Socioeconomic Status and the Quality of Acute Stroke Care

Background and Purpose—The association of socioeconomic status (SES) with quality of stroke care is not well understood, and few studies have examined the association with different indicators of SES simultaneously. We assessed the impacts of low levels of education, occupation, and income on the quality of stroke care. Methods—We examined data from the China National Stroke Registry recording consecutive stroke patients between September 2007 and August 2008. Baseline low SES was measured using educational level <6 years, occupation as manual workers or no job, and average family income per capita at ≤¥1000 per month. Compliance with 11 performances was summarized in a composite score defined as the proportion of all needed care given. Poor quality of care was defined as having a composite score of 0.71 or less. Results—Among 12 270 patients with ischemic stroke, 38.6% had <6 educational years, 37.6% had manual workers/no job, and 34.7% had income ≤¥1000 per month. There was an increased chance of receiving poor quality of care in patients with low education (adjusted odds ratio 1.15, 95% confidence interval 1.03–1.28), low occupation (adjusted odds ratio 1.16, 95% confidence interval 1.01–1.32), and low income (adjusted odds ratio 1.18, 95% confidence interval 1.06–1.30), respectively. People with low SES had poor performances on some aspects of care quality. Combined effects existed among these SES indicators; those with low SES from all 3 indicators had the poorest quality of care. Conclusions—There was a social gradient in the quality of stroke care. Continuous efforts of socioeconomic improvement will increase the quality of acute stroke care.The Ministry of Science and Technology of the People’s Republic of China (2006BAI01A11, 2011BAI08B01, 2011BAI08B02, 2012ZX09303-005-001, and 2013BAI09B03), The Beijing Biobank of Cerebral Vascular Disease (D131100005313003), Beijing Institute for Brain Disorders (BIBD-PXM2013_014226_07_000084

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

An Organic–Inorganic Hybrid Cathode Based on S–Se Dynamic Covalent Bonds

A diphenyl trisulfide–selenium nanowire (DPTS‐Se) organic–inorganic hybrid cathode material is presented for rechargeable lithium batteries. During discharge, three voltage plateaus associated with three lithiation processes are observed. During recharge, the combination of the radicals formed upon delithiation leads to several new phenyl sulfoselenide compounds which are confirmed by HPLC‐QTof‐MS. The hybrid cathode exhibits superior cycling stability over pristine Se or DPTS as cathode alone. The first discharge shows a capacity of 96.5 % of the theoretical specific capacity and the cell retains 69.2 % of the initial capacity over 250 cycles. The hybrid cathode also shows a high Coulombic efficiency of over 99 % after 250 cycles. This study demonstrates that the combination of organic polysulfide and selenium can not only improve the utilization of active materials but also enhance the cycling performance

Chaperone Spy Protects Outer Membrane Proteins from Folding Stress via Dynamic Complex Formation

Gram-negative bacteria have a multicomponent and constitutively active periplasmic chaperone system to ensure the quality control of their outer membrane proteins (OMPs). Recently, OMPs have been identified as a new class of vulnerable targets for antibiotic development, and therefore a comprehensive understanding of OMP quality control network components will be critical for discovering antimicrobials. Here, we demonstrate that the periplasmic chaperone Spy protects certain OMPs against protein-unfolding stress and can functionally compensate for other periplasmic chaperones, namely Skp and FkpA, in the Escherichia coli K-12 MG1655 strain. After extensive; in vivo; genetic experiments for functional characterization of Spy, we use nuclear magnetic resonance and circular dichroism spectroscopy to elucidate the mechanism by which Spy binds and folds two different OMPs. Along with holding OMP substrates in a dynamic conformational ensemble, Spy binding enables OmpX to form a partially folded β-strand secondary structure. The bound OMP experiences temperature-dependent conformational exchange within the chaperone, pointing to a multitude of local dynamics. Our findings thus deepen the understanding of functional compensation among periplasmic chaperones during OMP biogenesis and will promote the development of innovative antimicrobials against pathogenic Gram-negative bacteria.; IMPORTANCE; Outer membrane proteins (OMPs) play critical roles in bacterial pathogenicity and provide a new niche for antibiotic development. A comprehensive understanding of the OMP quality control network will strongly impact antimicrobial discovery. Here, we systematically demonstrate that the periplasmic chaperone Spy has a role in maintaining the homeostasis of certain OMPs. Remarkably, Spy utilizes a unique chaperone mechanism to bind OmpX and allows it to form a partially folded β-strand secondary structure in a dynamic exchange of conformations. This mechanism differs from that of other E. coli periplasmic chaperones such as Skp and SurA, both of which maintain OMPs in disordered conformations. Our study thus deepens the understanding of the complex OMP quality control system and highlights the differences in the mechanisms of ATP-independent chaperones

Strong nonlinear optical response and transient symmetry switching in Type-II Weyl semimetal β\beta-WP2

The topological Weyl semimetals with peculiar band structure exhibit novel nonlinear optical enhancement phenomena even for light at optical wavelengths. While many intriguing nonlinear optical effects were constantly uncovered in type-I semimetals, few experimental works focused on basic nonlinear optical properties in type-II Weyl semimetals. Here we perform a fundamental static and time-resolved second harmonic generation (SHG) on the three dimensional Type-II Weyl semimetal candidate $\beta$-WP$_2$. Although $\beta$-WP$_2$ exhibits extremely high conductivity and an extraordinarily large mean free path, the second harmonic generation is unscreened by conduction electrons, we observed rather strong SHG response compared to non-topological polar metals and archetypal ferroelectric insulators. Additionally, our time-resolved SHG experiment traces ultrafast symmetry switching and reveals that polar metal $\beta$-WP$_2$ tends to form inversion symmetric metastable state after photo-excitation. Intense femtosecond laser pulse could optically drive symmetry switching and tune nonlinear optical response on ultrafast timescales although the interlayer coupling of $\beta$-WP$_2$ is very strong. Our work is illuminating for the polar metal nonlinear optics and potential ultrafast topological optoelectronic applications.Comment: 8 pages, 5 figure

Inversion of thermal properties of lunar soil from penetration heat of projectile using a 2D axisymmetric model and optimized PSO algorithm

The thermophysical parameters of lunar soil can be inferred from the temperature field during the invasion process of reconnaissance projectile. This paper adopts a two-dimensional axisymmetric model to reconstruct the projectile invasion process. An optimized particle swarm optimization method is then used to retrieve the thermophysical parameters of lunar soil. When the reconnaissance projectile penetrates the lunar interior, it rubs against the lunar soil and generates heat, which diffuses between the projectile body and the lunar soil. The sensors inside the reconnaissance projectile measure the temperature variation of the projectile body to inverse the thermophysical parameters. This paper carried out physical modeling of the penetration process of reconnaissance projectile. A two-dimensional axisymmetric simulation model is constructed for the physical process, and the adaptive inertial weight particle swarm algorithm is adopted. The inversion experiment of lunar soil thermophysical parameters based on the simulation model shows that the inversion error is less than 10%, which verifies the feasibility of this method