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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.
This trial was conducted to study the effects of dietary rapeseed cake (RSC) containing high glucosinolates (GLS) on rumen fermentation, nutrient digestion and the rumen microbial community in steers. Eight growing steers and four rations containing RSC (GLS 226·1 μmol/g DM) at 0·00, 2·65, 5·35 and 8·00 % DM were assigned in a replicate 4 × 4 Latin square design. The results indicated that increasing RSC levels increased the ruminal concentration of thiocyanate (SCN) (P < 0·01), decreased the ruminal concentration of ammonia nitrogen (NH3-N) and the molar proportion of isovalerate (P < 0·05), did not affect the ruminal concentration of total volatile fatty acids (P > 0·05), decreased the crude protein (CP) digestibility (P < 0·05) and increased the ether extract (EE) digestibility (P < 0·01). Increasing RSC levels tended to decrease the abundances of ruminal Ruminobacter amylophilus (P = 0·055) and Ruminococcus albus (P = 0·086) but did not affect methanogens, protozoa, fungi and other bacteria (P > 0·05). Increasing RSC levels in the ration did not affect the ruminal bacterial diversity (P > 0·05), but it increased the operational taxonomic units and the bacterial richness (P < 0·05) and affected the relative abundances of some bacteria at the phylum level and genus level (P < 0·05). In conclusion, RSC decreased the ruminal concentration of NH3-N and the CP digestibility, increased the EE digestibility and partly affected the ruminal bacterial community. SCN, as the metabolite of GLS, could be a major factor affecting these indices.
In January 2016, static GPS measurements were carried out in a 30 × 30 km2 area centered around Kunlun station at Dome Argus (Dome A), East Antarctica, to acquire high-precision 3-D geodetic coordinates at 49 sites. By comparing the coordinates with previous GPS measurements in 2008 and 2013 at the same sites, we constructed a detailed and long-term record of the ice-surface velocity field, 2008–2016, around Dome A. During this time span, the estimated ice-surface velocity ranges from 0.8 ± 0.3 to 28.7 ± 1.6 cm a−1, with a mean of 10.4 ± 0.3 cm a−1. From 2013 to 2016, the surface elevation of most Dome A areas exhibits a rising trend, and the maximum increase of snow surface elevation is 84.8 cm. The mean snow surface elevation change rate at Dome A is estimated to be 6.6 ± 0.7 cm a−1. The difference of 1.0 cm a−1 between the snow surface change rate derived from GPS and pole-height change rate from surface mass balance is suspected to be a result of a combination of firn densification and basal melt under Dome A.
Mastery of strengthening strategies to achieve high-capacity anodes for lithium-ion batteries can shed light on understanding the nature of diffusion-induced stress and offer an approach to use submicro-sized materials with an ultrahigh capacity for large-scale batteries. Here, we report solute strengthening in a series of silicon (Si)–germanium (Ge) alloys. When the larger solute atom (Ge) is added to the solvent atoms (Si), a compressive stress is generated in the vicinity of Ge atoms. This local stress field interacts with resident dislocations and subsequently impedes their motion to increase the yield stress in the alloys. The addition of Ge into Si substantially improves the capacity retention, particularly in Si0.50Ge0.50, aligning with literature reports that the Si/Ge alloy showed a maximum yield stress in Si0.50Ge0.50. In situ X-ray diffraction studies on the Si0.50Ge0.50 electrode show that the phase change undergoes three subsequent steps during the lithiation process: removal of surface oxide layer, formation of cluster-size Lix(Si,Ge), and formation of crystalline Li15(Si,Ge)4. Furthermore, the lithiation process starts from higher index facets, i.e., (220) and (311), then through the low index facet (111), suggesting the orientation-dependence of the lithiation process in the Si0.50Ge0.50 electrode.
Using repeat GPS measurements during 2005–16, we calculated and updated two-dimensional high-resolution decadal ice surface velocity estimates along the traverse route from Zhongshan Station to and around Dome Argus, East Antarctica. Along the 71 sites of the transect, the magnitudes of ice velocity increased from near 0 in Dome Argus to 1, 10 and ~100 m a−1 at the sites DT416, DT333 and LT980, respectively. The comparison between GPS and interferometric synthetic aperture radar (InSAR) derived results agree well when the magnitude of the ice surface velocities is faster than 5 m a−1, and disagree for slower flow velocities. A scale value 1.15 and 0.12 can be applied to InSAR derived results over this region with ice surface velocity larger and <5 m a−1, respectively. We attributed the cause of the discrepancy to the insensitivity of InSAR to the magnitude of low ice surface velocities, thus confirming the importance of GPS fieldwork-based ground truth high-resolution ice velocity estimates to constrain ice-sheet dynamics.
The transition metal compound catalysts have been taken a great part in renewable energy conversion and storage systems. Herein, we report the uniform CoFe2O4 nanoparticles with abundant oxygen vacancies and specific active surface exposed through the simple hydrothermal reaction for improving the electrocatalytic performance and stability. They show good electrocatalytic performance for hydrogen evolution reaction in 0.5 M H2SO4 with an onset potential of 20 mV, the overpotential of 45 mV (at j = 10 mA/cm2), and remarkable long-term stability more than 100 h at different current densities and better oxygen reduction reaction activity with lower overpotential in 0.1 M KOH. Moreover, the home-made primary Zn–air batteries, using CoFe2O4 nanoparticles as an air–cathode display the high open-circuit voltage of 1.47 V and the maximum power density of 142 mW/cm2. The two-series-connected batteries fabricated by CoFe2O4 nanoparticles can support a light-emitting diode to work for more than 48 h.
Three gravity cores (LZK1, ZKA4, and CSJA6) from the incised Yangtze paleo-valley comprise a thick sequence of the post-glacial deposit. Nineteen genera (26 species) of the benthic foraminifers are described from these cores, with detailed down-core foraminiferal variations to investigate their paleoenvironmental implications. Three foraminiferal assemblages are recognized for the lower, middle, and upper parts of the cores respectively. The lower part is dominated by Ammonia beccarii var. and Florilus decorus with lower abundance and diversity. In the middle part, the foraminifers are abundant and diverse, dominated by both Ammonia beccarii var. and Elphidium advenum. Cavarotalia annectens, Pararotalia nipponica, and porcellaneous benthic foraminiferal forms are always present, sometimes abundant. The upper part is characterized by the Ammonia beccarii-Elphidium magellanicum assemblage, except for the Core ZKA4, which is barren of foraminifers in this interval. AMS 14C dates and foraminiferal assemblages both confirm that the transgression-regression sequence in these cores belongs to the “Ammonia transgression” during the Holocene. In addition to documenting the post-glacial sea-level fluctuations, the benthic foraminifers also reflect a warmer climate during the early–middle Holocene. The foraminiferal differences among the three cores can be used to interpret the influence of seawater during the post-glacial sea-level fluctuations. The area in the vicinity of Core ZKA4 was affected by marine water only during the middle Holocene, which was much shorter than the areas of the other cores.
Dilute magnetic semiconductors are attractive due to their potential in spintronic devices. In this work, vanadium doped ZnO system has been studied to see its future as a dilute magnetic semiconductor. Vanadium doped ZnO thin films where vanadium percentage is 2, 3, and 5% are deposited by pulsed laser technique (PLD). The lattice parameter c derived from the (002) diffraction peak increases as vanadium content increases, suggesting vanadium substitution for Zn in ZnO lattice. Photoluminescence (PL) measurements at low temperature shows the emission peak at 3.30 eV which hint toward p-type doping in ZnO. X-ray photoelectron spectroscopy (XPS) results show that vanadium exists in V2+ and V4+ valence state, which is in agreement with the XRD and PL results and support the vanadium doped ZnO phase. The ferromagnetic behavior also supports the formation of vanadium doped ZnO phase in thin film samples.
Disaster can strike people in any community at any time anywhere in the world. Disasters occur with high frequency, take on multiple forms, and exert wide influence, typically causing property damage, injuries, and death. As the world’s largest developing country, China incurs great costs when a disaster hits. After the Wenchuan earthquake in 2008, the Chinese government focused its attention on the construction of an emergency response system, the creation of disaster prevention and mitigation systems, and the development of a disaster medicine program. Here, we describe the current status of disaster medicine in China, focusing on the following four aspects: the Emergency Management System, Education & Training, Rescue Practices, and Research. We also discuss the future of disaster medicine in China. (Disaster Med Public Health Preparedness. 2018;12:157–165)
A new ultrahigh strength hot rolled Ti–Mo-bearing ferritic steel was developed through chemical composition design and rolling processing optimization. To maximize the potential of nanometer-sized (Ti, Mo)C carbide in terms of strengthening ferrite matrix, the optimal chemical composition of 0.1C–0.2Ti–0.4Mo (wt%) was determined through considering the atomic ratio of elements, the solubility temperature of (Ti, Mo)C in austenite, and the excessive growth critical temperature of austenite grain during reheating. The rolling condition in the region through austenite recrystallization region to austenite nonrecrystallization region was adopted to realize a homogenous and fine ferrite grain structure. Results showed that the simulated coiling at 600 °C was found to provide an attractive combination of ferrite grain refinement hardening (360 MPa) and precipitation hardening (324 MPa). An optimal combination of strength and ductility was achieved after coiling at 600 °C (yield strength: 912 MPa; ultimate tensile strength: 971 MPa; total elongation: 16.0%). In addition, the nanometer-sized (Ti, Mo)C carbide was characterized by transmission electron microscopy (TEM) and physical–chemical phase analysis, and its role was discussed in details.
The hot ductility of Ti-bearing steel was studied by theoretical calculation and a
thermal simulation experiment. Meanwhile, microsegregation and precipitates were analyzed.
The results showed that the S, P and O elements were enriched at the grain boundaries,
while the hot ductility was deteriorated by inclusions of (Fe, Mn, Si, Al)(S,O) in the
interdendritic region. At a temperature of 1300 °C, large TiN particles have little effect
on the hot ductility. In the temperature range from 1000 °C to 900 °C, the Reduction of
Area (R.A) declined rapidly from 81.77%
to 31.77%, with the size of particles decreasing from 5 to 20 nm and quantity increasing
from 1.2 inds/μm2 to 354 inds/μm2,
respectively. In the temperature range from 900 °C to 850 °C,
R.A decreased from 31.77% to 30.12%
with the ferric films gradually thickening. The critical stress, 63.58 MPa, was equal to
tensile strength at 912 °C. Intergranular fracture occurred easily with higher critical
stress below 912 °C.
Fast linear transformer driver (FLTD) has some advantages in repetitive operation compared with traditional pulsed power generators. However, different types of gas switches applied in the field of pulsed power technology in recent years cannot reach the requirements of repetitive operation of FLTD. Therefore, the capability of repetitive operation of a multigap gas switch has been investigated in a circuit similar to the basic discharge loop named as brick in this paper. The switch has been triggered more than 2000 times and the distribution of delay time and switch jitter are analyzed and reported. Also, the self-breakdown voltages of the switch during different segments of the triggered breakdown experiment have been tested. The experimental results indicate that the delay time obeys the Gauss distribution and the jitter of 2000 times of discharge is about 2.3 ns.
Contaminated water is one of the main sources of norovirus (NoV) gastroenteritis outbreaks globally. Waterborne NoV outbreaks are infrequently attributed to GII.4 NoV. In September 2009, a NoV outbreak affected a small school in Guangdong Province, China. Epidemiological investigations indicated that household use water, supplied by a well, was the probable source (relative risk 1·9). NoV nucleic acid material in concentrated well-water samples was detected using real-time RT–PCR. Nucleotide sequences of NoV extracted from diarrhoea and well-water specimens were identical and had the greatest sequence identity to corresponding sequences from the epidemic strain GII.4-2006b. Our report documents the first laboratory-confirmed waterborne outbreak caused by GII.4 NoV genotype in China. Our investigations indicate that well water, intended exclusively for household use but not for consumption, caused this outbreak. The results of this report serve as a reminder that private well water intended for household use should be tested for NoV.
Survivin is a novel member of the inhibitor of apoptosis gene family that bear baculoviral IAP repeats (BIRs), whose physiological roles in regulating meiotic cell cycle need to be determined. Confocal microscopy was employed to observe the localization of survivin in rat oocytes. At the germinal vesicle (GV) stage, survivin was mainly concentrated in the GV. At the prometaphase I (pro-MI) and metaphase I (MI) stage, survivin was mainly localized at the kinetochores, with a light staining detected on the chromosomes. After transition to anaphase I or telophase I stage, survivin migrated to the midbody, and signals on the kinetochores and chromosomes disappeared. At metaphase II (MII) stage, survivin became mainly localized at the kinetochores again. Microinjection of oocytes with anti-survivin antibodies at the beginning of the meiosis, thus blocking the normal function of survivin, resulted in abnormal spindle assembly, chromosome segregation and first polar body emission. These results suggest that survivin is involved in regulating the meiotic cell cycle in rat oocytes.
We report an experimental study of the large-scale circulation (LSC) in a turbulent Rayleigh–Bénard convection cell with aspect ratio unity. The temperature-extrema-extraction (TEE) method for obtaining the dynamic information of the LSC is presented. With this method, the azimuthal angular positions of the hot ascending and cold descending flows along the sidewall are identified from the measured instantaneous azimuthal temperature profile. The motion of the LSC is then decomposed into two different modes based on these two angles: the azimuthal mode and the translational or sloshing mode that is perpendicular to the vertical circulation plane of the LSC. Comparing to the previous sinusoidal-fitting (SF) method, it is found that both the TEE and the SF methods give the same information about the azimuthal motion of the LSC, but the TEE method in addition can provide information about the sloshing motion of the LSC. The sloshing motion is found to oscillate time-periodically around the cell's central vertical axis with an amplitude being nearly independent of the turbulent intensity and to have a π/2 phase difference with the torsional mode. It is further found that the azimuthal angular positions of the hot ascending and cold descending flows oscillate out of phase with each other by π, which leads to the observations of the torsional mode when these two flows are near the top and the bottom plates, respectively, and of the sloshing mode when they are both near the mid-height plane. A direct velocity measurement further confirms the existence of the bulk sloshing mode of the flow field.
N-polar and Ga-polar GaN grown on c-plane sapphire by a metal-organic chemical vapor deposition (MOCVD) system were used to fabricate platinum deposited Schottky contacts for hydrogen sensing at room temperature. Wurtzite GaN is a polar material. Along the c-axis, there are N-face (N-polar) or Ga-face (Ga-polar) orientations on the GaN surface. The Ohmic contacts were formed by lift-off of e-beam deposited Ti (200 Å)/Al (1000 Å)/Ni (400 Å)/Au (1200 Å). The contacts were annealed at 850°C for 45 s under a flowing N2 ambient. Isolation was achieved with 2000 Å plasma enhanced chemical vapor deposited SiNx formed at 300°C. A 100 Å of Pt was deposited by e-beam evaporation to form Schottky contacts. After exposure to hydrogen, Ga-polar GaN Schottky showed 10% of current change, while the N-polar GaN Schottky contacts became fully Ohmic. The N-polar GaN Schottky diodes showed stronger and faster response to 4% hydrogen than that of Ga-polar GaN Schottky diodes. The abrupt current increase from N-polar GaN Schottky exposure to hydrogen was attributed to the high reactivity of the N-face surface termination. The surface termination dominates the sensitivity and response time of the hydrogen sensors made of GaN Schottky diodes. Current-voltage characteristics and the real-time detection of the sensor for hydrogen were investigated. These results demonstrate that the surface termination is crucial in the performance of hydrogen sensors made of GaN Schottky diodes.
We present an efficient polymer-small molecule triple-tandem organic solar cell (OSC), consisting of poly(3-hexylthiophene) (P3HT) and 1-(3-methoxycarbonyl)-propyl-1-phenyl-(6,6)C61 (PCBM) bulk heterojunction as the first and second cells, and small molecules copper phthalocyanine (CuPc) and fullerene (C60) as the third cell on top. These sub-cells are connected by an intermediate layer of Al(1 nm)/MoO3(15 nm), which appears to be highly transparent, structurally smooth, and electrically functional. Compared to our previous all polymer triple-tandem organic solar cells (2.03%), this polymer-small molecule triple-tandem organic solar cell achieves an improved power conversion efficiency of 2.18% with a short-circuit current density (Jsc) = 3.02 mA/cm2, open-circuit voltage (Voc) = 1.51 V, and fill factor (FF) = 47.7% under simulated solar irradiation of 100 mW/cm2 (AM1.5G), which can be attributed to the increased photocurrent generation in the third cell since the third cell has the complementary absorption with two bottom cells despite a slightly reduced Voc.
We report high-resolution measurements of the properties of the velocity boundary layer in turbulent thermal convection using the particle image velocimetry (PIV) technique and measurements of the temperature profiles and the thermal boundary layer. Both velocity and temperature measurements were made near the lower conducting plate of a rectangular convection cell using water as the convecting fluid, with the Rayleigh number Ra varying from 109 to 1010 and the Prandtl number Pr fixed at 4.3. From the measured profiles of the horizontal velocity we obtain the viscous boundary layer thickness δυ. It is found that δυ follows the classical Blasius-like laminar boundary layer in the present range of Ra, and it scales with the Reynolds number Re as δυ/H = 0.64Re−0.50±0.03 (where H is the cell height). While the measured viscous shear stress and Reynolds shear stress show that the boundary layer is laminar for Ra < 2.0 × 1010, two independent extrapolations, one based on velocity measurements and the other on velocity and temperature measurements, both indicate that the boundary layer will become turbulent at Ra ~ 1013. Just above the thermal boundary layer but within the mixing zone, the measured temperature r.m.s. profiles σT(z) are found to follow either a power law or a logarithmic behaviour. The power-law fitting may be slightly favoured and its exponent is found to depend on Ra and varies from −0.6 to −0.77, which is much larger than the classical value of −1/3. In the same region, the measured profiles of the r.m.s. vertical velocity σw(z) exhibit a much smaller scaling range and are also consistent with either a power-law or a logarithmic behaviour. The Reynolds number dependence of several wall quantities is also measured directly. These are the wall shear stress τw ~ Re1.55, the viscous sublayer δw ~ Re−0.91, the friction velocity uτ ~ Re0.80, and the skin-friction coefficient cf ~ Re−0.34. All of these scaling properties are very close to those predicted for a classical Blasius-type laminar boundary layer, except that of cf. Similar to classical shear flows, a viscous sublayer is also found to exist in the present system despite the presence of a nested thermal boundary layer. However, velocity profiles normalized by wall units exhibit no obvious logarithmic region, which is likely to be a result of the very limited distance between the edge of the viscous sublayer and the position of the maximum velocity. Compared to traditional shear flows, the peak position of the wall-unit-normalized r.m.s. profiles is found to be closer to the plate (at z+ = z/δw ≃ 5). Our overall conclusion is that a Blasius-type laminar boundary condition is a good approximation for the velocity boundary layer in turbulent thermal convection for the present range of Rayleigh number and Prandtl number.