The Word-of-Mouth Effects on the Chinese Customers’ Choice Intention of Medical Tourism Destination

ZHANGJUN,Hoon-Young Lee 한국유통과학회 2016 유통과학연구 Vol.14 No.7

to have more interest in researches on customers’ behavior. This research was to investigate empirically WOM effects on the intention of Chinese customers when they select an international medical tourism destination. Interestingly, WOM effects on their choice and decision process may vary by the extent of their severity of illness. Research design, data, and methodology – The data was collected from 1,747 potential Chinese residents in main districts of China. Moderated regression analysis was used to estimate WOM effects on Chinese customers’ choice intention. Results – Results imply that WOM determinants of tie strength, credibility, and vividness do interact with medical tourism information and affect customers’ intention for health care abroad. Results also reveal that the severity of illness plays a critical moderating role in customers’ decision process. Conclusions – WOM and the severity of illness are important moderators for Chinese customers to make a decision for medical tourism. It provides some implications for service organizations for developing and implementing marketing strategies in international health care markets.

중국고객 해외의료관광국가 선택의도에 영향을 미치는 요인에 관한 연구: 구전 조절효과를 중심으로

ZHANGJUN,이훈영 한국유통과학회 2015 유통과학연구 Vol.13 No.12

Purpose – Given globalization, the new niche market of medical tourism is likely to experience sustainable growth for various reasons, such as aging populations and a shift in the medical consumerism paradigm toward prevention. Importantly, understanding medical customers’ behavior is necessary to benefit from a competitive advantage in this industry. The existing research primarily accessed the key factors of medical quality and costs to explain health customers’ behavior but is limited in terms of enabling an understanding of the decision process. This limitation exists because, given the intangibility and greater associated risks in the highly professional industry of international medical tourism, most customers lack the knowledge and experience needed to evaluate the central factors—such as the medical competence of health care countries—before purchases. Therefore, they actively search for useful information through various distributions to reduce uncertainty and to make better choices. Interestingly, most of these information channels are associated with word-of-mouth (WOM). However, no evidence is found in the literature to estimate the effect of WOM in the medical tourism field. Thus, this study focuses on WOM to explore its interaction with key medical characteristic factors and the attractiveness of destinations referred to by sources. This study also affects customers’ evaluations and, in turn, influences their intention to seek health care services abroad. Research design, data, and methodology – The literature review addressed an interesting research model for estimating therelations among WOM, medical characteristics, attractiveness, and customers’ choice intention regarding international health care. In the key economic regions in China, such as Beijing, Shanghai, Jiangsu, Shandong, and Guangdong, 2,500 survey questionnaires were distributed to potential customers of different ages, education, and income levels. A resulting 1,717 (68.68 percent of the original 2,500) usable surveys were obtained for analysis. Moderated regression analysis was used to determine the effects of WOM in the decision process regarding international health care destinations. Results – The results indicate that WOM is a good moderator of the relationships between the factors evaluated by sources and customers. More importantly, the WOM effects reflect the factors of tie strength, credibility, and vividness. The results also reveal that, given the moderating role of WOM, the intention of potential Chinese customers to seek the referred health care country varies according to the medical characteristics of medical competency and reputation as evaluated by customers. In contrast, the travel attractiveness of the attractions, facilities, accessibility, and social environment are critical determinants of destination choice intention. Conclusions – The moderating role of WOM has been confirmed through the international healthcare destination selection process. Medical tourism managers should user WOM as an effective marketing tool for industry development. Specially, marketers should consider the effects of WOM determinants, such as tie strength, credibility, and vividness, to develop an effective strategy. Furthermore, this study estimates the factors that affect customers’ selection of medical tourism destinations. Health care managers or policy makers should consider a broad variety of variables that may attract more Chinese customers to international health care.

A Study of the Impact of Medical Characteristics and Travel Attractiveness on Chinese Customers when Selecting an International Medical Tourism Destination

ZHANGJUN,이훈영 한국기업경영학회 2015 기업경영연구 Vol.22 No.3

This research is to identify why potential Chinese customers prefer to select one medical tourism destination over another. We focus on the main factors of medical characteristics and travel attractiveness to estimate Chinese customers’ intention for medical tourism abroad. We also verify the effects of disease pattern in the decision process. With the data of 1,717 potential Chinese customers collected from the main regions of China, results indicate that in spite of destinations, medical quality, health reputation, and social environment are the important predictors of customer intention to seek medical service abroad. Results also indicate that there exist significant different effects of medical cost, travel attractions, facilities, and accessibility on customer intention to select the medical service in the US or Korea over other countries. Moreover, results imply that disease pattern does matter in the international medical tourism destination selection process. Implications are discussed for health organizations to make marketing strategies in international medical tourism markets.

Association Between Single Nucleotide Polymorphisms in miRNA196a-2 and miRNA146a and Susceptibility to Hepatocellular Carcinoma in a Chinese Population

Zhang, Jun,Wang, Rui,Ma, Yan-Yun,Chen, Lin-Qi,Jin, Bo-Han,Yu, Hua,Wang, Jiu-Cun,Gao, Chun-Fang,Liu, Jie Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.11

Hepatocellular carcinoma (HCC) is one of the most prevalent cancers in the world and deeply threatens people's health, especially in China. Techniques of early diagnosis, prevention and prediction are still being discovered, among which the approaches based on single nucleotide polymorphisms in microRNA genes (miRNA SNPs) are newly proposed and show prospective potential. In particular, the association between SNPs in miRNA196a-2 (rs11614913) and miRNA146a (rs2910164) and HCC has been investigated. However, the conclusions made were conflicting, possibly due to insufficient sample size or population stratification. Further confirmations in well-designed large samples are still required. In this study, we verified the association between these two SNPs and the susceptibility to HCC by MassARRAY assay in a 2,000 large Chinese case-control sample. Significant association between rs11614913 and HCC was confirmed. Subjects with the genotype of CT+TT or T allele in rs11614913 were more resistant to HCC (CT+TT: OR (95% CI)=0.73 (0.57-0.92), P=0.01; T allele: OR (95% CI)=0.85 (0.75-0.97), P=0.02) and HBV-related HCC (CT+TT: OR (95% CI)=0.69 (0.53-0.90), P=0.01; T allele: OR (95% CI)=0.82 (0.71-0.95), P=0.01). The affected carriers of CT or TT also tended to have lower levels of serum AFP (P=0.01). This study demonstrated a role of rs11614913 in the etiology of HCC. Further research should focus on the clinical use of this miRNA SNP, so as to facilitate conquering HCC.

Effects of bioactive cements incorporating zinc-bioglass nanoparticles on odontogenic and angiogenic potential of human dental pulp cells

Zhang, Jun,Park, Yong-Duk,Bae, Won-Jung,El-Fiqi, Ahmed,Shin, Song-Hee,Lee, Eun-Jung,Kim, Hae-Won,Kim, Eun-Cheol SAGE Publications 2015 Journal of biomaterials applications Vol.29 No.7

<P><B>Background</B></P><P>The objective of this study was to investigate the effects of bioactive calcium phosphate cements (CPC, α-tricalcium phosphate-based) incorporating zinc-bioglass (ZnBG) on the odontogenic differentiation and angiogenesis of human dental pulp cells (HDPCs).</P><P><B>Methods</B></P><P>BGs with varying concentrations of Zn (0, 2.5 and 5%) were produced via a sol-gel process. The proliferation of HDPCs on CPC/BGs was determined by MTS assay. Alizarin red staining, RT-PCR, and ALP activity were used to assess odontogenic differentiation, and western blot analysis was used to asses signaling pathways. In vitro angiogenesis was examined via mRNA expression of angiogenic genes and tubule formation.</P><P><B>Results</B></P><P>All cement formulations showed no cytotoxicity. The CPCs with ZnBG showed increased ALP activity, enhanced formation of mineralized nodules, and upregulated mRNA expression of DMP-1, DSPP, Runx2, and osterix in a time- and dose-dependent manner, relative to CPCs without Zn. ZnBG upregulated integrins α1, α2, β1, and β3 and activated integrin downstream signal pathways, such as p-FAK, p-Akt, p-paxillin, RhoA, MAPK, and NF-κB, as well as canonical and non-canonical Wnt signaling. In addition, ZnBG upregulated VEGF mRNA in HDPCs and increased the tubular structure in endothelial cells.</P><P><B>Conclusions</B></P><P>Our results demonstrate that ZnBG incorporated within CPCs activates odontogenic differentiation and promotes angiogenesis in vitro through integrin, Wnt, MAPK, and NF-κB pathways. Thus, CPCs incorporating ZnBG are promising matrices in tissue engineering to stimulate endodontic regeneration.</P>

Automatic Craniomaxillofacial Landmark Digitization via Segmentation-Guided Partially-Joint Regression Forest Model and Multiscale Statistical Features

Zhang, Jun,Gao, Yaozong,Wang, Li,Tang, Zhen,Xia, James J.,Shen, Dinggang IEEE 2016 IEEE Transactions on Biomedical Engineering Vol.63 No.9

<P>Objective: The goal of this paper is to automatically digitize craniomaxillofacial (CMF) landmarks efficiently and accurately from cone-beam computed tomography (CBCT) images, by addressing the challenge caused by large morphological variations across patients and image artifacts of CBCT images. Methods: We propose a segmentation-guided partially-joint regression forest (S-PRF) model to automatically digitize CMF landmarks. In this model, a regression voting strategy is first adopted to localize each landmark by aggregating evidences from context locations, thus potentially relieving the problem caused by image artifacts near the landmark. Second, CBCT image segmentation is utilized to remove uninformative voxels caused by morphological variations across patients. Third, a partially-joint model is further proposed to separately localize landmarks based on the coherence of landmark positions to improve the digitization reliability. In addition, we propose a fast vector quantization method to extract high-level multiscale statistical features to describe a voxel's appearance, which has low dimensionality, high efficiency, and is also invariant to the local inhomogeneity caused by artifacts. Results: Mean digitization errors for 15 landmarks, in comparison to the ground truth, are all less than $2$ mm. Conclusion: Our model has addressed challenges of both interpatient morphological variations and imaging artifacts. Experiments on a CBCT dataset show that our approach achieves clinically acceptable accuracy for landmark digitalization. Significance: Our automatic landmark digitization method can be used clinically to reduce the labor cost and also improve digitalization consistency.</P>

INJECTIVE MODULES OVER ω-NOETHERIAN RINGS, II

Zhang, Jun,Wang, Fanggui,Kim, Hwankoo Korean Mathematical Society 2013 대한수학회지 Vol.50 No.5

By utilizing known characterizations of ${\omega}$-Noetherian rings in terms of injective modules, we give more characterizations of ${\omega}$-Noetherian rings. More precisely, we show that a commutative ring R is ${\omega}$-Noetherian if and only if the direct limit of GV -torsion-free injective R-modules is injective; if and only if every R-module has a GV -torsion-free injective (pre)cover; if and only if the direct sum of injective envelopes of ${\omega}$-simple R-modules is injective; if and only if the essential extension of the direct sum of GV -torsion-free injective R-modules is the direct sum of GV -torsion-free injective R-modules; if and only if every $\mathfrak{F}_{w,f}(R)$-injective ${\omega}$-module is injective; if and only if every GV-torsion-free R-module admits an $i$-decomposition.

Sphingobacterium wenxiniae sp. nov., a cypermethrin-degrading species from activated sludge

Zhang, Jun,Zheng, Jin-Wei,Cho, Byung Cheol,Hwang, Chung Yeon,Fang, Chengxiang,He, Jian,Li, Shun-Peng Microbiology Society 2012 International journal of systematic and evolutiona Vol.62 No.3

<P>A Gram-negative, non-motile, non-spore-forming, non-flagellated rod capable of degrading cypermethrin, designated LQY-18<SUP>T</SUP>, was isolated from activated sludge of a wastewater treatment plant in China. Strain LQY-18<SUP>T</SUP> grew at 8-40 °C (optimum 30 °C), at pH 5.0-10.0 (optimum pH 7.0) and with 0-5 % (w/v) NaCl (optimum 1 %). The predominant menaquinone was MK-7 (97 %) and the major fatty acids were summed feature 3 (comprising C16 : 1ω6<I>c</I> and/or C16 : 1ω7<I>c</I>), iso-C15 : 0 and iso-C17 : 0 3-OH. The DNA G+C content was 40.3 mol%. Phylogenetic analysis revealed that the isolate belonged to the genus <I>Sphingobacterium</I> of the phylum <I>Bacteroidetes</I> and showed low 16S rRNA gene sequence similarity with recognized members of the genus <I>Sphingobacterium</I>. The closest neighbour was <I>Sphingobacterium mizutaii</I> ATCC 33299<SUP>T</SUP> (92.9 % 16S rRNA gene sequence similarity). On the basis of phenotypic, genetic and phylogenetic data, strain LQY-18<SUP>T</SUP> ( = ACCC 05410<SUP>T</SUP> = CCTCC AB 2010005<SUP>T</SUP> = KCTC 23009<SUP>T</SUP>) should be classified as a representative of a novel species of the genus <I>Sphingobacterium</I>, for which the name <I>Sphingobacterium wenxiniae</I> sp. nov. is proposed.</P>

Detecting Anatomical Landmarks for Fast Alzheimer’s Disease Diagnosis

Zhang, Jun,Gao, Yue,Gao, Yaozong,Munsell, Brent C.,Shen, Dinggang Institute of Electrical and Electronics Engineers 2016 IEEE transactions on medical imaging Vol.35 No.12

<P>Structural magnetic resonance imaging (MRI) is a very popular and effective technique used to diagnose Alzheimer's disease (AD). The success of computer-aided diagnosis methods using structural MRI data is largely dependent on the two time-consuming steps: 1) nonlinear registration across subjects, and 2) brain tissue segmentation. To overcome this limitation, we propose a landmark-based feature extraction method that does not require nonlinear registration and tissue segmentation. In the training stage, in order to distinguish AD subjects from healthy controls (HCs), group comparisons, based on local morphological features, are first performed to identify brain regions that have significant group differences. In general, the centers of the identified regions become landmark locations (or AD landmarks for short) capable of differentiating AD subjects from HCs. In the testing stage, using the learned AD landmarks, the corresponding landmarks are detected in a testing image using an efficient technique based on a shape-constrained regression-forest algorithm. To improve detection accuracy, an additional set of salient and consistent landmarks are also identified to guide the AD landmark detection. Based on the identified AD landmarks, morphological features are extracted to train a support vector machine (SVM) classifier that is capable of predicting the AD condition. In the experiments, our method is evaluated on landmark detection and AD classification sequentially. Specifically, the landmark detection error (manually annotated versus automatically detected) of the proposed landmark detector is 2.41mm, and our landmark-based AD classification accuracy is 83.7%. Lastly, the AD classification performance of our method is comparable to, or even better than, that achieved by existing region-based and voxel-based methods, while the proposed method is approximately 50 times faster.</P>

Development and Evaluation of a Patient-Reported Outcome (PRO) Scale for Breast Cancer

Zhang, Jun,Yao, Yu-Feng,Zha, Xiao-Ming,Pan, Li-Qun,Bian, Wei-He,Tang, Jin Hai Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.18

Background: This study was guided by principles of the theoretical system of evidence-based medicine. In particular, when searching for evidence of breast cancer, a measuring scale is an instrument for evaluating curative effects in accordance with the laws and characteristics of medicine and exploring the establishment of a system for medically assessing curative effects. At present, there exist few tools for evaluating curative effects. Patient-reported outcomes (PROs) refer to outcomes directly reported by patients (without input or explanations from doctors or other intermediaries) with respect to all aspects of their health. Data obtained from PROs provide evidence of treatment effects. Materials and Methods: In accordance with the tenets of theoretical medicine and ancient medical theory regarding breast cancer, principles for developing a PRO scale were established, and a theoretical model was developed and a literature review was performed, items from this pool were combined and split, and an initial scale was constructed. After a pilot survey and additional modifications, a pre-questionnaire scale was formed and used in a field investigation. After the application of statistical methods, the item pool was used to create a formal scale. The reliability, validity and feasibility of this formal scale were then assessed. Results: In a clinical investigation, 479 responses were recovered, with an acceptance rate of 95%. a combination of various methods was employed, and the items that were selected by all methods or more than half of the methods were employed in the questionnaire. In these cases, the screening methods were combined with certain features of the item, A total of four domains and 38 items were reserved. The reliability analysis indicated that the PRO scale was relatively reliable. Conclusions: Scientific assessment proved that the proposed scale exhibited good reliability and validity. This scale was readily accepted and could be used to assess the curative effects of medical therapy. However, given the limited scope of this investigation, the capacity for adapting this scale to incorporate other theories could not be determined.