医保支付方式改革是优化医疗资源配置、规范医疗服务行为的重要手段,也是健全医保支付机制的核心,我国按疾病诊断相关分组(diagnosis related group,DRG)付费改革已经进入到全面推进的实践阶段。按DRG付费改革是推动医院进行成本管理、...医保支付方式改革是优化医疗资源配置、规范医疗服务行为的重要手段,也是健全医保支付机制的核心,我国按疾病诊断相关分组(diagnosis related group,DRG)付费改革已经进入到全面推进的实践阶段。按DRG付费改革是推动医院进行成本管理、绩效管理、质量评价的管理工具和方法,是医院迈向价值医疗和精细化管理的重要措施。文章通过梳理DRG的概念及国内发展历程,并结合我国公立医院现行的管理模式,从开展病种成本核算、提高病案质量、探索绩效考核新模式、优化临床路径四个方面,分析医保付费新模式对医院运营管理的影响,提出医保支付方式改革背景下医院的应对策略。展开更多
An effective electrocatalyst being highly active in all pH range for oxygen reduction reaction(ORR)is crucial for energy conversion and storage devices.However,most of the high-efficiency ORR catalysis was reported in...An effective electrocatalyst being highly active in all pH range for oxygen reduction reaction(ORR)is crucial for energy conversion and storage devices.However,most of the high-efficiency ORR catalysis was reported in alkaline conditions.Herein,we demonstrated the preparation of atomically dispersed Fe-Zn pairs anchored on porous N-doped carbon frameworks(Fe-Zn-SA/NC),which works efficiently as ORR catalyst in the whole pH range.It achieves high half-wave potentials of 0.78,0.85 and 0.72 V in 0.1 M HClO4,0.1 M KOH and 0.1 M phosphate buffer saline(PBS)solutions,respectively,as well as respectable stability.The performances are even comparable to Pt/C.Furthermore,when assembled into a Zn-air battery,the high power density of 167.2 mWcm−2 and 120 h durability reveal the feasibility of Fe-Zn-SA/NC in real energy-related devices.Theoretical calculations demonstrate that the superior catalytic activity of Fe-Zn-SA/NC can be contributed to the lower energy barriers of ORR at the Fe-Zn-N6 centers.This work demonstrates the potential of Fe-Zn pairs as alternatives to the Pt catalysts for efficient catalytic ORR and provides new insights of dual-atom catalysts for other energy conversion related catalytic reactions.展开更多
Converting solar energy into chemical energy by artificial photosynthesis is promising in addressing the issues of the greenhouse effect and fossil fuel crisis.Herein,a novel photocatalyst,i.e.CdS/TiO_(2) hollow micro...Converting solar energy into chemical energy by artificial photosynthesis is promising in addressing the issues of the greenhouse effect and fossil fuel crisis.Herein,a novel photocatalyst,i.e.CdS/TiO_(2) hollow microspheres(HS),were dedicatedly designed to boost overall photocatalytic efficiency.TiO_(2) nanoparticles were in-situ decorated on the inside and outside the shell of Cd S HS,ensuring close contact between TiO_(2) and CdS.The CdS/TiO2 HS with abundant mesopores inside of the shell boost the light absorption via multiscattering effect as well as accessible to reactions in all directions.The heterojunction was scrutinized and the charge transfer across it was revealed by in-situ irradiated X-ray photoelectron spectroscopy(ISI-XPS).Ultimately,the charge transfer in this composite was determined to follow stepscheme mechanism,which not only facilitates the separation of charge carriers but also preserves strong redox ability.Benefited from the intimate linkage between Cd S and TiO_(2) and the favorable step-scheme heterojunction,enhanced photocatalytic CO_(2) reduction activity was accomplished.The CH4 yield rate of CdS/TiO_(2) reaches 27.85μmol g^(–1) h^(–1),which is 145.6 and 3.8 times higher than those of pristine CdS and TiO_(2),respectively.This work presents a novel insight into constructing step-scheme photocatalytic system with desirable performance.展开更多
Transformers,the dominant architecture for natural language processing,have also recently attracted much attention from computational visual media researchers due to their capacity for long-range representation and hi...Transformers,the dominant architecture for natural language processing,have also recently attracted much attention from computational visual media researchers due to their capacity for long-range representation and high performance.Transformers are sequence-to-sequence models,which use a selfattention mechanism rather than the RNN sequential structure.Thus,such models can be trained in parallel and can represent global information.This study comprehensively surveys recent visual transformer works.We categorize them according to task scenario:backbone design,high-level vision,low-level vision and generation,and multimodal learning.Their key ideas are also analyzed.Differing from previous surveys,we mainly focus on visual transformer methods in low-level vision and generation.The latest works on backbone design are also reviewed in detail.For ease of understanding,we precisely describe the main contributions of the latest works in the form of tables.As well as giving quantitative comparisons,we also present image results for low-level vision and generation tasks.Computational costs and source code links for various important works are also given in this survey to assist further development.展开更多
Software-Defined Networking (SDN) has been a hot topic for future network development, which implements the different layers of control plane and data plane respectively. Despite providing high openness and programmab...Software-Defined Networking (SDN) has been a hot topic for future network development, which implements the different layers of control plane and data plane respectively. Despite providing high openness and programmability, the “three-layer two-interface” architecture of SDN changes the traditional network and increases the network attack nodes, which results in new security issues. In this paper, we firstly introduced the background, architecture and working process of SDN. Secondly, we summarized and analyzed the typical security issues from north to south: application layer, northbound interface, control layer, southbound interface and data layer. Another contribution is to review and analyze the existing solutions and latest research progress of each layer, mainly including: authorized authentication module, application isolation, DoS/DDoS defense, multi-controller deployment and flow rule consistency detection. Finally, a conclusion about the future works of SDN security and an idealized global security architecture is proposed.展开更多
OBJECTIVE:To further evaluate the complementary effect of Yiqi Huoxue Jiedu decoction(YHJD)on patients with advanced epithelial ovarian cancer(EOC).METHODS:All 330 enrolled participants diagnosed with stageⅢc EOC wer...OBJECTIVE:To further evaluate the complementary effect of Yiqi Huoxue Jiedu decoction(YHJD)on patients with advanced epithelial ovarian cancer(EOC).METHODS:All 330 enrolled participants diagnosed with stageⅢc EOC were randomly divided into two groups that received YHJD or a placebo.The primary end point was health-related quality of life(HRQL)measured by the functional assessment of cancer therapy-ovary cancer(FACT-O)questionnaire.The secondary end point was progression-free survival(PFS).RESULTS:A total of 299 participants completed the trial with 153 and 146 in YHJD and control groups,respectively.After 6 months of treatment,YHJD increased physical wellbeing(PWB),functional wellbeing(FWB),additional concerns(AC),and the trial outcome index(TOI)(P<0.05)by various degrees compared with the baseline.YHJD also had notable advantages over the placebo at 3 and 6 months in terms of PWB,FWB,AC(P<0.05),and TOI(P<0.01).In addition,YHJD had a significant advantage in terms of PFS compared with the placebo(21 vs18 months,P<0.05).No adverse events were reported.CONCLUSION:YHJD is an effective and safe choice as a complementary therapy to improve HRQL and prolong PFS of stageⅢc EOC patients.展开更多
Chlorin e6-pHLIPss-AuNRs, a gold nanorod-photosensitizer conjugate containing a pH （low） insertion peptide （pHLIP） with a disulfide bond which imparts extracellular pH （pHe）-driven tumor targeting ability, has b...Chlorin e6-pHLIPss-AuNRs, a gold nanorod-photosensitizer conjugate containing a pH （low） insertion peptide （pHLIP） with a disulfide bond which imparts extracellular pH （pHe）-driven tumor targeting ability, has been successfully developed for bimodal photodynamic and photothermal therapy. In this bimodal therapy, chlorin e6 （Ce6）, a second-generation photosensitizer （PS）, is used for photodynamic therapy （PDT）. Gold nanorods （AuNRs） are used as a hyperthermia agent for photothermal therapy （PTT） and also as a nanocarrier and quencher of Ce6. pHLIPss is designed as a pile-driven targeting probe to enhance accumulation of Ce6 and AuNRs in cancer cells at low pH. In Ce6- pHLIPss-AuNRs, Ce6 is close to and quenched by AuNRs, causing little PDT effect. When exposed to normal physiological pH 7.4, Ce6-pHLIPs^-AuNRs loosely associate with the cell membrane. However, once exposed to acidic pH 6.2, pHLIP actively inserts into the cell membrane, and the conjugates are translocated into cells. When this occurs, Ce6 separates from the AuNRs as a result of disulfide bond cleavage caused by intracellular glutathione （GSH）, and singlet oxygen is produced for PDT upon light irradiation. In addition, as individual PTT agent, AuNRs can enhance the accumulation of PSs in the tumor by the enhanced permeation and retention （EPR） effect. Therefore, as indicated by our data, when exposed to acidic pH, Ce6-pHLIPss-AuNRs can achieve synergistic PTT/PDT bimodality for cancer treatment.展开更多
文摘医保支付方式改革是优化医疗资源配置、规范医疗服务行为的重要手段,也是健全医保支付机制的核心,我国按疾病诊断相关分组(diagnosis related group,DRG)付费改革已经进入到全面推进的实践阶段。按DRG付费改革是推动医院进行成本管理、绩效管理、质量评价的管理工具和方法,是医院迈向价值医疗和精细化管理的重要措施。文章通过梳理DRG的概念及国内发展历程,并结合我国公立医院现行的管理模式,从开展病种成本核算、提高病案质量、探索绩效考核新模式、优化临床路径四个方面,分析医保付费新模式对医院运营管理的影响,提出医保支付方式改革背景下医院的应对策略。
基金This work was financially supported by National Key R&D Program of China(No.2017YFA0700104)the National Natural Science Foundation of China(Nos.22075211,21601136,51971157,51761165012,and 62005173)+2 种基金Project funded by China Postdoctoral Science Foundation(No.2020TQ0201)Tianjin Science Fund for Distinguished Young Scholars(No.19JCJQJC61800)The authors also acknowledge National Supercomputing Center in Shenzhen for providing the computational resources and materials studio(version 7.0,DMol3).
文摘An effective electrocatalyst being highly active in all pH range for oxygen reduction reaction(ORR)is crucial for energy conversion and storage devices.However,most of the high-efficiency ORR catalysis was reported in alkaline conditions.Herein,we demonstrated the preparation of atomically dispersed Fe-Zn pairs anchored on porous N-doped carbon frameworks(Fe-Zn-SA/NC),which works efficiently as ORR catalyst in the whole pH range.It achieves high half-wave potentials of 0.78,0.85 and 0.72 V in 0.1 M HClO4,0.1 M KOH and 0.1 M phosphate buffer saline(PBS)solutions,respectively,as well as respectable stability.The performances are even comparable to Pt/C.Furthermore,when assembled into a Zn-air battery,the high power density of 167.2 mWcm−2 and 120 h durability reveal the feasibility of Fe-Zn-SA/NC in real energy-related devices.Theoretical calculations demonstrate that the superior catalytic activity of Fe-Zn-SA/NC can be contributed to the lower energy barriers of ORR at the Fe-Zn-N6 centers.This work demonstrates the potential of Fe-Zn pairs as alternatives to the Pt catalysts for efficient catalytic ORR and provides new insights of dual-atom catalysts for other energy conversion related catalytic reactions.
基金financially supported by the National Natural Science Foundation of China(NSFC)(Nos.51872220,51932007,51961135303,21871217,U1905215 and U1705251)the National Key Research and Development Program of China(No.2018YFB1502001)the Fundamental Research Funds for the Central Universities(No.WUT:2019IVB050)。
文摘Converting solar energy into chemical energy by artificial photosynthesis is promising in addressing the issues of the greenhouse effect and fossil fuel crisis.Herein,a novel photocatalyst,i.e.CdS/TiO_(2) hollow microspheres(HS),were dedicatedly designed to boost overall photocatalytic efficiency.TiO_(2) nanoparticles were in-situ decorated on the inside and outside the shell of Cd S HS,ensuring close contact between TiO_(2) and CdS.The CdS/TiO2 HS with abundant mesopores inside of the shell boost the light absorption via multiscattering effect as well as accessible to reactions in all directions.The heterojunction was scrutinized and the charge transfer across it was revealed by in-situ irradiated X-ray photoelectron spectroscopy(ISI-XPS).Ultimately,the charge transfer in this composite was determined to follow stepscheme mechanism,which not only facilitates the separation of charge carriers but also preserves strong redox ability.Benefited from the intimate linkage between Cd S and TiO_(2) and the favorable step-scheme heterojunction,enhanced photocatalytic CO_(2) reduction activity was accomplished.The CH4 yield rate of CdS/TiO_(2) reaches 27.85μmol g^(–1) h^(–1),which is 145.6 and 3.8 times higher than those of pristine CdS and TiO_(2),respectively.This work presents a novel insight into constructing step-scheme photocatalytic system with desirable performance.
基金supported by National Key R&D Program of China under Grant No.2020AAA0106200National Natural Science Foundation of China under Grant Nos.61832016 and U20B2070.
文摘Transformers,the dominant architecture for natural language processing,have also recently attracted much attention from computational visual media researchers due to their capacity for long-range representation and high performance.Transformers are sequence-to-sequence models,which use a selfattention mechanism rather than the RNN sequential structure.Thus,such models can be trained in parallel and can represent global information.This study comprehensively surveys recent visual transformer works.We categorize them according to task scenario:backbone design,high-level vision,low-level vision and generation,and multimodal learning.Their key ideas are also analyzed.Differing from previous surveys,we mainly focus on visual transformer methods in low-level vision and generation.The latest works on backbone design are also reviewed in detail.For ease of understanding,we precisely describe the main contributions of the latest works in the form of tables.As well as giving quantitative comparisons,we also present image results for low-level vision and generation tasks.Computational costs and source code links for various important works are also given in this survey to assist further development.
基金supported by the Wuhan Frontier Program of Application Foundation (No.2018010401011295)National High Technology Research and Development Program of China (“863” Program) (Grant No. 2015AA016002)
文摘Software-Defined Networking (SDN) has been a hot topic for future network development, which implements the different layers of control plane and data plane respectively. Despite providing high openness and programmability, the “three-layer two-interface” architecture of SDN changes the traditional network and increases the network attack nodes, which results in new security issues. In this paper, we firstly introduced the background, architecture and working process of SDN. Secondly, we summarized and analyzed the typical security issues from north to south: application layer, northbound interface, control layer, southbound interface and data layer. Another contribution is to review and analyze the existing solutions and latest research progress of each layer, mainly including: authorized authentication module, application isolation, DoS/DDoS defense, multi-controller deployment and flow rule consistency detection. Finally, a conclusion about the future works of SDN security and an idealized global security architecture is proposed.
基金Supported by National Natural Science Foundation of China(NSFC)-funded Project:the Mechanisms of Tailored Immunotherapy of Yiqi Huoxue Jiedu Decoction Modulating T Regulatory Cells at the Level of the Tumor Microenvironment and Inherited Single Nucleotide Polymorphisms in Advanced Ovarian Cancer(No.81473566).
文摘OBJECTIVE:To further evaluate the complementary effect of Yiqi Huoxue Jiedu decoction(YHJD)on patients with advanced epithelial ovarian cancer(EOC).METHODS:All 330 enrolled participants diagnosed with stageⅢc EOC were randomly divided into two groups that received YHJD or a placebo.The primary end point was health-related quality of life(HRQL)measured by the functional assessment of cancer therapy-ovary cancer(FACT-O)questionnaire.The secondary end point was progression-free survival(PFS).RESULTS:A total of 299 participants completed the trial with 153 and 146 in YHJD and control groups,respectively.After 6 months of treatment,YHJD increased physical wellbeing(PWB),functional wellbeing(FWB),additional concerns(AC),and the trial outcome index(TOI)(P<0.05)by various degrees compared with the baseline.YHJD also had notable advantages over the placebo at 3 and 6 months in terms of PWB,FWB,AC(P<0.05),and TOI(P<0.01).In addition,YHJD had a significant advantage in terms of PFS compared with the placebo(21 vs18 months,P<0.05).No adverse events were reported.CONCLUSION:YHJD is an effective and safe choice as a complementary therapy to improve HRQL and prolong PFS of stageⅢc EOC patients.
文摘Chlorin e6-pHLIPss-AuNRs, a gold nanorod-photosensitizer conjugate containing a pH （low） insertion peptide （pHLIP） with a disulfide bond which imparts extracellular pH （pHe）-driven tumor targeting ability, has been successfully developed for bimodal photodynamic and photothermal therapy. In this bimodal therapy, chlorin e6 （Ce6）, a second-generation photosensitizer （PS）, is used for photodynamic therapy （PDT）. Gold nanorods （AuNRs） are used as a hyperthermia agent for photothermal therapy （PTT） and also as a nanocarrier and quencher of Ce6. pHLIPss is designed as a pile-driven targeting probe to enhance accumulation of Ce6 and AuNRs in cancer cells at low pH. In Ce6- pHLIPss-AuNRs, Ce6 is close to and quenched by AuNRs, causing little PDT effect. When exposed to normal physiological pH 7.4, Ce6-pHLIPs^-AuNRs loosely associate with the cell membrane. However, once exposed to acidic pH 6.2, pHLIP actively inserts into the cell membrane, and the conjugates are translocated into cells. When this occurs, Ce6 separates from the AuNRs as a result of disulfide bond cleavage caused by intracellular glutathione （GSH）, and singlet oxygen is produced for PDT upon light irradiation. In addition, as individual PTT agent, AuNRs can enhance the accumulation of PSs in the tumor by the enhanced permeation and retention （EPR） effect. Therefore, as indicated by our data, when exposed to acidic pH, Ce6-pHLIPss-AuNRs can achieve synergistic PTT/PDT bimodality for cancer treatment.
