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To examine the association between physician–patient treatments shared decision making (SDM), patient satisfaction, and adoption of a new health technology.
A cross-sectional study was conducted from July 2016 to October 2016 in Fujian Province and Shanghai, in Eastern China. A total of 542 physicians and 619 patients in eleven hospitals were surveyed. Patients and their treating physicians completed self-reported questionnaires on patient–physician SDM, satisfaction with treatment decision making and adoption of a new health technology. Correlation analysis, multivariate logistic regression and multivariate linear regression were performed.
The majority (68.20 percent) of patients preferred SDM. Involvement of patients in SDM was positively associated with their satisfaction with treatment decision making (p < .001) and adoption of a new health technology (p < .05). Better concordance between their preference and actual SDM was positively associated with patients' adoption behavior (p < .05), but no statistically significant association was found between concordance and satisfaction.
SDM was the most important predictor of patients' satisfaction with decision making and adoption of a new health technology. Therefore, better communication between physicians and patients is recommended to improve their SDM, increase patient satisfaction and to assist with the adoption of new technologies. Training healthcare provider and teaching communication skills in working with patients in the initial stage of technology diffusion is required.
Fullerene dimers have attracted extensive attention due to their unique structures and fascinating properties. Here, fullerene dimer derivatives with four to six carbon atoms in the esters are designed and synthesized. The property differences that caused by the carbon number in the esters of the fullerene dimers are investigated by performing their electrochemical, optical, and photoelectric measurements. As the carbon atom numbers in the esters increase from four to five and six, the absorption intensities increase to 1.6- and 4.4-folds. The intensities of the fluorescence spectra increase to 1.8- and 5.2-folds. Their photocurrent increases to 2- and 7-folds under the irradiation of a 405-nm laser. The LUMO energy levels move downward slightly from −3.89 to −3.90 and −3.92 eV, respectively. Our results indicate that as the carbon number increases, the carbon chain lengths in the ester structures increase, very slight effects produced on the energy levels of the fullerene dimers, but strongly contribute to their chemical activities and thus the photoelectronic efficiencies.
The clinical characteristics of patients with COVID-19 were analysed to determine the factors influencing the prognosis and virus shedding time to facilitate early detection of disease progression. Logistic regression analysis was used to explore the relationships among prognosis, clinical characteristics and laboratory indexes. The predictive value of this model was assessed with receiver operating characteristic curve analysis, calibration and internal validation. The viral shedding duration was calculated using the Kaplan–Meier method, and the prognostic factors were analysed by univariate log-rank analysis and the Cox proportional hazards model. A retrospective study was carried out with patients with COVID-19 in Tianjin, China. A total of 185 patients were included, 27 (14.59%) of whom were severely ill at the time of discharge and three (1.6%) of whom died. Our findings demonstrate that patients with an advanced age, diabetes, a low PaO2/FiO2 value and delayed treatment should be carefully monitored for disease progression to reduce the incidence of severe disease. Hypoproteinaemia and the fever duration warrant special attention. Timely interventions in symptomatic patients and a time from symptom onset to treatment <4 days can shorten the duration of viral shedding.
Physicians' attitudes and adoption behavior toward the delivery of prenatal tests take vital significance for its influence on their professional practice and patient acceptance. This study aimed to identify how physicians have perceived the diffusion of non-invasive prenatal testing (NIPT) in China.
A cross-sectional study was conducted from July 2016 to October 2016 in Shanghai, and Fujian and Sichuan Provinces in China. Physicians working on prenatal screening completed a self-report questionnaire. Following Roger's diffusion of innovation model, multivariable logistic regressions were performed separately for the following key elements of the theory which influence diffusion: physician-perceived attributes of NIPT, communication channels, the nature of the social system, the extent of change agent (who introduces innovations into a society), promotion efforts, and physicians' benefits from adopting NIPT.
Most specialists had a positive attitude (53.2 percent) toward NIPT, whereas 58.9 percent of physicians had already adopted NIPT in their clinical practice. Physician adoption of NIPT was positively associated with the strength of HTA evidence (p = .03), perceived communication frequency with colleagues (p = .04), adoption by other physicians (p = .07), hospital competition (p = .06), hospital teaching status (p = .02), perceived for-profit genetic testing company's promotion (p < .001), and perceived clinical practice skill improvement (p = .02). However, the adoption behavior toward NIPT may be negatively associated with physician-perceived ethical concerns of NIPT (p = .06).
Obstetricians and gynecologists’ positive perceptions facilitate the adoption of NIPT. Combined with cost-effectiveness analysis of prenatal screening methods, health policy makers can promote the adoption of appropriate, cost-effective prenatal screening in pregnant women.
In the search for chemically stable two-dimensional (2D) materials with high in-plane mobility, proper bandgap, and compatibility with vapor-based fabrication, van der Waals semiconductor SiP has become a potential candidate as a robust variation of black phosphorous. While bulk SiP crystals were synthesized in the 1970s, the vapor-based synthesis of SiP nanostructures or thin films is still absent. We here report the first chemical vapor growth of SiP nanostructures on SiO2/Si substrate. SiP islands with lateral size up to 20 μm and showing well-defined Raman signals were grown on SiO2/Si substrate or on SiP-containing concentric rings. The presence of SiP phase is confirmed by XRD. The formation of rings and islands is explained by a multiple coffee ring growth model where a dynamic fluctuation of droplet growth front induces the topography of concentric ring surfaces. This new growth method might shed light on the controlled growth of group IV-III high-mobility 2D semiconductors.
Maternal supraphysiological estradiol (E2) environment during pregnancy leads to adverse perinatal outcomes. However, the influence of oocyte exposure to high E2 levels on perinatal outcomes remains unknown. Thus, a retrospective cohort study was conducted to explore the effect of high E2 level induced by controlled ovarian stimulation (COH) on further outcomes after frozen embryo transfer (FET). The study included all FET cycles (n = 10,581) between 2014 and 2017. All cycles were categorized into three groups according to the E2 level on the day of the human Chorionic Gonadotropin trigger. Odds ratios (ORs) and their confidence intervals (CIs) were calculated to evaluate the association between E2 level during COH and pregnancy outcomes and subsequent neonatal outcomes. From our findings, higher E2 level was associated with lower percentage of chemical pregnancy, clinical pregnancy, ongoing pregnancy, and live birth as well as increased frequency of early miscarriage. Preterm births were more common among singletons in women with higher E2 level during COH (aOR1 = 1.93, 95% CI: 1.22–3.06; aOR2 = 2.05, 95% CI: 1.33–3.06). Incidence of small for gestational age (SGA) was more common in both singletons (aOR1 = 2.01, 95% CI: 1.30–3.11; aOR2 = 2.51, 95% CI: 1.69–3.74) and multiples (aOR1 = 1.58, 95% CI: 1.03–2.45; aOR2 = 1.99, 95% CI: 1.05–3.84) among women with relatively higher E2 level. No association was found between high E2 level during COH and the percentage of macrosomia or large for gestational age. In summary, oocyte exposure to high E2 level during COH should be brought to our attention, since the pregnancy rate decreasing and the risk of preterm birth and SGA increasing following FET.
The dipeptide dl-methionyl-dl-methionine (Met-Met) has extremely low water solubility and better absorption than other methionine sources (such as dl-methionine and l-methionine) available in the market. Therefore, six diets (D1, D2, D3, D4, D5 and D6) containing 0, 0·07, 0·15, 0·21, 0·28 and 0·38 % Met-Met were formulated to investigate the effects of Met-Met in juvenile Nile tilapia, Oreochromis niloticus (17 g initial body weight). The results indicated that percentage weight gain and specific growth rate of fish fed with D2 and D3 diets were higher than those fed with D1, D4–D6 diets. The levels of total essential amino acid in whole body of fish fed with D3 and D4 diets were significantly higher than those fed the D1 diet. Superoxide dismutase activity and malondialdehyde content have no significant difference in fish fed the diet with or without Met-Met supplementation. Majority of reads derived from the fish intestine belonged to members of Fusobacteria, followed by Bacteroidetes and Proteobacteria. Diversity of intestinal microbiota and total antioxidant capacity in fish fed with D3 diet was significantly higher than that of other groups. Based on the growth results, the authors conclude that the optimal level of Met is 0·61 % Met with the addition of 0·15 % Met-Met for grower-phase O. niloticus.
North-east China occupies an important geographic position for understanding the process of Neolithisation in East Asia. Although archaeologists have long debated the trajectory of change in this region, a lack of intensive survey and excavation has precluded convincing interpretations. This article presents research on the newly excavated sites of Huayang and Taoshan in the southern Lesser Khingan Mountains, with a particular focus on the lithic assemblages. Comparative and environmental analyses demonstrate the largely uniform trajectory of lithic technologies across north-east China and close correspondence with Late Glacial palaeoclimatic and palaeoenvironmental changes.
This study examined Echinococcus spp. genotypes and genetic variants isolated from humans as well as domestic and wild animals from the Qinghai-Tibetan Plateau Area using the cox1 gene. All samples except the pika isolates were identified as the Echinococcus granulosus sensu stricto. Sixteen different haplotypes with considerable intraspecific variation were detected and characterized in mitochondrial cox1 sequences. The parsimonious network of cox1 haplotypes showed star-like features, and the neutrality indexes computed via Tajima's D and Fu's Fs tests showed high negative values in E. granulosus s. s., indicating deviations from neutrality; the Fst values were low among the populations, implying that the populations were not genetically differentiated. The pika isolates were identified as E. multilocularis and E. shiquicus. Only one haplotype was recognized in the pika isolates. E. granulosus s. s. was the predominant species found in animals and humans, followed by E. multilocularis and E. shiquicus, with high genetic diversity circulating among the animals and humans in this area. Further studies are needed to cover many sample collection sites and larger numbers of pathogen isolates, which may reveal abundant strains and/or other haplotypes in the hydatid cysts infecting human and animal populations of the QTPA, China.
Compared with commercial polyolefin membranes, polyacrylonitrile (PAN) membrane prepared by electrostatic spinning has higher porosity, electrolyte uptake, thermal stability, and lithium-ion conductivity, etc. However, poor mechanical performance has largely limited the application of electrospun PAN separators. In this study, PAN/polyimide (PI) composite membrane is prepared by electrostatic spinning to improve the mechanical and electrochemical performances. Scanning electron microscopy, thermal analysis method, and electrochemical methods were used for evaluation of the electrospun composite membrane. The results show that the composite membrane possesses good thermal stability and exhibits better mechanical performance than pristine PAN membrane (increasing by 1.1 times in tension strength). The addition of PI can increase porosity and fluid absorption rate obviously. In addition, the composite membrane has high ionic conductivity (18.77 × 10−4 S/cm), wide electrochemical window (about 4.0 V), and excellent cycling performance. It can retain a discharge specific capacity of 153 mA h/g even after 50 cycles at 0.5 C. The electrospun PAN/PI membrane may be a promising candidate for lithium-ion battery separators.
To investigate the protein-sparing effect of α-lipoic acid (LA), experimental fish (initial body weight: 18·99 (sd 1·82) g) were fed on a 0, 600 or 1200 mg/kg α-LA diet for 56 d, and hepatocytes were treated with 20 μm compound C, the inhibitor of AMP kinase α (AMPKα), treated for 30 min before α-LA treatment for 24 h. LA significantly decreased lipid content of the whole body and other tissues (P<0·05), and it also promoted protein deposition in vivo (P<0·05). Further, dietary LA significantly decreased the TAG content of serum and increased the NEFA content of serum (P<0·05); however, there were no significant differences among all groups in the hepatopancreas and muscle (P>0·05). Consistent with results from the experiment in vitro, LA activated phosphorylation of AMPKα and notably increased the protein content of adipose TAG lipase in intraperitoneal fat, hepatopancreas and muscle in vivo (P<0·05). Meanwhile, LA significantly up-regulated the mRNA expression of genes involved in fatty acid β-oxidation in the same three areas, and LA also obviously down-regulated the mRNA expression of genes involved in amino acid catabolism in muscle (P<0·05). Besides, it was observed that LA significantly activated the mammalian target of rapamycin (mTOR) pathway in muscle of experimental fish (P<0·05). LA could promote lipolysis and fatty acid β-oxidation via increasing energy supply from lipid catabolism, and then, it could economise on the protein from energy production to increase protein deposition in grass carp. Besides, LA might directly promote protein synthesis through activating the mTOR pathway.
Suboptimal vitamin B2 status is encountered globally. Riboflavin deficiency depresses growth and results in a fatty liver. The underlying mechanisms remain to be established and an overview of molecular alterations is lacking. We investigated hepatic proteome changes induced by riboflavin deficiency to explain its effects on growth and hepatic lipid metabolism. In all, 360 1-d-old Pekin ducks were divided into three groups of 120 birds each, with twelve replicates and ten birds per replicate. For 21 d, the ducks were fed ad libitum a control diet (CAL), a riboflavin-deficient diet (RD) or were pair-fed with the control diet to the mean daily intake of the RD group (CPF). When comparing RD with CAL and CPF, growth depression, liver enlargement, liver lipid accumulation and enhanced liver SFA (C6 : 0, C12 : 0, C16 : 0, C18 : 0) were observed. In RD, thirty-two proteins were enhanced and thirty-one diminished (>1·5-fold) compared with CAL and CPF. Selected proteins were confirmed by Western blotting. The diminished proteins are mainly involved in fatty acid β-oxidation and the mitochondrial electron transport chain (ETC), whereas the enhanced proteins are mainly involved in TAG and cholesterol biosynthesis. RD causes liver lipid accumulation and growth depression probably by impairing fatty acid β-oxidation and ETC. These findings contribute to our understanding of the mechanisms of liver lipid metabolic disorders due to RD.
Excited by the great success of metal halide perovskites in the optoelectronic and electro-optic fields and the interesting emerging physics (Rashba splitting, quantum anomalous hall effect) of layered metal halides, metal halides have recently been attracting significant attentions from both research and industrial communities. It is shown that most progresses have been made when these materials are obtained at reduced dimensions. Among several growth methods, vapor phase epitaxy has been demonstrated with a universal control on morphology, phase, and composition. We thus believe that a thorough understanding on the physical properties and on the growth of general metal halide compounds at reduced dimensions would be very beneficial in the study of recent perovskites and layered metal halide materials. This review covers the physical properties of most studied metal halides and summarizes the vapor phase epitaxial growth knowledge collected in the past century. We hope that this comprehensive review could be helpful in designing new physical properties and in planning growth parameters for emerging metal halide crystals.
Partial differential equations (PDE) on manifolds arise in many areas, including mathematics and many applied fields. Due to the complicated geometrical structure of the manifold, it is difficult to get efficient numerical method to solve PDE on manifold. In the paper, we propose a method called point integral method (PIM) to solve the Poisson-type equations from point clouds. Among different kinds of PDEs, the Poisson-type equations including the standard Poisson equation and the related eigenproblem of the Laplace-Beltrami operator are one of the most important. In PIM, the key idea is to derive the integral equations which approximates the Poisson-type equations and contains no derivatives but only the values of the unknown function. This feature makes the integral equation easy to be discretized from point cloud. In the paper, we explain the derivation of the integral equations, describe the point integral method and its implementation, and present the numerical experiments to demonstrate the convergence of PIM.
Tungstate based phosphors have efficient absorption in the UV region and can be used for UV-pumped light emitting. For novel and effective materials and synthesis methods in this system, a series of Eu3+ and Tb3+ co-doped NaY(WO4)2 phosphors have been synthesized via the molten salt method. The powder X-ray diffraction (PXRD) patterns, scanning electronic microscope (SEM), and photoluminescent spectra have been characterized for the prepared samples. The results show the flux (NaCl) not only decreases the reaction temperature (700–900 °C) than the normal solid state synthesis (∼1000 °C), but also controls the morphology of the products. The shape and size of products can be changed simply and effectively by the reaction conditions, such as temperature and heating time. It is also found that the emission colors of the samples can be tuned from red to green by simply adjusting the doping concentrations of Eu3+ and Tb3+ ions under the same wave length excitation, which has potential applications for multi-color display and illumination as a single-component phosphor.
Semi-Lagrangian (S-L) methods have no CFL stability constraint, and are more stable than the Eulerian methods. In the literature, the S-L method for the level-set re-initialization equation was complicated, which may be unnecessary. Since the re-initialization procedure is auxiliary, we propose to use the first-order S-L scheme coupled with a projection technique to improve the accuracy at the grid points just adjacent to the interface. Standard second-order S-L method is used for evolving the level-set convection equation. The implementation is simple, including on the block-structured adaptive mesh. The efficiency of the S-L method is demonstrated by extensive numerical examples including passive convection of interfaces with corners/kinks/large deformation under given velocity fields, a geometrical flow with topological changes, simulations of bubble/ droplet dynamics in incompressible two-phase flows. In terms of accuracy it is comparable to the other existing methods.
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