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There is a great imbalance and difference in the distribution of Chinese medical resources in urban and rural areas, as most medical resources are concentrated in urban areas. Against the backdrop of China’s promotion of "Internet + medical healthcare", medical institutions are encouraged to apply Internet and other information technologies to expand the space and content of medical services, but patients in remote places lack independent choice of consultation platform. Based on the theory of Maslow's hierarchy of needs, customer perception theory, Synergy theory, TAM and ACSIM, the model building of remote patients' perceived value satisfaction with online medical services for specialties is hypothesized. Take F hospital as the subject, The research provides an empirical research on the process rebuilding and redesigning specialized online health services based on the perceived value of remote patients. To obtain the perceived value needs of remote patients’ visits, this study carries out questionnaire survey to understand the main needs of remote patients visiting. The results show that: social contact and respect value need > safety and survival value need > self-value need > cost losses value. Meanwhile, the preliminary evaluation indicators of patients' perceived value are derived based on the results of the questionnaire. The research is mainly to verify the effect of the implementation of the Internet-based specialized medical partnership medical service access model for remote patients. The post-test questionnaire is designed to understand the overall level of remote patients’ perceived value of online medical services, including the level of perceived ease of use, the level of perceived usefulness, the level of perceived value, the level of satisfaction, and the level of synergy. Among them, the perceived usefulness scores the highest, It is found that the cost of the new model in terms of time, distance, expense, and energy has been significantly reduced. The research, through building the SEM model, tests the path relationships of relevant dimensions and mediating effect of the model of remote patients’ perceived value satisfaction with online medical services for specialties. Verifica-se um grande desequilíbrio na distribuição dos recursos médicos chineses nas áreas urbanas e rurais, visto que a maioria dos recursos médicos está concentrada nas áreas urbanas. No contexto da promoção chinesa de "Internet + saúde médica", as instituições médicas são incentivadas a recorrer à Internet e a outras tecnologias de informação para expandir o espaço e o conteúdo dos serviços médicos, mas os pacientes em lugares remotos não têm escolha independente da plataforma de consulta. Com base na teoria da hierarquia de necessidades de Maslow, teoria da perceção do cliente, teoria da sinergia, TAM e ACSIM, realizou-se a construção do modelo de satisfação do valor percebido de pacientes remotos, com serviços médicos online para especialidades. Considerou-se o hospital F como caso de estudo. A investigação fornece uma pesquisa empírica sobre o processo de reconstrução e redesenho de serviços de saúde online especializados, com base no valor percebido de pacientes remotos. Para obter as necessidades de valor percebido das visitas de pacientes remotos, neste estudo realizou-se uma pesquisa por questionário para entender as principais necessidades das visitas de pacientes remotos. Os resultados mostram que: contato social e respeito valor necessidade e > segurança e valor de sobrevivência necessidade > necessidade de valor próprio > valor de perdas de custo. Enquanto isso, os indicadores de avaliação preliminar do valor percebido dos pacientes são derivados com base nos resultados do questionário. O objetivo principal do presente trabalho é verificar o efeito da implementação do modelo de acesso a serviços médicos especializados, baseada na Internet para pacientes remotos. O questionário pós-teste foi projetado para compreender o nível geral de valor percebido de pacientes remotos de serviços médicos online, incluindo o nível de facilidade de uso percebida, o nível de utilidade percebida, o nível de valor percebido, o nível de satisfação e o nível de sinergia. Entre eles, a utilidade percebida pontua mais alto. Verifica-se que o custo do novo modelo em termos de tempo, distância, despesa e energia foi reduzido significativamente. Por meio da construção do modelo SEM, testaram-se as relações do caminho de dimensões relevantes, e o efeito mediador do modelo de satisfação de valor percebido de pacientes remotos, com serviços médicos online para especialidades.

The emergence of the motilities paradigm places tourism at the core of social sciences. Thus, understanding the tourist mobility is fundamental for both tourism management practice and tourism research. This study proposes a heuristic method that combines dynamic time warping and the earth mover's distance, to accurately measure the similarity of tourist trajectories. A case study at Xiamen University Campus was conducted to estimate the performance of our proposed method, and the results of two experiments suggest that our method has better measurement accuracy and noise resistance than current methods. Furthermore, our method has vast potential applications in the fields of personalized service, tourism attraction marketing and management.

Siyuan He,1,2,* Yuzhen Zou,1,2,* Mengling Zhan,1,2,* Qi Guo,1,2 Yongjie Zhang,1,2 Zhemin Zhang,1 Bing Li,1 Shaoyan Zhang,1 Haiqing Chu1,3 1Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, People’s Republic of China; 2Tongji University School of Medicine, Shanghai 200092, People’s Republic of China; 3Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, People’s Republic of China*These authors contributed equally to this workCorrespondence: Haiqing Chu; Shaoyan ZhangDepartment of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai 200433, People’s Republic of ChinaTel/ Fax +86 21 6511 5006Email chu_haiqing@126.com; zhangshaoyan000@163.comPurpose: Imipenem is one of the very few effective options for treating Mycobacterium abscessus (M. abscessus) infections; the development of imipenem resistance is a major health concern.Materials and Methods: The susceptibility of 194 clinical M. abscessus isolates to imipenem was determined. The ability of imipenem to synergize with N,N,N′,N′-tetrakis(2-pyridylmethyl)ethylenediamine (TPEN), a zinc chelator and a metallo-β-lactamases (MBLs) inhibitor, to inhibit M. abscessus growth was also assessed.Results: M. abscessus exhibited an elevated resistance to imipenem (MIC50 = 16 mg/L, MIC90 = 64 mg/L). A combination of TPEN and imipenem synergized to inhibit the growth of 100% of imipenem-resistant and 79.2% of imipenem-resistance intermediate isolates; no synergy was observed treating imipenem-sensitive isolates. A remarkable decrease in the MIC50 (from 16 to 4 mg/L) and MIC90 (from 64 to 8 mg/L) of imipenem was observed when it was combined with TPEN; the portion of imipenem-resistant isolates also decreased (from 48.4% to 0%). Consistent with these results demonstrating synergy, a time-kill assay showed the addition of TPEN significantly improved the bactericidal activity of imipenem toward M. abscessus. Similarly, EDTA (a potent MBLs inhibitor) promoted the anti-M. abscessus activity of imipenem in a disk assay, corroborating the effect of TPEN and supporting the role of MBLs in imipenem resistance exhibited by some isolates.Conclusion: These findings demonstrate that TPEN can reduce the resistance of M. abscessus to imipenem and suggest that the inhibition of MBLs activity is the underlying mechanism.Keywords: Mycobacterium abscessus, TPEN, imipenem resistance, metallo-β-lactamases

Qi Guo,1,2 Jianhui Chen,1,2 Shaoyan Zhang,1 Yuzhen Zou,1,2 Yongjie Zhang,1,2 Dongdong Huang,1 Zhemin Zhang,1 Bing Li,1 Haiqing Chu1,3 1Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, People’s Republic of China; 2Tongji University School of Medicine, Shanghai 200092, People’s Republic of China; 3Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, People’s Republic of ChinaCorrespondence: Haiqing Chu; Bing LiDepartment of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai 200433, People’s Republic of ChinaTel/Fax +86 021 6511 5006Email chu_haiqing@126.com; libing044162@163.comPurpose: The emergence of clarithromycin resistance is a challenge in treating Mycobacterium abscessus infections. Known mechanisms that contribute to intrinsic clarithromycin resistance focus on rrl gene-related mutations, but resistant clinical isolates often exhibit an inconsistent rrl genotype.Patients and Methods: In this study, 194 clinical Mycobacterium abscessus isolates were collected from patients with lung infections and the whole genome of each isolate was sequenced. A comprehensive examination of the molecular mechanisms underlying intrinsic clarithromycin resistance was performed, combining MIC determination, comparative genome sequence analysis and qRT-PCR.Results: Of the 194 isolates, 13 (6.7%) were clarithromycin resistant; only seven of these harbored a rrl 2270/2271 mutation. The remaining six resistant isolates did not exhibit a specific resistance-associated mutation in the clarithromycin target-site genes, rrl, rplC, rplD and rplV, or in the rrl modification gene erm(41). qRT-PCR analysis showed that the increased expression of the efflux pump genes, MAB_2355c, MAB_1409c and MAB_1846, as well as their positive regulatory gene whiB7, consistently correlated with increased clarithromycin resistance. The presence of efflux pump inhibitors significantly decreased the MIC of clarithromycin for nonsusceptible isolates, especially the intrinsic resistant isolates that exhibited no rrl 2270/2271 mutation.Conclusion: These findings indicate that efflux pumps play a prominent role in the intrinsic resistance of M. abscessus to clarithromycin, complementing other known resistance mechanisms.Keywords: Mycobacterium abscessus, clarithromycin resistance, efflux pumps