An economic evaluation of a primary care-based technology-enabled intervention for stroke secondary prevention and management in rural China : a study protocol

Introduction: Secondary prevention of stroke is a leading challenge globally and only a few strategies have been tested to be effective in supporting stroke survivors. The system-integrated and technology-enabled model of care (SINEMA) intervention, a primary care-based and technology-enabled model of care, has been proven effective in strengthening the secondary prevention of stroke in rural China. The aim of this protocol is to outline the methods for the cost-effectiveness evaluation of the SINEMA intervention to better understand its potential economic benefits. Methods: The economic evaluation will be a nested study based on the SINEMA trial; a cluster-randomized controlled trial implemented in 50 villages in rural China. The effectiveness of the intervention will be estimated using quality-adjusted life years for the cost-utility analysis and reduction in systolic blood pressure for the cost-effectiveness analysis. Health resource and service use and program costs will be identified, measured, and valued at the individual level based on medication use, hospital visits, and inpatients' records. The economic evaluation will be conducted from the perspective of the healthcare system. Conclusion: The economic evaluation will be used to establish the value of the SINEMA intervention in the Chinese rural setting, which has great potential to be adapted and implemented in other resource-limited settings

Correlation between tibial valgus deformity and aspect ratio of resected tibial surface in female Chinese patients undergoing total knee arthroplasty

BackgroundMorphology of the resected tibial surface is the reference for tibial component design, selection, and implantation in total knee arthroplasty (TKA). This comparative study sought to answer whether valgus deformity of the tibia would affect the morphology of the resected tibial surface in TKA.MethodsThirty-one female Chinese patients with valgus tibias were retrospectively and consecutively identified from a single-center registration database. Thirty-one patients with well-aligned tibias were matched in terms of gender, height, and weight. Weight-bearing full-length radiographs and computed tomography images of the whole lower limb were obtained for every case. Tibial resection was mimicked perpendicular to the mechanical axis of the tibia in the frontal plane with 3° of posterior slope and a cut level individualized by the actual intraoperative cut. On the resected surface, mediolateral dimension (MLD), medial anteroposterior dimensions (mAPD), and lateral anteroposterior dimensions (lAPD) were measured, and aspect ratios (AR) were calculated. We compared the AR between the two groups.ResultsThe aspect ratio of resected tibial surface positively correlated with tibial valgus alignment. Patients with valgus tibias had significantly smaller AR (MLD/mAPD) for the medial plateau (1.50 ± 0.06 vs. 1.54 ± 0.07, P = 0.032). However, the AR for the lateral plateau was similar between the two groups (1.63 ± 0.08 vs. 1.65 ± 0.07, P = 0.328).ConclusionThis difference in morphology of resected tibial surface between valgus and well-aligned tibias should be considered in tibial component design, as well as in the selection and placement of TKA implants for knees with valgus tibias

Multiband Electrostatic Waves below and above the Electron Cyclotron Frequency in the Near-Sun Solar Wind

Using the Parker Solar Probe measurements, this Letter reports two new types of multiband electrostatic waves in and near the heliospheric current sheet. They are classified into the f &lt; fce and f &gt; fce multiband electrostatic waves, in which most (or all) of the bands in the former type are lower than fce, and all of the bands in the latter type are higher than fce, where f and fce denotes the wave frequency and the electron cyclotron frequency, respectively. This Letter also exhibits observational evidence of the existence of nonlinear wave&ndash;wave interactions of both types of electrostatic waves. In particular, the f &gt; fce multiband electrostatic waves are found to be modulated in the presence of low-frequency oblique ion-scale waves. According to the observed frequency distribution, this Letter proposes that the mode nature of the f &lt; fce multiband electrostatic waves could be the oblique ion acoustic wave or the lower-hybrid wave, and the f &gt; fce multiband electrostatic waves are the electron Bernstein mode wave. These findings provide a challenge to understand the complex electron and ion dynamical processes in and near the heliospheric current sheet. &nbsp;</p

Synthesis and antifungal properties of 6-amino-6-deoxyinulin, a kind of precursors for facile chemical modifications of inulin

Inulin, a kind of abundant, water-soluble, renewable polysaccharide, is mainly extracted from such low-requirement crops as Jerusalem artichoke, chicory, and yacon. The objective of this study was to modify inulin at its primary hydroxyls to give 6-amino-6-deoxyinulin, allowing for the facile chemical manipulation of inulin to encourage the employment of this currently underutilized biodegradable and environmentally benign resource. Additionally, its antifungal properties against two strains of phytopathogens. Cladosporium cucumerinum (Ell.) et Arthur and Fusarium oxysporum sp. Cucumis sativus L. were also evaluated by hypha measurement in vitro and the inhibitory indices against these two fungi were 60.1% and 53.3% at 1000 mu g/mL, respectively. Because 6-amino-6-deoxyinulin is easy to prepare and exhibits improved potential activities, this material may represent an attractive new platform for chemical modifications of inulin. (C) 2011 Elsevier Ltd. All rights reserved

The Radial Distribution of Ion-scale Waves in the Inner Heliosphere

Determining the mechanism responsible for the plasma heating and particle acceleration is a fundamental problem in the study of the heliosphere. Due to efficient wave-particle interactions of ion-scale waves with charged particles, these waves are widely believed to be a major contributor to ion energization, and their contribution considerably depends on the wave occurrence rate. By analyzing the radial distribution of quasi-monochromatic ion-scale waves observed by the Parker Solar Probe, this work shows that the wave occurrence rate is significantly enhanced in the near-Sun solar wind, specifically 21%$-$29% below 0.3 au, in comparison to 6%$-$14% beyond 0.3 au. The radial decrease of the wave occurrence rate is not only induced by the sampling effect of a single spacecraft detection, but also by the physics relating to the wave excitation, such as the enhanced ion beam instability in the near-Sun solar wind. This work also shows that the wave normal angle $\theta$, the absolute value of ellipticity $\epsilon$, the wave frequency $f$ normalized by the proton cyclotron frequency $f_{\mathrm{cp}}$, and the wave amplitude $\delta B$ normalized by the local background magnetic field $B_0$ slightly vary with the radial distance. The median values of $\theta$, $|\epsilon|$, $f$, and $\delta B$ are about $9^\circ$, $0.73$, $3f_{\mathrm{cp}}$, and $0.01B_0$, respectively. Furthermore, this study proposes that the wave mode nature of the observed left-handed and right-handed polarized waves corresponds to the Alfv\'en ion cyclotron mode wave and the fast-magnetosonic whistler mode wave, respectively.Comment: Accepted for publication by The Astrophysical Journal (ApJ

The sequence and <i>de novo</i> assembly of the giant panda genome

Using next-generation sequencing technology alone, we have successfully generated and assembled a draft sequence of the giant panda genome. The assembled contigs (2.25 gigabases (Gb)) cover approximately 94% of the whole genome, and the remaining gaps (0.05 Gb) seem to contain carnivore-specific repeats and tandem repeats. Comparisons with the dog and human showed that the panda genome has a lower divergence rate. The assessment of panda genes potentially underlying some of its unique traits indicated that its bamboo diet might be more dependent on its gut microbiome than its own genetic composition. We also identified more than 2.7 million heterozygous single nucleotide polymorphisms in the diploid genome. Our data and analyses provide a foundation for promoting mammalian genetic research, and demonstrate the feasibility for using next-generation sequencing technologies for accurate, cost-effective and rapid de novo assembly of large eukaryotic genomes