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BackgroundThere is a growing trend in the use of mobile health (mHealth) technologies in traditional Chinese medicine (TCM) and telemedicine, especially during the coronavirus disease (COVID-19) outbreak. Tongue diagnosis is an important component of TCM, but also plays a role in Western medicine, for example in dermatology. However, the procedure of obtaining tongue images has not been standardized and the reliability of tongue diagnosis by smartphone tongue images has yet to be evaluated. ObjectiveThe first objective of this study was to develop an operating classification scheme for tongue coating diagnosis. The second and main objective of this study was to determine the intra-rater and inter-rater reliability of tongue coating diagnosis using the operating classification scheme. MethodsAn operating classification scheme for tongue coating was developed using a stepwise approach and a quasi-Delphi method. First, tongue images (n=2023) were analyzed by 2 groups of assessors to develop the operating classification scheme for tongue coating diagnosis. Based on clinicians’ (n=17) own interpretations as well as their use of the operating classification scheme, the results of tongue diagnosis on a representative tongue image set (n=24) were compared. After gathering consensus for the operating classification scheme, the clinicians were instructed to use the scheme to assess tongue features of their patients under direct visual inspection. At the same time, the clinicians took tongue images of the patients with smartphones and assessed tongue features observed in the smartphone image using the same classification scheme. The intra-rater agreements of these two assessments were calculated to determine which features of tongue coating were better retained by the image. Using the finalized operating classification scheme, clinicians in the study group assessed representative tongue images (n=24) that they had taken, and the intra-rater and inter-rater reliability of their assessments was evaluated. ResultsIntra-rater agreement between direct subject inspection and tongue image inspection was good to very good (Cohen κ range 0.69-1.0). Additionally, when comparing the assessment of tongue images on different days, intra-rater reliability was good to very good (κ range 0.7-1.0), except for the color of the tongue body (κ=0.22) and slippery tongue fur (κ=0.1). Inter-rater reliability was moderate for tongue coating (Gwet AC2 range 0.49-0.55), and fair for color and other features of the tongue body (Gwet AC2=0.34). ConclusionsTaken together, our study has shown that tongue images collected via smartphone contain some reliable features, including tongue coating, that can be used in mHealth analysis. Our findings thus support the use of smartphones in telemedicine for detecting changes in tongue coating.

Chronic kidney disease (CKD) is characterized by abnormal urine test or progressive kidney function decline. Patients with CKD are at a higher risk of COVID-19 infection with higher conversion and mortality rates after infection for their reduced kidney function, long-term use of immunosuppressive agents or combination of underlying diseases. Therefore, rational drug use is particularly important for CKD patients combined with COVID-19 infection. This article summarizes special considerations for the use of relevant medications in patients with CKD by integrating the current evidence of medications for the treatment of COVID-19 infection, including antiviral drugs, anti-inflammatory drugs, antithrombotic drugs, convalescent plasma and neutralizing monoclonal antibodies, as well as commonly used symptomatic drugs of respiratory system (such as antfebrile, antisputum and cough medicine and anti-allergic drugs), high lighting the modified medication regiments according to kidney function levels, in order to provide a reference for clinical professionals, assist in clinical decision-making and rational drug use, and ensure clinical efficacy and safety.

MXenes have been garnering significant attention in diverse fields, such as energy storage, catalysis, sensing, and electromagnetic interference shielding. Recently, MXenes were predicted to exhibit excellent thermoelectric properties, and attempts have been conducted to fabricate relevant devices. Nevertheless, the complexity of the preparation process, low productivity, and susceptibility to oxidation have obstructed their full potential. In this study, we investigated the stability of undelaminated multilayers Mo2TiC2 and Mo2C under different conditions, which exhibited a much better thermal stability and oxidation resistance compared to their monolayer counterparts. Moreover, the thermoelectric properties of undelaminated multilayers Mo2TiC2 and Mo2C were studied, which revealed comparable TE performance to monolayer counterparts, with the economy, productivity and stability being greatly improved. Finally, block TE devices with 2 pairs of p/n-type multilayer MXene blocks were prepared in the form of a commercial TE module and generated an open-circuit voltage of 3.43 mV at a temperature difference of 25 K with the maximum output power of 22.68 nW. These results demonstrate a feasible and economical method to process MXene-based thermoelectric devices, opening a new avenue for both MXene and thermoelectric communities. [ABSTRACT FROM AUTHOR]

As a highly promising thermoelectric material in the mid‐temperature region, pristine GeTe shows deteriorated thermoelectric properties due to the low Seebeck coefficient and the intrinsic high thermal conductivity. Herein, it is discovered that the introduction of strongly correlated d, f electrons by alloying rare‐earth atoms at Ge sites will increase the band effective mass and promote band convergency, which can largely improve the electric transport property. Moreover, the heavy atoms (Pb, Bi) doping induces optical phonon softening and the avoided crossing between acoustic and optical phonon branches, decelerating both optical and acoustic phonon velocities. The modulated composition wave from the fluctuated multi‐component distribution introduces a complicated hierarchical structure including point defects and nanoprecipitates, which provides all‐scale scattering sources for heat‐carrying phonons and results in low lattice thermal conductivity. Consequently, a high zT of 2.4 at 800 K can be obtained in the Ge0.86Pb0.09Bi0.03Ce0.005Te sample due to the combination of strong correlation for d, f electrons and the full‐spectrum scattering for phonons. This work provides an effective strategy to increase the thermoelectric performance of IV–VI compounds by combining the modulated band structure and the softening phonon dispersion. [ABSTRACT FROM AUTHOR]