Search

Background The phenomenon of "no referral" still exists against the backdrop of implementing the hierarchical medical system, which has been preliminarily constructed in China. Most existing studies on addressing this phenomenon are mostly from the perspective of hospital management policies, ignoring the role of doctors as "health gatekeepers" in making decisions during the hierarchical diagnosis and treatment process. Objective To investigate the influence of personal, institutional, environmental, and policy factors on the willingness of physicians in county hospitals to refer patients with common diseases to lower level of institutions from physicians' perspective. Methods This study was conducted from July to August 2021. By use of region-based stratified and convenience sampling, seven county-level people's hospitals were selected as settings from eastern, central and western China. By use of cluster sampling, physicians (n=142) in internal medical departments were selected from the above-mentioned hospitals to attend an online (through the WJX.cn platform) or off-line (hospital) questionnaire survey to understand their willingness to refer patients with a common illness to lower level institutions, and personal, institutional, environmental, and policy factors associated with their willingness during a consultation described using the scenario simulation method. The survey achieved a response rate of 96.5% (137/142). Binary Logistic regression was used to analyze the effects of personal, institutional, environmental, and policy factors on physicians' willingness to refer the patients to a lower level institution. Results The mean score of physicians' willingness to refer the patients to a lower level institution was (9.92±2.20). Fifty-six physicians (40.9%) had higher level of willingness to conduct downward referrals. Education level, awareness level of referrals, and frequency of communication of referrals between higher and lower level institutions were associated with scores of physicians' willingness to conduct downward referrals (P

Carbon dot-based room-temperature phosphorescence materials have emerged as a shining new star in the carbon nanomaterial family in recent years due to their excellent optical properties. However, there still exists a significant challenge in obtaining carbon dots (CDs) with ultra-long phosphorescence lifetimes. In this study, tetraethyl orthosilicate (TEOS) was used to achieve in situ growth and encapsulation of CDs in a 3D SiO2 network using a one-pot hydrothermal method. It was demonstrated that Na+ is the key factor to achieve ultra-long afterglow lifetimes of CDs in dense SiO2 matrices, and the introduction of Na+ has a significant effect on extending the afterglow lifetime of various CDs. The designed Na/CDs@SiO2 nanomaterial exhibited an ultra-long afterglow lifetime of 6.69 s, which surpassed most reported CD-based afterglow lifetimes. This work provides a design principle and general strategy for achieving ultra-long afterglow lifetimes of CDs in dense SiO2 matrices. Due to the stable photoluminescence (PL) properties, low biotoxicity, and ultra-long afterglow lifetime of the Na/CDs@SiO2 nanomaterial, it was successfully applied in HeLa cell imaging. [ABSTRACT FROM AUTHOR]

Clostridium perfringens causes necrotic enteritis (NE) after proliferation in the intestine of poultry, resulting in considerable losses to the poultry industry. This study aimed to investigate the impact of tannic acid on the antioxidant, immunity, and gut health of broilers with NE. In the experiment, 630 one-day-old Cobb500 male chicks were randomly divided into six treatment groups, with seven replicate cages and with fifteen birds in each cage. The treatment groups were as follows: control group (NC), challenged group (PC), and challenged NE chickens treated with 250, 500, 750, and 1000 mg/kg tannic acid (PTA1, PTA2, PTA3, and PTA4, respectively). To induce NE, coccidia vaccine and Clostridium perfringens were administered on day 19 and days 22–28, respectively. Indexes related to antioxidant, immune, and intestinal health were measured on days 28 and 35. During the infection period, we observed significant increases in fecal water content, D-LA, TNF-α, and malondialdehyde concentrations (p < 0.05). Conversely, significant decreases were noted in chyme pH and in T-AOC, IL-4, and IL-10 concentrations (p < 0.05). The addition of tannic acid exhibited a linear decrease in fecal water content and TNF-α concentration (p < 0.05). Furthermore, tannic acid supplementation resulted in a quadratic curve decrease in D-LA concentration and linear increases in T-AOC, IL-4, and IL-10 (p < 0.05). Cecal microbiological analysis revealed that Ruminococcaceae and Butyricimona were dominant in PTA3. In conclusion, the dietary addition of tannic acid may reduce the negative effects of NE by increasing antioxidant and anti-inflammatory capacity, improving the intestinal barrier, and regulating the intestinal flora. [ABSTRACT FROM AUTHOR]

Aiming at the problems that the analysis of track circuit dynamic detection data is insufficient and the evaluation of the actual operation state of track circuit is difficult, the comprehensive evaluation method of the track circuit dynamic operation quality based on feature index extraction is improved. Track circuit Evaluation Index of Dynamic operation quality (TEI) is obtained by synthetically weighting the scores of seven characteristic indexes. For the problem of the unreasonable allocation of index weight, a weight allocation model based on mixed integer linear programming (MILP) is proposed to optimize the index weight allocation, and the track circuit evaluation index of dynamic operation quality ( TEI) is obtained. Combined with the actual dynamic inspection data, the application of proposed evaluation method of track circuit in the analysis of section evaluation and the analysis of influencing factors is discussed. Analysis results show that: ( 1) Compared with the existing evaluation method, the TEI obtained by the improved method is more reasonable and has sufficient differentiation; (2) Sections in tunnel are more likely to sustain interference from neighboring sections, which leads to the lower dynamic operation quality than that of sections on bridge; (3) It is likely for ballasted sections to sustain the invasion of interference signal from neighboring sections, which leads to lower dynamic operation quality than ballastless sections; (4) The best dynamic operating quality of the track circuit is achieved in the sections with mechanically insulated joint at the transmitting end and electrically insulated joint at the receiving end. [ABSTRACT FROM AUTHOR]

In this work, a spherical spider web-like structure Ru Ni/Ni foam catalyst was prepared for hydrogen evaluation from sodium borohydride (NaBH 4) by a combination of electroless plating and electroplating. Microstructure, surface morphology, surface area and elemental composition of the Ru Ni/Ni foam catalyst were analyzed by X-ray Diffraction (XRD), Scanning Electron Microscopy (SEM-EDS and X-ray Photoelectron Spectroscopy (XPS), Brunauere-Emmette-Teller method (BET, AS-1C-VP), respectively. The influences of Ru Ni with different molar ratios, NaOH concentration, NaBH 4 concentration, and solution temperature on the hydrogen production rate were investigated in this paper. The results showed that the Ru Ni metals were arrayed densely and uniformly on the surface of Ni foam. The average hydrogen production rate is 360 mL min −1 g−1 in 20 wt % of NaBH 4 , 1 wt% of NaOH at 30 °C in the presence of the Ru Ni/Ni foam catalysts. The calculated activation energy was 39.96 kJ mol−1 for hydrogen production from sodium borohydride using the Ru Ni/Ni foam catalyst. Image 1 • Prepare the spherical spider web-like structure Ru Ni/Ni foam catalysts. • The Ru Ni catalyst is uniformly distributed on the Ni foam. • This novel structure increased the specific surface area of the catalyst. • The reaction activity energy is 39.96 kJ mol−1. [ABSTRACT FROM AUTHOR]