Daniel Wang

Jian Zhou,* Weiqiang Ju,* Xiaopeng Yuan, Xiaofeng Zhu, Dongping Wang, Xiaoshun HeOrgan Transplant Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China *These authors contributed equally to this work: Hyperosmolar nonketotic hyperglycemic coma is a serious, rare complication induced by methylprednisolone pulse therapy for acute rejection after orthotopic liver transplantation. Herein, we report an unusual case of a 58-year-old woman who experienced acute rejection at 30 months after OLT, only one case in which HNKHC resulted in MP pulse therapy for acute rejection in all 913 recipients in our center. The general morbidity of HNKHC was 1.09‰ in this study. HNKHC is characterized by rapid onset, rapid progression, and a lack of specific clinical manifestations. High-dose MP management was a clear risk factor. The principle of treatment included rapid rehydration, low-dose insulin infusion, and correcting disorders of electrolytes and acidosis. In conclusion, clinicians considering MP pulse therapy after OLT should be alert to the occurrence of HNKHC. Keywords: liver transplantation, complications, hyperosmolar nonketotic hyperglycemic coma, methylprednisolone pulse therapy, principle of treatment.

As health policy-makers around the world seek to make progress towards universal health coverage they must navigate between two important ethical imperatives: to set national spending priorities fairly and efficiently; and to safeguard the right to health. These imperatives can conflict, leading some to conclude that rights-based approaches present a disruptive influence on health policy, hindering states’ efforts to set priorities fairly and efficiently. Here, we challenge this perception. We argue first that these points of tension stem largely from inadequate interpretations of the aims of priority setting as well as the right to health. We then discuss various ways in which the right to health complements traditional concerns of priority setting and vice versa. Finally, we set out a three-step process by which policy-makers may navigate the ethical and legal considerations at play.

As health policy-makers around the world seek to make progress towards universal health coverage they must navigate between two important ethical imperatives: to set national spending priorities fairly and efficiently; and to safeguard the right to health. These imperatives can conflict, leading some to conclude that rights-based approaches present a disruptive influence on health policy, hindering states’ efforts to set priorities fairly and efficiently. Here, we challenge this perception. We argue first that these points of tension stem largely from inadequate interpretations of the aims of priority setting as well as the right to health. We then discuss various ways in which the right to health complements traditional concerns of priority setting and vice versa. Finally, we set out a three-step process by which policy-makers may navigate the ethical and legal considerations at play.

© 2015 Wiley Periodicals, Inc. One of the major findings from multimodal neuroimaging studies in the past decade is that the human brain is anatomically and functionally organized into large-scale networks. In resting state fMRI, spatial patterns emerge when temporal correlations between various brain regions are tallied, evidencing networks of ongoing intercortical cooperation. However, the dynamic structure governing the brain's spontaneous activity is far less understood due to the short and noisy nature of the rs-fMRI signal. Here, we develop a wavelet-based regularity analysis based on noise estimation capabilities of the wavelet transform to measure recurrent temporal pattern stability within the rs-fMRI signal across multiple temporal scales. The method consists of performing a stationary wavelet transform to preserve signal structure, followed by construction of "lagged" subsequences to adjust for correlated features, and finally the calculation of sample entropy across wavelet scales based on an "objective" estimate of noise level at each scale. We found that the brain's default mode network areas manifest a higher level of irregularity in rs-fMRI time series than rest of the brain. In 25 aged subjects with mild cognitive impairment and 25 matched healthy controls, wavelet-based regularity analysis showed improved sensitivity in detecting changes in the regularity of rs-fMRI signals between the two groups within the DMN and executive control networks, compared with standard multiscale entropy analysis. Wavelet-based regularity analysis based on noise estimation capabilities of the wavelet transform is a promising technique to characterize the dynamic structure of rs-fMRI as well as other biological signals.

Both developing and developed countries face an increasing mismatch between what patients expect to receive from healthcare and what the public healthcare systems can afford to provide. Where there has been a growing recognition of the entitlement to receive healthcare, the frustrated expectations with regards to the level of provision has led to lawsuits challenging the denial of funding for health treatments by public health systems. This book analyses the impact of courts and litigation on the way health systems set priorities and make rationing decisions. In particular, it focuses on how the judicial protection of the right to healthcare can impact the institutionalization, functioning and centrality of Health Technology Assessment (HTA) for decisions about the funding of treatment. Based on the case study of three jurisdictions - Brazil, Colombia, and England - it shows that courts can be a key driver for the institutionalization of HTA. These case studies show the paradoxes of judicial control, which can promote accountability and impair it, demand administrative competence and undermine bureaucratic capacities. The case studies offer a nuanced and evidence-informed understanding of these paradoxes in the context of health care by showing how the judicial control of priority-setting decisions in health care can be used to require and control an explicit scheme for health technology assessment, but can also limit and circumvent it.

This paper is concerned with the target tracking problem of an autonomous surface vehicle in the presence of a maneuvering target. The velocity information of target is totally unknown to the follower vehicle, and only the relative distance and angle between the target and follower are obtained. First, a reduced-order extended state observer is used to estimate the unknown relative dynamics due to the unavailable velocity of the target. Based on the reduced-order extended state observer, an antidisturbance guidance law for target tracking is designed. The input-to-state stability of the closed-loop target tracking guidance system is analyzed via cascade theory. Furthermore, the above result is extended to the case that collisions between the target and leader are avoided during tracking, and a collision-free target tracking guidance law is developed. The main feature of the proposed guidance law is twofold. First, the target tracking can be achieved without using the velocity information of the target. Second, collision avoidance can be achieved during target tracking. Simulation results show the effectiveness of the proposed antidisturbance guidance law for tracking a maneuvering target with the arbitrary bounded velocity.

Mental health issues are becoming increasingly prevalent amongst university students. However, research on the psychological profile of the general university population is relatively limited. Thus, this study analyses the current state of university students’ psychological conditions; the demographic differences in depression, anxiety, and stress and the influencing factors. The objectives are to provide additional appropriate guidance in mental health for university students with different demographic characteristics. A cross-sectional study of 6,032 university students nationwide was conducted from October 2020 to January 2021. A randomized whole-group sampling method was used to select the study participants, and the 21-item Depression, Anxiety, and Stress Scale was used. P < 0.05 in the final model were considered statistically significant. The number of university students with no complain of depression, anxiety, or stress was 3,751. The odds of developing complain of depression were higher amongst anxious respondents and senior year than their counterparts. Students with “myopia” were 1.263 times more likely to be anxious. In terms of “impaired” or not, impaired is defined as any injury, such as sprain, strain, and fracture, “impaired” university students were 1.321 times more likely to be anxious. Furthermore, history of impairment and myopia increased the odds of stress by 1.305 and 1.305, respectively. Myopia, physical-activity-related injury and irrational eating habits are risk factors for complain of anxiety and stress. Males, upper grades, low parental education, and irrational eating habits are risk factors for complain of depression. Low physical activity levels are also an influential factor for complain of depression. DASS consists of interchangeable risk factors and multiple complains of DASS may coexist.

Although previous research shows that general self-efficacy is related to employability, the mechanism of them is unclear. Thus, this study aims to explore the relationship between general self-efficacy and employability, examines the mediating role of achievement motivation and career aspirations among financially underprivileged college students in China. The analysis of 651 participants from six provinces indicates that general self-efficacy positively predicts employability through the mediating chain of achievement motivation and career aspirations. Based on these findings, the researchers propose feasible suggestions for related issues of financially underprivileged college students and future research.

Drawing on social exchange theory, the present study seeks to understand how ethical leaders channel followers’ responses to positive treatment from the organization into a dutiful mindset, resulting in in-role and extra-role performance. Specifically, it examines the influence of perceived organizational support on both followers’ job performance and organizational citizenship behaviors, and the mediating effects of duty orientation on such relationships. In addition, it examines whether the mediated effects are contingent on the ethical leadership exhibited by the team leader. Based on multi-source, multi-level data obtained from 233 employees in 60 teams from the Chinese public sector, we found that ethical leadership moderated the mediated relationship between perceived organizational support and follower work behaviors through duty orientation, such that this relationship was stronger in the presence of higher ethical leadership.

Purpose To investigate the reliability and accuracy of two pseudo-continuous arterial spin labeling sequences, using two-dimensional gradient-echo echo planar imaging and 3D gradient and spin echo as the readout, respectively. Materials and Methods Each sequence was performed twice 4 weeks apart on six normal control subjects, six elderly subjects with mild cognitive impairment, and one participant with Alzheimer's disease. Eight of these subjects also underwent H 215O positron emission tomography scans on the same day or proximal to their second MRI scan. The longitudinal repeatability of EPI and GRASE pCASL were evaluated with the intraclass correlation coefficient and within-subject coefficient of variation. Results The ICCs of global perfusion measurements were 0.697 and 0.413 for GRASE and EPI based pCASL respectively. GRASE pCASL also demonstrated a higher longitudinal repeatability for regional perfusion measurements across 24 regions-of-interests compared with EPI pCASL. When compared with PET, EPI pCASL showed a higher degree of spatial correlation with PET than GRASE pCASL, although the difference was not statistically significant. Conclusion The 3D GRASE pCASL offers better repeatability than 2D EPI pCASL, thereby may provide a reliable imaging marker for the evaluation of disease progression and treatment effects in MCI and early AD subjects. © 2013 Wiley Periodicals, Inc.

Despite the importance of ethical leadership, the impacts of its different facets on firm-level performance are unclear. Drawing on the resource-based view of the firm and the group engagement model, we propose that ethical leadership consisting of leader humane orientation, leader responsibility and sustainability orientation and leader moderation orientation are beneficial to firm performance, and leader justice orientation plays moderating roles. We empirically tested this theoretical framework employing multi-source survey data collected from 264 Chinese firms. The findings reveal that both leader humane orientation and leader responsibility and sustainability orientation have positive influences on both firm financial and social performance, while leader moderation orientation only has positive influence on firm financial performance. In addition, leader justice orientation positively moderates the relationship between leader humane orientation and leader responsibility and sustainability orientation and financial performance as well as the relationship between leader moderation orientation and social performance. These findings provide theoretical and practical implications for understanding how different facets of ethical leadership jointly function to influence firm performance.

This study utilizes hierarchical regression analysis to explore how environmental management systems influence financial performance through customer satisfaction and customer loyalty, and the moderating effects of switching cost. The originality of the present research is to unpack the “black box” through which a firm can profit from EMSs. The empirical results indicate that EMSs have positive and significant impacts on customer satisfaction, customer loyalty, and financial performance. In addition, switching cost negatively and significantly moderates the relationship between EMSs and customer satisfaction, but does not significantly moderates the relationship between EMSs and customer loyalty. The results also demonstrate that customer satisfaction and customer loyalty partially mediate the relationship between EMSs and financial performance. Our findings highlight that customer satisfaction, customer loyalty, and switching cost play important roles for a firm to profit from EMSs.

I. EXECUTIVE SUMMARY The MRCT Center Post-trial Responsibilities: Continued Access to an Investigational Medicine Framework outlines a case-based, principled, stakeholder approach to evaluate and guide ethical responsibilities to provide continued access to an investigational medicine at the conclusion of a patient’s participation in a clinical trial. The Post-trial Responsibilities (PTR) Framework includes this Guidance Document as well as the accompanying Toolkit. A 41-member international multi-stakeholder Workgroup convened by the Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard University (MRCT Center) developed this Guidance and Toolkit. Project Motivation A number of international organizations have discussed the responsibilities stakeholders have to provide continued access to investigational medicines. The World Medical Association, for example, addressed post-trial access to medicines in Paragraph 34 of the Declaration of Helsinki (WMA, 2013): “In advance of a clinical trial, sponsors, researchers and host country governments should make provisions for post-trial access for all participants who still need an intervention identified as beneficial in the trial. This information must also be disclosed to participants during the informed consent process.” This paragraph and other international guidance documents converge on several consensus points: • Post-trial access (hereafter referred to as “continued access” in this Framework [for terminology clarification – see definitions]) is the responsibility of sponsors, researchers, and host country governments; • The plan for continued access should be determined before the trial begins, and before any individual gives their informed consent; • The protocol should delineate continued access plans; and • The plan should be transparent to potential participants and explained during the informed consent process. However, there is no guidance on how to fulfill these responsibilities (i.e., linking specific responsibilities with specific stakeholders, conditions, and duration). To fill this gap, the MRCT Center convened a working group in September of 2014 to develop a framework to guide stakeholders with identified responsibilities. This resultant Framework sets forth applicable principles, approaches, recommendations and ethical rationales for PTR regarding continued access to investigational medicines for research participants.