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Based on an analysis of a landmark case Lim Mey Lee Susan v Singapore Medical Council in Singapore where a doctor was professionally disciplined for over-charging a wealthy patient, a judgement upheld by the Singapore High Court, this paper will discuss the notion of an ‘ethical price’ (EP) and its determination with respect to the provision of healthcare services. It will first examine the limitations of a legal approach for setting an ethical limit to pricing. From there, it will argue that Confucian philosophy provides a useful ethical framework to explore EP, with focus on the context of Singapore. The following question is addressed: What is an ethical pricing standard for medical practice from a Confucian perspective? The strengths and limitations of a Confucian value base as regards the determination of an objective EP will be analysed through an examination of the shortcomings of the doctor’s behaviour in the Susan Lim case as well as other case scenarios. The paper will conclude with some practical suggestions on how Confucian-based ideas can be applied to decision-making on pricing and the importance of this for medical professionalism and ethics teaching.

Eczema herpeticum is an uncommon complication of atopic dermatitis, but often has a typical recognisable appearance. This report serves to highlight this feature in a patient who was misdiagnosed initially with a bacterial skin infection and then with a severe cutaneous drug reaction.

An injured sports personality of celebrity status, for example, saves millions in income and endorsements if the surgeon’s skills can help him achieve a speedy recovery. Since there is no discretionary exploitation occurring, should not the surgeon gain a share commensurate with his efforts? Liberties can only be exercised through participation within a community (Tsai, 2001) and with an emphasis on rites or customs, or “Li” 礼 which may not need to be codified (Wang & Solum, 2012). [...]the physician’s behaviour should be guided by the norms and prevailing practice of his fellow practitioners, hence allowing for a dynamic, evolving ethical price limit. From this perspective, if a physician seeks personal gain in pricing decisions, he transgresses the ethical limit. [...]Confucianism espouses the principle of “Yi” 义 or righteousness.

The capacity of palm oil production is directly affected by the ripeness of the fresh fruit bunches (FFB) upon harvesting. Conventional harvesting standards rely on rigid harvesting scheduling as well as the number of fruitlets that have loosened from the bunch. Harvesting is usually done every 10 to 14 days, and an FFB is deemed ready to be harvested if there are around 5 to 10 empty sockets on the fruit bunch. Technology aided by imaging techniques relies heavily on the color of the fruit bunch, which is highly dependent on the surrounding light intensities. In this study, Raman spectroscopy is used for ripeness classification of oil palm fruits, based on the molecular assignments extracted from the Raman bands between 1240 cm−1 and 1360 cm−1. The Raman spectra of 52 oil palm fruit samples which contain the fingerprints of different organic compounds were collected. Signal processing was applied to perform baseline correction and to reduce background noises. Characteristic data of the organic compounds were extracted through deconvolution and curve fitting processes. Subsequently, a correlation study between organic compounds was developed and eight hidden Raman peaks including protein, beta carotene, carotene, lipid, guanine/cytosine, chlorophyll-a, and tryptophan were successfully located. Through ANOVA statistical analysis, a total of six peak intensities from proteins through Amide III (β-sheet), beta-carotene, carotene, lipid, guanine/cytosine, and carotene and one peak location from lipid were found to be significant. An automated oil palm fruit ripeness classification system deployed with artificial neural network (ANN) using the seven signification features showed an overall performance of 97.9% accuracy. An efficient and accurate ripeness classification model which uses seven significant Raman peak features from the correlation analysis between organic compounds was successfully developed.

This study compared the performance of a single blood draw of high-sensitivity troponin T (hsTnT), high-sensitivity troponin I (hsTnI) and conventional troponin I (cTnI) within a modified HEART score for predicting 30-day MACE at Emergency Department (ED) presentation, and established local reference norms for all three assays by determining the cut-off point which yielded the highest sensitivity and negative predictive value for acute myocardial infarction and 30-day MACE. This single-center prospective cohort study recruited chest pain patients at the ED, whose hsTnT, hsTnI and cTnI were taken on admission. Subjects were classified into low and non-low risk group according to their modified HEART score, with MACE as the primary endpoint. Receiver-operating characteristic (ROC) curves were generated, area under the curves (AUCs) were calculated; the performance characteristics were determined. The performance of modified HEART scores was comparable among the three assays for 30-day MACE (84.9–87.0% sensitivity, 95.6–96.0% NPV, 95%CI) and none of these had very high AUC and specificity (AUC 0.70–0.71, 53.7–56.7% specificity, 95% CI). The modified HEART score using a single blood draw of either hsTnT (3.9ng/L), hsTnI (0.9ng/L) or cTnI (0.0ng/L) at presentation yielded a sensitivity of 100% for 30-day MACE. The modified HEART score using a single blood draw of either hsTnT, hsTnI or cTnI was equally effective in risk-stratifying chest pain patients for safe discharge. The theoretical cut-off points yielding 100% sensitivity are potentially useful (when achieved) for safely discharging low risk patients with undifferentiated chest pain in the ED.

Aim Understanding ecological niche shifts is crucial for predicting future changes under climate change. Modelling past niche dynamics provides a baseline for gauging the severity and direction of ongoing shifts. However, reconstructing historical habitats for data‐limited, range‐restricted species is challenging, as sparse species records hinder robust inference. We introduce and apply a hierarchical modelling framework to reconstruct historical habitats, assess niche shifts over time, and estimate prediction uncertainty for data‐limited species. We applied this framework to the Sierra Nevada Grey‐crowned Rosy‐Finch (Leucosticte tephrocotis dawsoni) to evaluate changes in breeding habitat suitability under climate change. Location Alpine regions of California, USA. Methods We applied a hierarchical habitat selection approach based on three orders. Available habitats of finer orders were selected based on insights from broader orders. For each covariate we defined a range of nested scales of effects and employed indicator variable selection and spike‐and‐slab priors for variable selection. Historical niche relationships (1954–1980) were used as priors alongside current survey and bioclimatic data to characterise present‐day suitable habitats (2018–2022), estimate niche shifts, validate models and assess conservation implications. Results We found substantial habitat declines, with suitability contracting by 40%–64% across habitat selection orders and suitable breeding areas shifting upslope by approximately 280 m. Historically, suitable habitats were characterised by rugged, high‐elevation terrain with persistent snow. Contemporary distributions show reduced topographic constraints but increased reliance on diminishing snow resources, suggesting potential niche expansion. Main Conclusions Our approach effectively identified key variables across habitat selection orders, revealing both niche contraction and expansion driven by reduced snow persistence, processes likely affecting many alpine species globally. This framework offers a robust tool for characterising habitat changes for data‐limited species, with broad applicability for conservation planning. It also highlights the dynamic role of scale in species niches across space and time.

The content of this work presents the implementation of Fuzzy Logic Control (FLC) on a microbial electrolysis cell (MEC) for storage applications. Hydrogen has been touted as one of the potential alternative sources of renewable energy to the depleting fossil fuels. MEC is one of the most extensively studied methods of hydrogen production. One of main advantages of MEC is its ability to utilize organic wastes as the substrates for biohydrogen production. However, the MEC system involves microbial interaction contributes to the system’s nonlinear behaviour. Due to its high complexity, a precise process control system must be implemented to ensure the MEC systems could operate in a stable manner. Proportional Integral-Derivative (PID) controller has been one of the pioneer control loop mechanism. However, the conventional PID controller has its drawbacks such as the lacking in its ability to adapt properly in the presence of disturbance within a nonlinear system. Advanced process control mechanism known as FLC can prove to be a better solution to be implemented on a nonlinear system due to its similarity in human-natured thinking. In this research, the FLC is implemented onto the MEC system and its performance is evaluated using several control schemes such as constant setpoints, multiple setpoints tracking, internal disturbance rejection, external disturbance rejection and noise disturbance rejection to ensure a timely readiness of hydrogen storage. Similar evaluations are conducted on Proportional-Integral (PI) and PID controllers as well for comparison purposes. FLC has generally resulted in desirable outcomes over the PI and PID controllers. Integral absolute error (IAE) evaluation shows improvement ranging from 42.3% to 99.4% from PI controller to FLC and 36.2% to 99.4% from PID controller to FLC can be obtained from this study.

Timely removal of oxidatively damaged proteins is crit- ical for cells exposed to oxidative stresses; however, cellular mechanism for clearing oxidized proteins is not clear. Our study reveals a novel type of protein modifi- cation that may play a role in targeting oxidized proteins and remove them. In this process, DSS1 （deleted in split hand/split foot 1）, an evolutionally conserved small protein, is conjugated to proteins induced by oxidative stresses in vitro and in vivo, implying oxidized proteins are DSS1 clients. A subsequent ubiquitination targeting DSSl-protein adducts has been observed, suggesting the client proteins are degraded through the ubiquitin- proteasome pathway. The DSS1 attachment to its clients is evidenced to be an enzymatic process modulated by an unidentified ATPase. We name this novel protein modification as DSSylation, in which DSS1 plays as amodifier, whose attachment may render target proteins a signature leading to their subsequent ubiquitination, thereby recruits proteasome to degrade them.

HONG KONG, Thurs: The World Bank is prepared to assist the \"tragic problem of burning\" which is clouding the skies in the region either through technical or financial aid...