Search

Chemo-photothermal therapy has attracted tremendous attention due to its synergistic effect in killing cancer cells, making it one of the most efficient therapies. Although most of the applied core–shell hybrid nanoparticles (NPs) can perform such a function, the lowering of their thermal efficiency through polymer coating and limited drug loading capacity severely limit their performance. Janus NPs with exposed metal and a polymer/silica matrix show improved chemo- and photothermal-efficiency, but have a complicated synthesis, and their loading capacity for hydrophobic drugs still needs to be optimized. Herein, we report the facile synthesis of Janus NPs comprising Au nanorods (NRs) and a hydrophobic polydivinylbenzene (PDVB) matrix. The UV-vis extinction of the Janus NPs is in the near infrared region (the region used in medicine), which makes it an ideal candidate for photothermal therapy, and the hydrophobic PDVB component is a good anticancer drug (curcumin) carrier for chemotherapy. With this combination of chemo- and photothermal-effects, a significant decrease in cell viability, migration, and invasion was realised, making the material a promising biomedical candidate for the treatment of cancer.

Background Numerous studies have assessed the association between xeroderma pigmentosum complementation group C (XPC) polymorphisms and susceptibility of prostate cancer (PCa); however, the findings remain inconsistent. Methods We performed an updated analysis utilizing data from electronic databases to obtain a more accurate estimation of the relationship between XPC rs2228001 A/C polymorphism and PCa risk. We further used in silico tools to investigate this correlation. Results Totally, 5,305 PCa cases and 6,499 control subjects were evaluated. When all studies pooled together, we detected no positive result (recessive genetic model: OR = 1.14, 95% CI = 0.93-1.40, Pheterogeneity = 0.001, P = .212); nevertheless, the XPC rs2228001 A/C variant was associated with PCa risk in Asian descendants in the subgroup analysis (OR = 1.21, 95% CI = 1.01-1.43, Pheterogeneity = 0.008, P = .034). In silico tools showed that more than 20 proteins can participate in the protein crosstalk with XPC. The expression of XPC was down-regulated in all Gleason scores of prostate cancer. Conclusions The present study indicated that the XPC rs2228001 A/C variant may be associated with elevated PCa risk in Asian patients.

The use of potassium (K) metal anodes could result in high-performance K-ion batteries that offer a sustainable and low-cost alternative to lithium (Li)-ion technology. However, formation of dendrites on such K-metal surfaces is inevitable, which prevents their utilization. Here, we report that K dendrites can be healed in situ in a K-metal battery. The healing is triggered by current-controlled, self-heating at the electrolyte/dendrite interface, which causes migration of surface atoms away from the dendrite tips, thereby smoothening the dendritic surface. We discover that this process is strikingly more efficient for K as compared to Li metal. We show that the reason for this is the far greater mobility of surface atoms in K relative to Li metal, which enables dendrite healing to take place at an order-of-magnitude lower current density. We demonstrate that the K-metal anode can be coupled with a potassium cobalt oxide cathode to achieve dendrite healing in a practical full-cell device.

Objectives The adoption and use of health information technology (IT) by health systems in ambulatory care can be an important driver of care quality. We examine recent trends in health IT adoption by health system-affiliated ambulatory clinics in the context of the federal government's Meaningful Use and Promoting Interoperability programs. Study design We analyzed a national sample of 17,861 ambulatory clinics affiliated with 1711 health systems, using longitudinal data (2014-2016) from the HIMSS Analytics annual surveys. Methods We used descriptive analyses and linear probability models to examine the adoption of electronic health records (EHRs), as well as 16 specific functionalities, at the clinic level and the system level. We compared the differential trends of adoption by various characteristics of health systems. Results We find that the adoption of an EHR certified by the Office of the National Coordinator for Health IT (ONC) increased from 73% to 91%. However, in 2016, only 38% of clinics reported having all 16 health IT functionalities included in this study. Small health systems lag behind large systems in ambulatory health IT adoption. Patient-facing functionalities were less likely to be adopted than those oriented toward physicians. Health information exchange capabilities are still low among ambulatory clinics, pointing to the importance of the ONC's recent Promoting Interoperability initiative. Conclusions The relatively low uptake of health IT functionalities important to care improvement suggests substantial opportunities for further improving adoption of ambulatory health IT even among the current EHR users.

A new strategy for preparing amphibious ZnO quantum dots (QDs) with blue fluorescence within hyper-branched poly(ethylenimine)s (HPEI) was proposed in this paper. By changing [Zn2+]/[OH−] molar ratio and heating time, ZnO QDs with a quantum yields (QY) of 30% in ethanol were obtained. Benefiting from the amphibious property of HPEI, the ZnO/HPEI nanocomposites in ethanol could be dissolved in chloroform and water, acquiring a QY of 53%, chloroform and 11% in water. By this strategy, the ZnO/HPEI nano-composites could be applied in not only in optoelectronics, but also biomedical fields (such as bio-imaging and gene transfection). The bio-imaging application of water-soluble ZnO/HPEI nanocomposites was investigated and it was found that they could easily be endocytosed by the COS-7 cells, without transfection reagent, and they exhibited excellent biological imaging behavior.

Molecular dynamics simulations were used to study the atomic mechanisms of deformation of nanocrystalline gold with 2.65–18 nm in grain size to explore the inverse Hall–Petch effect. Based on the mechanical responses, particularly the flow stress and the elastic-to-plastic transition, one can delineate three regimes: mixed (10–18 nm, dislocation activities and grain boundary sliding), inverse Hall-Petch (5–10 nm, grain boundary sliding), and super-soft (below 5 nm). As the grain size decreases, more grain boundaries present in the nanocrystalline solids, which block dislocation activities and facilitate grain boundary sliding. The transition from dislocation activities to grain boundary sliding leads to strengthening-then-softening due to grain size reduction, shown by the flow stress. It was further found that, samples with large grain exhibit pronounced yield, with the stress overshoot decrease as the grain size decreases. Samples with grain sizes smaller than 5 nm exhibit elastic-perfect plastic deformation without any stress overshoot, leading to the super-soft regime. Our simulations show that, during deformation, smaller grains rotate more and grow in size, while larger grains rotate less and shrink in size.

Additional file 1. Additional analysis examining two medication-related outcomes: e-prescribing for new medications and e-prescribing for refill requests. N = 19,804 clinics.

In this paper, we confirm the conjecture of Wang and Zhang (J. Stat. Phys. 134 (5-6): 953--968, 2009) in a long time scale, i.e., the displacement of the wavefront for $1D$ nonlinear random Schroedinger equation is of logarithmic order in time $|t|$., Comment: A revised version, to appear in J. Stat. Phys

OBJECTIVE The objective of this study was to measure the dissemination of comparative provider quality information (CPQI) and evaluate its impact on consumers' awareness and use of CPQI. DATA SOURCES Two-period, random-digit-dial panel survey of chronically ill consumers residing in 14 regions of the United States; summaries of CPQI dissemination activities of regional multistakeholder alliances; and the LexisNexis Academic and Access World News databases. STUDY DESIGN/METHODS Fixed effects regression to isolate the effect of CPQI producers' dissemination activities and the print media's CPQI coverage on chronically ill consumers' self-reported awareness and use of CPQI. PRINCIPAL FINDINGS Direct CPQI dissemination had no overall effect on either awareness or use of CPQI. One unit increase in the media coverage of an Aligning Forces for Quality (AF4Q) multistakeholder alliance report increased consumer awareness and use of CPQI by 1.4 percentage points (P=0.049) and 1.1 percentage points (P=0.009), respectively. Similar increases for the Centers for Medicare and Medicaid Services (CMS) CPQI and for the nonalliance, non-CMS CPQI improved CPQI use by 1.6 percentage points (P

To exploit a green way to produce polymer nanoparticles using biodegradable and renewable macromolecules instead of petroleum-based ones, we initiated a novel and facile method to synthesize lignin nanoparticles (LNPs). The LNPs, having a hydrodynamic diameter ranging from ca. 80 to 230 nm, were formed by self-assembly in a recyclable and non-toxic aqueous sodium p-toluenesulfonate (pTsONa) solution at room temperature, with a lowest concentration of up to 48 g/L. We eliminated the unfavorable factors of restricted processing pH and lignin species by taking advantage of the hydrotropic chemistry and the synergistic dissociation of the entrapped pTsONa and intrinsic phenolic hydroxyl and carboxylic acid moieties of the LNPs. Because of the hydrotropic system, various water-soluble or water-insoluble drugs can be dissolved and encapsulated in the LNPs with an encapsulation efficiency of up to 90%. The drug-encapsulated LNPs also showed great properties, with sustained drug-releasing capability and biocompatibility. Furthermore, the unloaded drugs and free pTsONa could be easily recycled for multiple use, thereby achieving environmental sustainability. This synthesis approach with broad processing window could realize the industrial scale-up production of LNPs and have wide potential applications, including but not limited to versatile drug/bioactive macromolecule loading in the biomedical field.

To ensure both adequate axial load-bearing capacity and radial vulnerability of a circumferentially notched thin cylindrical shell is one of the major challenges in designing some crucial aerospace structures such as the pyrotechnic separation devices. The most favorable design for such a shell is to optimize the notch geometry such that zero stress at the notch root is realized, which enhances the axial strength without impacting the notch failure during separation. However, few studies have focused on such extreme stress concentration-free designs of a single-side notch on a shell because the asymmetrical structure under common eccentric loading brings much difficulty for theoretical analysis, while numerical approaches can hardly meet the requirements of highly efficient rapid optimal designs. In this paper, a theoretical and experimental study toward extreme stress concentration-free designs of single-side-notched thin cylindrical shells is presented. The general stress concentration factors (SCFs) for single-side notches with arbitrary depths are obtained based on the theory of notch stresses, which are well validated by the refined finite element modeling. An important finding reveals that, for a common notched shell in aerospace vehicles, the stress at the notch root approaches zero when a specific ratio of load eccentricity to minimum section width is attained. Comprehensive experiments for specially designed notched specimens confirm the theoretical finding. The present study provides an effective approach to analyzing single-side-notched structures and yields an explicit quantitative guideline for the optimal design of circumferentially notched thin cylindrical shells.

A new strategy for nanocrystal encapsulation, release and application based on pH-sensitive covalent dynamic hyperbranched polymers is described. The covalent dynamic hyperbranched polymers, with multi-arm hydrophobic chains and a hydrophilic hyperbranched poly(amidoamine) (HPAMAM) core connected with pH-sensitive imine bonds (HPAMAM&ndash, DA), could encapsulate CdTe quantum dots (QDs) and Au nanoparticles (NPs). Benefiting from its pH response property, CdTe QDs and Au NPs encapsulated by HPAMAM&ndash, DA could be released to aqueous phase after imine hydrolysis. The released CdTe/HPAMAM and Au/HPAMAM nanocomposites exhibited excellent biological imaging behavior and high catalytic activities on p-nitrophenol hydrogenation, respectively.

Background Computerized provider order entry (CPOE) can help providers deliver better quality care. We aimed to understand recent trends in use of CPOE by health system-affiliated ambulatory clinics. Methods We analyzed longitudinal data (2014–2016) for 19,109 ambulatory clinics that participated in all 3 years of the Healthcare Information and Management Systems Society Analytics survey to assess use of CPOE and identify characteristics of clinics associated with CPOE use. We calculated descriptive statistics to examine overall trends in use, location of order entry (bedside vs. clinical station), and system-level use CPOE across all clinics. We used linear probability models to explore the association between clinic characteristics (practice size, practice type, and health system type) and two outcomes of interest: CPOE use at any point between 2014 and 2016, and CPOE use beginning in 2015 or 2016. Results Between 2014 and 2016, use of CPOE increased more than 9 percentage points from 58 to 67%. Larger clinics and those affiliated with multi-hospital health systems were more likely to have reported use of CPOE. We found no difference in CPOE use by primary care versus specialty care clinics. When used, most clinics reported using CPOE for most or all of their orders. Health systems that used CPOE usually did so for all system-affiliated clinics. Conclusions Small practice size or not being part of a multi-hospital system are associated with lower use of CPOE between 2014 and 2016. Less than optimal use in these environments may be harming patient outcomes.

Metallic glasses (MGs) are arguably one of the most exciting metallic systems in the past 30 years, attracting significant research effort and undergoing rapid development. Parallel to research on crystalline metals, the sample size has been exploited as property-tuning parameters for MGs. It has been shown that nanometre-sized MG samples exhibit higher-than-bulk elastic limit, tensile strength, and non-zero tensile ductility. While some of the size-related observations have been generally accepted, others have been poorly understood, even hotly debated. Of particular interests is the importance of sample preparation in experiments and model generation in simulations. Here, we will review how the sample size affects mechanical properties including the elastic, plastic, fracture properties, and fatigue endurance, as well as various proposed size-dependent mechanisms and relevant length scales.

High specific capacity anode materials such as silicon (Si) are increasingly being explored for next-generation, high performance lithium (Li)-ion batteries. In this context, Si films are advantageous compared to Si nanoparticle based anodes since in films the free volume between nanoparticles is eliminated, resulting in very high volumetric energy density. However, Si undergoes volume expansion (contraction) under lithiation (delithiation) of up to 300%. This large volume expansion leads to stress build-up at the interface between the Si film and the current collector, leading to delamination of Si from the surface of the current collector. To prevent this, adhesion promotors (such as chromium interlayers) are often used to strengthen the interface between the Si and the current collector. Here, we show that such approaches are in fact counter-productive and that far better electrochemical stability can be obtained by engineering a van der Waals "slippery" interface between the Si film and the current collector. This can be accomplished by simply coating the current collector surface with graphene sheets. For such an interface, the Si film slips with respect to the current collector under lithiation/delithiation, while retaining electrical contact with the current collector. Molecular dynamics simulations indicate (i) less stress build-up and (ii) less stress "cycling" on a van der Waals slippery substrate as opposed to a fixed interface. Electrochemical testing confirms more stable performance and much higher Coulombic efficiency for Si films deposited on graphene-coated nickel (i.e., slippery interface) as compared to conventional nickel current collectors.

In this paper, it is proved that the full dimensional invariant tori obtained by Bourgain [J. Funct. Anal., 229 (2005), no. 1, 62–94] is stable in a very long time for 1D nonlinear Schrodinger equation with periodic boundary conditions.

Healing away the dendrites The formation of lithium dendrites during charge-discharge cycles limits the development of lithium metal batteries, because the dendrites can cause electrical shorting of the cells. A number of tricks have been used to try to prevent dendrite formation. Li et al. took the opposite approach (see the Perspective by Mukhopadhyay and Jangid). They operated their cells at higher current densities, under which one would expect dendrites to form owing to the higher nucleation rates. However, under these conditions, the dendrites that started to form heated up and annealed, leading to their disappearance. Science , this issue p. 1513 ; see also p. 1463

In this paper, we study the non-self dual extended Harper’s model with a Liouvillean frequency. By establishing quantitative reducibility results together with the averaging method, we prove that the lengths of the spectral gaps decay exponentially.

The Covariance Matrix Adaptation Evolution Strategy (CMA-ES) algorithm is one of the most successful continuous black-box optimization algorithms widely used in many fields. However, the algorithm would be computationally unaffordable due to the sharp increase in dimension and complexity of problems. To improve the computational efficiency and global optimizing ability, a competitive variable-fidelity surrogate-assisted CMA-ES (CVFS-CMA-ES) algorithm using data mining techniques is proposed in this paper. In the first data mining of CVFS-CMA-ES, the establishment method of the competitive variable-fidelity model (VFM) based on the fuzzy clustering algorithm is developed, aiming at making full use of high-fidelity information and focusing more on potential areas of design space. In the second data mining of CVFS-CMA-ES, the Lower Confidence Bound (LCB) method is modified by introducing the step size of CMA-ES to control the uncertain term adaptively, and the sample points are screened in each generation of CMA-ES based on the modified LCB method, which can make a balance between exploration and exploitation in the optimization process. The performance of CVFS-CMA-ES is compared with four known black-box optimization algorithms. Firstly, ten numerical examples of 10-dimensional and 30-dimensional benchmark functions are carried out, respectively. Moreover, a 20-dimensional engineering example of the aerospace variable-stiffness composite shell under combined loadings is studied in detail. Results of benchmark functions and engineering examples verify the high efficiency, robustness and high global optimizing ability of the proposed CVFS-CMA-ES in comparison to other algorithms.

Strong interactions between loading drugs and nanocarriers contribute greatly to the high loading capacity while bringing about the problems on effective drug release. To solve this dilemma, we develop a density functional theory (DFT)-guided drug loading strategy to construct a dismountable nanoplatform for sensitized tumor-homing thermotherapy. DFT, a kind of computational method, is used to screen out a heat shock protein90 (HSP90) inhibitor, geldanamycin (GDM), that highly matched the structure of nanocarriers, thus providing a high drug loading efficiency (~ 42%). Of special note, GDM could be effectively released inside tumor cells because the isoelectric points of cancer cell membrane (CCM) and polydopamine (PDA) are both around pH 4.0 ~ 5.0, which could exactly match with the acidic environment of endo/lysosome. The CCM envelope enables self-targeting of PDA/GDM@CCM to the source cancer cells and homologous tumors while effectively inhibiting recognition and clearance by macrophages. Efficient photothermal ablation is attributed to the efficient suppression of tumor heat resistance by GDM and precise selection of the best matched tumor type by using The Cancer Genome Atlas (TCGA). This DFT-guided drug loading strategy points out a new avenue for optimization of drug-loading into nanocarriers, and ultimately contributes to the high drug availability and excellent curative effect.

The car-following model is an important micro-traffic model for simulating car-following behaviour in traffic engineering and research studies. Conventional car-following models are always presented using mathematical equations reflecting ideal traffic conditions. In the big data era, data-driven models become a popular trend. In this study, a data-driven car-following model based on the rough set theory is proposed to consider information hidden in a field data set. On the basis of field data obtained from measurement devices such as the next generation simulation (NGSIM) trajectory data set, and using the methods of the rough set theory, an optimal decision rule set is established. Redundant attributes and redundant attribute values are removed for simplifying the car-following behaviour decision problem. Attribute significance and weights are computed for selecting matching rules. A car-following behaviour decision algorithm is designed to choose appropriate rules to determine the follower's velocity according to current observations. Simulations illustrate that the proposed data-driven car-following model can simulate the micro-traffic behaviour of followers well.

We conducted molecular dynamics (MD) simulations to study how solvent chains affect the diffusion of linear polymers in the unentangled regime. For monodisperse solvent chains, the self-diffusivity of a tagged chain scales with its chain length. The solvent chain length affects both the prefactor and the exponent, the latter of which ranges from -0.79 to -0.85. The scaling exponent here deviates from -1 as predicted by the Rouse model, which may suggest that the friction coefficient increases with the solvent chain length. In addition, we carried out diffusion simulations on two polydisperse melts, one with the Flory-Schulz distribution and the other with the Gaussian distribution. The measured diffusivity as a function of the tagged chain length agrees with a simple proposed model accounting for the heterogeneous medium.

Mechanical properties of glassy nanowires have been intensively investigated recently by both nanomechanical experiments and atomic-level simulations. Unfortunately, there exists a huge gap in the strain rate of the nanomechanical tests between experiments and simulations, which makes it difficult to compare results even for the same material system. Using accelerated atomistic simulations based on a self-learning metabasin escape algorithm, here, we report the tensile mechanical properties of amorphous Stillinger–Weber silicon nanowires with different intrinsic ductility under strain rates ranging from 1010 to 10−1 s−1. It is found that both brittle and ductile glassy silicon nanowires display weakened strength with a decreasing strain rate, in agreement with the cooperative shear model. Moreover, as the strain rate decreases, the amount of plasticity remains unchanged for the brittle nanowires, yet it decreases for the ductile ones. Such deteriorated plasticity in ductile glassy nanowires is caused by enhanced strain localization at low strain rates. Lastly, we show that via the distance matrix of nonaffine displacement, a more hierarchical potential energy landscape is responsible for the higher strain localization propensity in ductile silicon glassy nanowires.

Clay rock in the Tamusu (TMS) area in the Inner Mongolia province is one candidate as a geological disposal site for highly radioactive waste in China. The diffusion behavior of HTO and Se(IV) in Tamusu clay rock was studied by through-diffusion (TD) experiments and numerical analysis to determine the spatial and temporal variation. A minimum error analysis was conducted to determine the HTO and Se(IV) diffusion coefficients in compacted TMS clay. The TD experimental results and numerical analysis showed that the diffusion of HTO and Se reached a steady state within 7 and 50 days, respectively, and the apparent diffusion coefficients (Da) decreased with the increases in the compacted density. In fact, there was retardation of Se diffusion in intact TMS clay rock. A two-site sorption model for Se was applied to simulate fast and slow sorption behavior quantitatively.

Al2O3–SiO2 binary glasses with structural and chemical heterogeneities were prepared by consolidating glassy nanoparticles with different compositions using classical molecular dynamics simulations. Consolidated glasses show both excellent ductility and enhanced flow strength. It was found that the structural heterogeneities such as over-coordinated network formers and neighboring oxygen induced during consolidation serve as plasticity carriers to increase the ductility. On the other hand, the enhanced yield strength in consolidated glasses is due to the chemical heterogeneity inherited from the starting glassy nanoparticles, which does not compromise the ductility. Furthermore, apparent work hardening behavior appears upon cold work in the consolidated glasses, with an increase in yield strength from ~3.3 to ~6.4 GPa after 40% cold work. Consolidation with glassy nanoparticles could be a viable way to synthesize strong, damage resistant and transparent oxide glasses that cannot be obtained through the traditional melt-quench process.

Key Points Question Is the adoption of more advanced electronic health record (EHR) capabilities associated with better ambulatory clinical quality of care? Findings In cross-sectional analyses of 3 states from 2014 to 2017, ambulatory clinics (769-972 per year) with more advanced EHR capabilities had higher scores on a composite measure of ambulatory clinical quality than did other clinics, which translated into an approximately 9% difference in rank order of quality. Across the much smaller number of clinics that gained advanced EHR capabilities between 2014 and 2017 (n = 72), the composite of ambulatory clinical quality improved more than for other clinics, but the difference was not statistically significant. Meaning This study suggests that ambulatory clinics with advanced EHR capabilities were associated with a better performance on a composite measure of ambulatory clinical quality than clinics with less-advanced EHR capabilities; clinics that adopted advanced EHR capabilities during a 3-year period were not associated with significant increases in ambulatory clinical quality performance., Importance Electronic health records (EHRs) are widely promoted to improve the quality of health care, but information about the association of multifunctional EHRs with broad measures of quality in ambulatory settings is scarce. Objective To assess the association between EHRs with different degrees of capabilities and publicly reported ambulatory quality measures in at least 3 clinical domains of care. Design, Setting, and Participants This cross-sectional and longitudinal study was conducted using survey responses from 1141 ambulatory clinics in Minnesota, Washington, and Wisconsin affiliated with a health system that responded to the Healthcare Information and Management Systems Society Annual Survey and reported performance measures in 2014 to 2017. Statistical analysis was performed from July 10, 2019, through February 26, 2021. Main Outcomes and Measures A composite measure of EHR capability that considered 50 EHR capabilities in 7 functional domains, grouped into the following ordered categories: no functional EHR, EHR underuser, EHR, neither underuser or superuser, EHR superuser; as well as a standardized composite of ambulatory clinical performance measures that included 3 to 25 individual measures (median, 13 individual measures). Results In 2014, 381 of 746 clinics (51%) were EHR superusers; this proportion increased in each subsequent year (457 of 846 clinics [54%] in 2015, 510 of 881 clinics [58%] in 2016, and 566 of 932 clinics [61%] in 2017). In each cross-sectional analysis year, EHR superusers had better clinical quality performance than other clinics (adjusted difference in score: 0.39 [95% CI, 0.12-0.65] in 2014; 0.29 [95% CI, −0.01 to 0.59] in 2015; 0.26 [95% CI, –0.05 to 0.56] in 2016; and 0.20 [95% CI, –0.04 to 0.45] in 2017). This difference in scores translates into an approximately 9% difference in a clinic’s rank order in clinical quality. In longitudinal analyses, clinics that progressed to EHR superuser status had only slightly better gains in clinical quality between 2014 and 2017 compared with the gains in clinical quality of clinics that were static in terms of their EHR status (0.10 [95% CI, −0.13 to 0.32]). In an exploratory analysis, different types of EHR capability progressions had different degrees of associated improvements in ambulatory clinical quality (eg, progression from no functional EHR to a status short of superuser, 0.06 [95% CI, −0.40 to 0.52]; progression from EHR underuser to EHR superuser, 0.18 [95% CI, −0.14 to 0.50]). Conclusions and Relevance Between 2014 and 2017, ambulatory clinics in Minnesota, Washington, and Wisconsin with EHRs having greater capabilities had better composite measures of clinical quality than other clinics, but clinics that gained EHR capabilities during this time had smaller increases in clinical quality that were not statistically significant., This cross-sectional study assesses the association between electronic health records with different degrees of capabilities and publicly reported ambulatory quality measures in at least 3 clinical domains of care.

A new strategy for the construction, release and cellular imaging application of triethylamine-responsive fluorescent quantum dots (QDs) based on supramolecular self-assembly has been described. The supramolecular self-assembly (HPEI/SA), which was constructed through the electrostatic interactions between terminal amine groups of hyperbranched polyethylenimines (HPEI) and carboxylic acid groups of stearic acid (SA), first captured aqueous Zn2+ ions into the hydrophilic dendritic core and subsequently encapsulated QDs/S2- by the complexation interactions and reactions between Zn2+ and S2- on QDs. Due to the pH-responsive property of the HPEI/SA supramolecular self-assembly, the fluorescence of encapsulated QDs is sensitive to the triethylamine/SA mole ratio, and the encapsulated QDs can be released to the aqueous phase by cleaving HPEI/SA. The resulting fluorescent QDs/HPEI nanocomposites show promising prospects in bioimaging.

Metallic glasses, like many other glasses and ceramics, generally have zero tensile ductility. Distinct from common wisdom which seeks to toughen brittle glasses with ductile phases, we show that composites made from two brittle glasses can be ductile, strong and even harden under tension as a result of microstructure and stiffness contrast. Using molecular dynamics simulations, we designed and tested composites consisting of alternating wavy nanofilaments of two brittle glasses with different stiffness. The composites exhibit failure strain over 40% and strain hardening modulus over 2 GPa. The tensile ductility is determined by both the flexibility of nanofilaments and the propensity of crack deflection, with which a ductile composite design map can be constructed. The strain hardening is due to filament alignment analogous to linear polymer. The brittle-brittle composite design strategy proposed here is not material-specific and should be applicable to, for instance, ultra-hard materials as constituents in achieving new damage-resistance composites.

Garden path sentence is a kind of complex sentence which may cause structural and semantic ambiguity. Psycholinguistic analysis is the conventional approach to it. This paper will survey garden path sentence via viewpoint analysis within a systemic functional linguistic frame. In another word, garden path sentence will be discussed in term of lexicogrammar, clause complex, transitivity, theme and rheme, and cohesion and their relationship with viewpoint. It is expected that this approach will help to the interpretation and disambiguation of garden path sentences. Garden path effect attributes to polysemy of lexis, syntactic structure and sentence reader’s viewpoint.

The glucagon-like peptide-1 (GLP-1) receptor is currently being explored as a therapeutic target for anti-diabetic drugs. GLP-1 analogs possess therapeutic effects similar to those of other anti-diabetic drugs such as guanidine and sulfonylureas but do not cause hypoglycemia and gastrointestinal discomfort. GLP-1 has the ability to reduce blood glucose in a glucose-dependent manner. Several GLP-1 analog agonists have been developed. However, polypeptide drugs are easily degraded by DPP4 in vivo. Therefore, the focus is now on the development of nonpolypeptide anti-diabetic drugs targeting the GLP-1 receptor. In this study, computer-aided drug design was applied to search for potential molecules of this type. Cochinchinenin C, extracted from sangusis draconi, interacted well with GLP-1 receptor via hydrophobic interaction, which was confirmed by fluorescence spectroscopy and molecular simulation. In cell experiments, it was demonstrated that pancreatic beta cells promoted insulin secretion upon treatment with cochinchinenin C, and increases of intracellular cAMP and ATP levels also occurred, indicating GLP-1 receptor activation and glucose metabolism. These results showed that cochinchinenin C has potential for the development of drugs for treating diabetes.

We report a dynamic self-assembly system of ‘living’ polymeric chains sustained by chemistry using reactive molecular dynamics simulations. The linear polymeric chains consist of self-assembled nanoparticles connected by metastable linker molecules. As such, the polymeric chains, once assembled, undergo spontaneous dissociation driven by thermodynamics. However, with a continuous supply of linker molecules and the stored chemical energy therein, the polymeric chains can survive and maintain a steady state averaged chain length. These dynamically self-assembled polymeric chains are analogous to biological systems that both are thermodynamically metastable, yet dynamically stable upon continuous influx of matter and energy.

Atomic level computer simulation has become indispensable in understanding the mechanical properties of glasses, among other properties. However, the majority of model glasses are more ductile than their intended experimental counterparts, partially reflected by the overestimation of the Poisson's ratio. We have previously introduced an effective force field tuning method of imposing an additional energy penalty term to embrittle a binary Lennard–Jones glass. Here, we improved this method by varying the applied range of the energy penalty. The new method stabilizes the model glass even for high energy penalty values. Furthermore, unlike the old method, there is no unintended reduction in density for brittle glasses. Uniaxial tension tests were conducted to show the ductile-to-brittle transition as the energy penalty increases in strength. Crack propagation simulation was also conducted to demonstrate the efficacy of studying brittle fracture using the model glass.

The diamond cutting of transition metal alloys, particularly steel, is severely hindered by accelerated chemical wear of the tool. Recent experimental findings show that the presence of graphene platelets mitigates this problem. However, the specific mechanisms responsible for this wear mitigation are currently unknown. In this paper, molecular dynamics techniques are successfully used to identify these diamond tool wear mitigation mechanisms. A modified embedded atom method force field is first evaluated for its ability to accurately simulate the catalyzed graphitization of diamond in the presence of steel. This force field is then used to simulate nanometric diamond cutting of steel in the presence of a 1 or 3 layered graphene platelet. Coordination analysis of these simulations shows that the presence of the graphene platelet results in 34%–96% reduction in tool wear, when compared to the graphene-free cutting condition. This is attributed to the graphene platelet serving as a physical barrier protecting the tool cutting edge, and also as a sacrificial source for carbon transfer into the workpiece. Other mechanisms, such as platelet cleaving and interlayer sliding, are also observed. The reduction in tool wear reported by the simulations is comparable to the trends observed in prior experiments.

Macrophages play an important role in inflammatory responses; however, miRNA-mediated repolarization of macrophages is essential for fulfilling this function. To clarify a series of changes at the RNA level in alveolar macrophages under normal and inflammatory conditions, bronchial alveolar lavage liquid (BALF) was collected from healthy volunteers or patients with pneumonia. This approach, which differs from that used in previously, provides more accurate information about the states of macrophages in different lung microenvironments. In this study, the density plots of macrophage subtypes (M1 and M2) in the BALF of healthy volunteers differed from that of the patients with pneumonia. The M2 subtype dominated in healthy volunteers and was rapidly repolarized to M1 in response to miRNA-mediated gene regulation. Differential miRNA expression in the two macrophage subtypes revealed lower expression of miR-155 and MIR-146a in patients with pneumonia compared with healthy volunteers; this may be related to inflammation and the use of anti-inflammatory drugs. We also found increased TNF-α and IL-6 expression at the RNA level, while macrophage galactose-type C-type lectin 1 (MGL-1) expression decreased with downregulation of miR-155 and miR-146a expression. These results indicate that the gene regulation mediated by miR-155 and miR-146a contributes to human alveolar macrophage phenotype repolarization, thus leading to an early switch from pro-inflammatory to anti-inflammatory cytokine production.

We establish Anderson localization for general analytic $k$-frequency quasi-periodic operators on $\mathbb{Z}^d$ for \textit{arbitrary} $k,d$.

Solids exhibit transverse shrinkage when they are stretched, except auxetics that abnormally demonstrate lateral expansion instead. Graphene possesses the unique normal-auxeticity (NA) transition when it is stretched along the armchair direction but not along the zigzag direction. Here we report on the anisotropic temperature-dependent NA transitions in strained graphene using molecular dynamics simulations. The critical strain where the NA transition occurs increases with respect to an increase in the tilt angle deviating from armchair direction upon uniaxial loading. The magic angle for the NA transition is 10.9°, beyond which the critical strain is close to fracture strain. In addition, the critical strain decreases with an increasing temperature when the tilt angle is smaller than the NA magic angle. Our results shed lights on the unprecedented nonlinear dimensional response of graphene to the large mechanical loading at various temperatures.

As the opioid epidemic has drawn increased attention, many researchers are attempting to estimate the financial burden of opioid misuse. These estimates have become particularly relevant as state and local governments have begun to take legal action against pharmaceutical manufacturers, distributors, and others who are identified as being potentially responsible for the worsening epidemic. An important category of costs includes those related to the effect of opioid misuse on labor market outcomes and productivity. Most published estimates of opioid-attributable productivity losses estimate the financial burden borne by society, failing to distinguish between costs internalized by individuals and those that spill over to third parties, such as state and federal governments. This article provides an overview and a conceptual framework for 2 types of labor market-related costs borne by state and federal governments that typically have not been incorporated into existing estimates, which may represent important categories of expenditures. Because detailed estimates of lost tax revenue are available elsewhere, this article focuses largely on whether, and how, to incorporate opioid-related expenses incurred by means-tested government programs into more general estimates of the economic harm created by the opioid epidemic.

The brittleness of oxide glasses has dramatically restricted their practical applications as structural materials despite very high theoretical strength. Herein, using molecular dynamics simulations, we show that silica glass prepared by consolidating glassy nanoparticles exhibit remarkable tensile ductility. Because of dangling bonds at surfaces and high contact stresses, the pressure applied for consolidating glassy nanoparticles to achieve ductility is significantly lower than that required to toughen bulk glass via permanent densification. We have identified 5-fold silicon, with a higher propensity to carry out local shear deformation than 4-fold silicon, as the structural origin for the observed tensile ductility. Interestingly, the work hardening effect has been, for the first time, observed in thus-prepared silica glass, with its strength increasing from 4 GPa to ∼7 GPa upon cold work. This is due to stress-assisted relaxation of 5-fold silicon to 4-fold during cold work, analogous to transformation hardening.

Purpose Multisector health care alliances (alliances) are increasingly viewed as playing an important role in improving the health and health care of local populations, in part by disseminating innovative practices, yet alliances face a number of challenges to disseminating these practices beyond a limited set of initial participants. The purpose of this paper is to examine how alliances attempt to disseminate innovative practices and the facilitating and inhibiting factors that alliances confront when trying to do so. Design/methodology/approach The authors adopted multiple holistic case study design of eight alliances with a maximum variation case selection strategy to reflect a range of structural and geographic characteristics. Semi-structured interviews with staff, leaders and board members were used. Findings The findings show that dissemination is a multidirectional process that is closely if not inextricably intertwined with capacity- and context-related factors (of the alliance, partnering organizations and target organizations). Thus, standardized approaches to dissemination are likely the exception and not the rule, and highlight the value of existing frameworks as a starting point for conceptualizing the important aspects of dissemination, but they are incomplete in their description of the “on-the-ground” dissemination processes that occur in the context of collaborative organizational forms such as alliances. Originality/value Despite a rapidly expanding evidence base to guide clinical and managerial decision making, this knowledge often fails to make its way into routine practice. Consequently, the search for effective strategies to reduce this gap has accelerated in the past decade. This study sheds light on those strategies and the challenges to implementing them.

International audience; Multispectral Imaging (MSI) provides a sequence of en-face fundus spectral slices and allows for the examination of structures and signatures throughout the thickness of retina to characterize diabetic retinopathy (DR) lesions comprehensively. Manual interpretation of MSI images is commonly conducted by qualitatively analyzing both the spatial and spectral properties of multiple spectral slices. Meanwhile, there exist few computerbased algorithms that can effectively exploit the spatial and spectral information of MSI images for the diagnosis of DR. We propose a new approach that can quantify the spatialspectral features of MSI retinal images for automatic DR lesion segmentation. It combines a generalized low-rank approximation of matrices (GLRAM) with a supervised regularization term (SRT) to generate low-dimensional spatial-spectral representations using the feature vectors in all spectral slices. Experimental results showed that the proposed approach is very effective for the segmentation of DR lesions in MSI images, which suggests it as an interesting tool for assisting ophthalmologists in diagnosing, analyzing, and managing DR lesions in MSI.

The main purpose of this study was to estimate the tax revenue lost by state and federal governments as a result of adverse labor market outcomes attributable to opioid misuse.We pair existing, plausibly causal estimates of the effect of opioid misuse on the decline in the labor force from 2000 to 2016 with a variety of data sources to compute tax revenues lost by state and federal governments using the online TAXSIM calculator.We find that between 2000 and 2016, opioid misuse cost state governments $11.8 billion, including $1.7 billion in lost sales tax revenue and $10.1 billion in lost income tax revenue. In addition, the federal government lost $26.0 billion in income tax revenue.By omitting lost tax revenue due to labor force exits, prior studies have missed an important component of opioid-related costs borne by state and federal governments.As more states and the federal government contemplate litigation for opioid-related damages, lost tax revenue represents an important cost that could be recouped and allocated to opioid prevention and treatment programs.

In this paper, we study the multi-frequency quasi-periodic operator with a Gevrey type perturbation. We first establish the large deviation theorem (LDT) for the multi-dimensional operator with a sub-exponential (or Gevrey) long-range hopping and then prove the pure point spectrum property. Based on the LDT and the Aubry duality, we show the absence of point spectrum for the $1D$ exponential long-range operator with a multi-frequency and a Gevrey potential. We also prove the spectrum has the positive Lebesgue measure., Comment: A revised version. To appear in Journal d'Analyse Mathematique

In this paper, we consider the nonlinear elliptic equations on rectangular tori. Using methods in the study of KAM theory and Anderson localization, we prove that these equations admit many analytic solutions., Comments are welcome

There is growing interest in the use of intersectoral collaboration (e.g., alliances, coalitions, partnerships) to address complex, health-related issues in local communities. Relatively little empirical research, however, has examined how to foster and sustain collaboration across sectors during later stages of development, despite a recognition that the needs and goals for collaboration may change over time. The purpose of this study was to address this gap by examining the perceptions of alliance participants regarding the importance of collaborating with different industry sectors as alliances transitioned from stable, prescriptive foundation support to a more uncertain future. Our findings suggest that, in addition to the contextual characteristics highlighted in previous research, the perceived importance of intersectoral collaboration varies for different types of alliances and participants. Moreover, the salience of these characteristics varied for different types of collaboration, in our case, collaboration with nonmedical health care sectors and nonhealth care sectors. Collectively, our findings point to the importance of thinking more comprehensively, across multiple levels of influence, when considering ways to foster or sustain intersectoral collaboration.

Background Ara h 1 is a major food allergen in peanuts. Recently, many studies have revealed that the Maillard reaction (MR) affects the allergenicity of food proteins. Results To investigate the influence of the MR on the allergenicity of Ara h 1, R-Ara h 1 was processed with glucose in dry heating conditions for different periods. The extent of the MR was assessed by four methods. The changes in secondary and tertiary structures were characterized through spectroscopy assays. Advanced glycation end products (AGE) structures were identified by protein sample dry heating for 60 min, indicating the formation of AGE-Ara h 1. Simulated gastric fluid (SGF) digestion analysis showed that AGE-Ara h 1 has higher resistance to peptic digestion than R-Ara h 1. The BALB/c mouse model was also utilized to explore the effect of the MR on the allergenicity of Ara h 1, and the results showed that the Th2-type cytokines, antibodies, and histamine content increased, and there was a greater degree of degranulation of rat basophilic leukemia (RBL) cells in the AGE-Ara h 1 group compared with the R-Ara h 1 group. Conclusion During the process of dry heating, proteins participated in the MR with changes in secondary and tertiary structures. The condition applying a temperature of 100 °C for 60 min caused the formation of AGE-Ara h 1. Simulated gastric fluid digestion analysis showed that AGE-Ara h 1 had a greater resistance to peptic digestion than R-Ara h 1. The BALB/c mouse model showed that AGE-Ara h 1 had more allergenicity, indicating that the MR could enhance the allergenicity of Ara h 1. © 2020 Society of Chemical Industry.

Dilemma zone problem describes vehicles trapped in the road segment at the signalized intersection where drivers hard make accurate decisions for next movements. Such phenomenon can easily trigger traffic accidents or congestion, eventually, which likely decreases intersection capacity and also increases traffic pressure. How dose the issue evolve under Cooperative Vehicles Infrastructure Systems (CVIS)? In this paper, an optimization method is proposed to reduce the dilemma zone for enhancing the traffic capacity and safety of signalized intersections, which is based on the real-time traffic information by vehicles-to-infrastructure (V2I) communication. The problem is formulated as a Binary Mixed Integer Linear Program (BMILP) that can be solved by a standard branch-and-bound routine. A set of constraints is designed to ensure feasibility and safety of movements for connected vehicles. Numerical experiments show the capacity has a different degree of increase with the market penetration rate of connected vehicles increasing. Moreover, experimental results indicate the vehicle queue length at the signalized intersection reduces correspondingly.

Nanocrystalline ultrathin metallic thin films have various applications for which mechanical properties and durability are important, such as electrodes and electrical interconnects. We investigated the effect of voids on mechanical behavior of thin nanocrystalline gold films using molecular dynamics. Different kinds of voids were considered. We found that the nature and geometry of the void was important for the mechanical properties in this model ductile material. It was found that in the half voids films the flow stress decreased following the decrease of mass density with a linear relation. For the full voids films, the strain–stress curve was different from that of voids-free film and half voids films. The plastic deformation could be activated with smaller amount of dislocations. Following the strain increase over the strain of ultimate tensile strength, the flow stress decreased. This implied that the voids which penetrated through the films would weaken the ductility of films. The deformation main mechanism was grain boundaries sliding with voids coalescence. On the contrary, if the void depth was less than the thickness of film, the ductility of film wasn’t influenced apparently, though the ultimate tensile strength decreased with the increase of voids size and decrease of mass density.

Background Despite significant investments in health information technology (IT), the technology has not yielded the intended performance effects or transformational change. We describe activities that health systems are pursuing to better leverage health IT to improve performance. Methods We conducted semi-structured telephone interviews with C-suite executives from 24 U.S. health systems in four states during 2017–2019 and analyzed the data using a qualitative thematic approach. Results Health systems reported two broad categories of activities: laying the foundation to improve performance with IT and using IT to improve performance. Within these categories, health systems were engaged in similar activities but varied greatly in their progress. The most substantial effort was devoted to the first category, which enabled rather than directly improved performance, and included consolidating to a single electronic health record (EHR) platform and common data across the health system, standardizing data elements, and standardizing care processes before using the EHR to implement them. Only after accomplishing such foundational activities were health systems able to focus on using the technology to improve performance through activities such as using data and analytics to monitor and provide feedback, improving uptake of evidence-based medicine, addressing variation and overuse, improving system-wide prevention and population health management, and making care more convenient. Conclusions and implications Leveraging IT to improve performance requires significant and sustained effort by health systems, in addition to significant investments in hardware and software. To accelerate change, better mechanisms for creating and disseminating best practices and providing advanced technical assistance are needed.

Surface diffusion is an interesting and practically important phenomenon in many areas of chemistry and physics. One emerging problem is that of Li wetting on high-Z plasma-facing metals, especially tungsten, for application in tokamak reactors. We report construction of a Li-W binary force field to describe the interface between liquid Li and solid W. We show that this force field can simulate well the atomic processes of liquid Li diffusing across the W surface, as compared with results from first-principles calculations. We find that Li atoms have different wetting behaviors on different surfaces of W. Diffusion is the fastest on the (110) surface and the slowest on the (100) surface. Diffusion of second Li layer on the (110) surface is activated at relatively low temperatures above 262 K. In addition, the diffusion rate of single-layer Li changes with the coverage rate of Li on (110) surface. High diffusion coefficients at coverage rate of θ = 1/6, 1/3 and 1 are found to be related to the 2D phase transition of Li on the (110) surface.