. violascens varieties and 10 Phyllostachys species. Our study provides abundant EST-SSR resources that are useful for genetic diversity analysis and molecular verification of bamboo and suggests that SSR markers developed from Lei bamboo are more efficient and reliable than ISSR, SRAP or AFLP markers