Efficiency evaluation of healthcare services in China based on stochastic multicriteria acceptability analysis and directional distance function

Evaluating the efficiency of healthcare services accurately can help in analyzing the rationality of inputs and outputs in such services. Considering the consistency and equity of assessment criteria, this study conducts the stochastic multicriteria acceptability analysis (SMAA-2) with a directional distance function to evaluate the efficiency of healthcare services in 31 provincial administrative regions of mainland China, as observed in 2018. We use SMAA-DDF to explore all the projection directions to the efficient frontier instead of a certain projection direction. We measure the maximum and average efficiencies for each of the 31 provincial healthcare services. Our empirical findings show that only seven provinces achieve optimal healthcare service efficiency; the eastern area performed the best, followed by the central, western, and northeast areas. Furthermore, the path along the projection directions is provided to help inefficient provinces improve their efficiency and obtain the best possible positions.     

A Tradeoff Between Accuracy and Speed for K-Means Seed Determination

With a sharp increase in the information volume, analyzing and retrieving this vast data volume is much more essential than ever. One of the main techniques that would be beneficial in this regard is called the Clustering method. Clustering aims to classify objects so that all objects within a cluster have similar features while other objects in different clusters are as distinct as possible. One of the most widely used clustering algorithms with the well and approved performance in different applications is the k-means algorithm. The main problem of the k-means algorithm is its performance which can be directly affected by the selection in the primary clusters. Lack of attention to this crucial issue has consequences such as creating empty clusters and decreasing the convergence time. Besides, the selection of appropriate initial seeds can reduce the cluster’s inconsistency. In this paper, we present a new method to determine the initial seeds of the k-mean algorithm to improve the accuracy and decrease the number of iterations of the algorithm. For this purpose, a new method is proposed considering the average distance between objects to determine the initial seeds. Our method attempts to provide a proper tradeoff between the accuracy and speed of the clustering algorithm. The experimental results showed that our proposed approach outperforms the Chithra with 1.7% and 2.1% in terms of clustering accuracy for Wine and Abalone detection data, respectively. Furthermore, achieved results indicate that comparing with the Reverse Nearest Neighbor (RNN) search approach, the proposed method has a higher convergence speed.     

Shared human–robot path following control of an unmanned ground vehicle

This paper considers the shared path following control of an unmanned ground vehicle by a single person. A passive measure of human intent is used to blend the human and machine inputs in a mixed initiative approach. The blending law is combined with saturated super-twisting sliding mode speed and heading controllers, so that exogenous disturbances can be counteracted via equivalent control. It is proven that when the proposed blending law is used, the combined control signals from both the human and automatic controller respect the actuator magnitude constraints of the machine. To demonstrate the approach, shared control experiments are performed using an unmanned ground vehicle, which follows a lawn mower pattern shaped path.     

Thermal shock effects on the impact resistance,tolerance and flexural strength of alumina based oxide/oxide ceramic matrix composites

In this study the effects of thermal shock on the impact damage resistance, damage tolerance and flexural strength of Nextel 610/alumina silicate ceramic matrix composites were experimentally evaluated. Composite laminates with balanced and symmetric layup were gradually heated to 1200°C in an air-based furnace and held for at least 30 min before being removed and immersed in water at room temperature. The laminates were then subjected to low velocity impacts via a hemispherical steel impactor. The resultant damage was characterized non-destructively, following which the laminates were subjected to compression tests. Three-point bend tests were also performed to evaluate the effect of thermal shock on the flexural strength and related failure modes of the laminates. Thermally shocked laminates showed smaller internal damage and larger external damage areas in comparison to their pristine counterparts. For the impact energy and resultant damage size considered, the residual compressive strengths for the thermally shocked and pristine laminates were similar.     

Adaptation to Endoplasmic Reticulum Stress Enhances Resistance of Oral Cancer Cells to Cisplatin by Up-Regulating Polymerase η and Increasing DNA Repair Efficiency

Endoplasmic reticulum (ER) stress response is an adaptive program to cope with cellular stress that disturbs the function and homeostasis of ER, which commonly occurs during cancer progression to late stage. Late-stage cancers, mostly requiring chemotherapy, often develop treatment resistance. Chemoresistance has been linked to ER stress response; however, most of the evidence has come from studies that correlate the expression of stress markers with poor prognosis or demonstrate proapoptosis by the knockdown of stress-responsive genes. Since ER stress in cancers usually persists and is essentially not induced by genetic manipulations, we used low doses of ER stress inducers at levels that allowed cell adaptation to occur in order to investigate the effect of stress response on chemoresistance. We found that prolonged tolerable ER stress promotes mesenchymal–epithelial transition, slows cell-cycle progression, and delays the S-phase exit. Consequently, cisplatin-induced apoptosis was significantly decreased in stress-adapted cells, implying their acquisition of cisplatin resistance. Molecularly, we found that proliferating cell nuclear antigen (PCNA) ubiquitination and the expression of polymerase η, the main polymerase responsible for translesion synthesis across cisplatin-DNA damage, were up-regulated in ER stress-adaptive cells, and their enhanced cisplatin resistance was abrogated by the knockout of polymerase η. We also found that a fraction of p53 in stress-adapted cells was translocated to the nucleus, and that these cells exhibited a significant decline in the level of cisplatin-DNA damage. Consistently, we showed that the nuclear p53 coincided with strong positivity of glucose-related protein 78 (GRP78) on immunostaining of clinical biopsies, and the cisplatin-based chemotherapy was less effective for patients with high levels of ER stress. Taken together, this study uncovers that adaptation to ER stress enhances DNA repair and damage tolerance, with which stressed cells gain resistance to chemotherapeutics.     

Radiation- and Photo-Induced Oxidation Pathways of Methionine in Model Peptide Backbone under Anoxic Conditions

Within the reactive oxygen species (ROS) generated by cellular metabolisms, hydroxyl radicals (HO^•) play an important role, being the most aggressive towards biomolecules. The reactions of HO^• with methionine residues (Met) in peptides and proteins have been intensively studied, but some fundamental aspects remain unsolved. In the present study we examined the biomimetic model made of Ac-Met-OMe, as the simplest model peptide backbone, and of HO^• generated by ionizing radiation in aqueous solutions under anoxic conditions. We performed the identification and quantification of transient species by pulse radiolysis and of final products by LC-MS and high-resolution MS/MS after γ-radiolysis. By parallel photochemical experiments, using 3-carboxybenzophenone (CB) triplet with the model peptide, we compared the outcomes in terms of short-lived intermediates and stable product identification. The result is a detailed mechanistic scheme of Met oxidation by HO^•, and by CB triplets allowed for assigning transient species to the pathways of products formation.     

Form selection of concomitant polymorphs: A case study informed by crystallization kinetics modeling

Molecular mechanisms and process kinetics of crystallizing concomitant polymorphs remain poorly understood. Solvent-mediated phase transformation and concomitant crystallization are difficult to be distinguished in practice, as multiple forms can be detected at the same time. Herein, we developed a population balance model to simulate a concomitant crystallization process of two polymorphs of tolfenamic acid. Our kinetic modeling aims to understand concomitant crystallization and help guide form selection of such a molecular system. Crystallization kinetics of ethanolic solutions were uncovered from induction time measurements, as well as seeded and unseeded crystallization experiments. Experimental and simulation results demonstrate that the stable form I crystallizes concomitantly with the metastable form II. The faster growing form II results in an intermediate decline in the composition of form I in crystallized samples, a characteristic feature of the concomitantly crystallized system. A four-quadrant scheme of attainable polymorph outcome was simulated under various crystallization conditions.