Learning implementation of a guideline based decision support system to improve hypertension treatment in primary care in China: pragmatic cluster randomised controlled trial

Objective: To evaluate the effectiveness of a clinical decision support system (CDSS) in improving the use of guideline accordant antihypertensive treatment in primary care settings in China. Design: Pragmatic, open label, cluster randomised trial. Setting: 94 primary care practices in four urban regions of China between August 2019 and July 2022: Luoyang (central China), Jining (east China), and Shenzhen (south China, including two regions). Participants: 94 practices were randomised (46 to CDSS, 48 to usual care). 12 137 participants with hypertension who used up to two classes of antihypertensives and had a systolic blood pressure <180 mm Hg and diastolic blood pressure <110 mm Hg were included. Interventions: Primary care practices were randomised to use an electronic health record based CDSS, which recommended a specific guideline accordant regimen for initiation, titration, or switching of antihypertensive (the intervention), or to use the same electronic health record without CDSS and provide treatment as usual (control). Main outcome measures: The primary outcome was the proportion of hypertension related visits during which an appropriate (guideline accordant) treatment was provided. Secondary outcomes were the average reduction in systolic blood pressure and proportion of participants with controlled blood pressure (<140/90 mm Hg) at the last scheduled follow-up. Safety outcomes were patient reported antihypertensive treatment related events, including syncope, injurious fall, symptomatic hypotension or systolic blood pressure <90 mm Hg, and bradycardia. Results: 5755 participants with 23 113 visits in the intervention group and 6382 participants with 27 868 visits in the control group were included. Mean age was 61 (standard deviation 13) years and 42.5% were women. During a median 11.6 months of follow-up, the proportion of visits at which appropriate treatment was given was higher in the intervention group than in the control group (77.8% (17 975/23 113) v 62.2% (17 328/27 868); absolute difference 15.2 percentage points (95% confidence interval (CI) 10.7 to 19.8); P<0.001; odds ratio 2.17 (95% CI 1.75 to 2.69); P<0.001). Compared with participants in the control group, those in the intervention group had a 1.6 mm Hg (95% CI −2.7 to −0.5) greater reduction in systolic blood pressure (−1.5 mm Hg v 0.3 mm Hg; P=0.006) and a 4.4 percentage point (95% CI −0.7 to 9.5) improvement in blood pressure control rate (69.0% (3415/4952) v 64.6% (3778/5845); P=0.07). Patient reported antihypertensive treatment related adverse effects were rare in both groups. Conclusions: Use of a CDSS in primary care in China improved the provision of guideline accordant antihypertensive treatment and led to a modest reduction in blood pressure. The CDSS offers a promising approach to delivering better care for hypertension, both safely and efficiently. Trial registration: ClinicalTrials.gov NCT03636334

Uniform in time error analysis of HDG approximation for Schrödinger equation based on HDG projection

This paper presents error analysis of hybridizable discontinuous Galerkin (HDG) time-domain method for solving time dependent Schrödinger equations. The numerical trace and numerical flux are constructed to preserve the conservative property for the density of the particle described. We prove that there exist the superconvergence properties of the HDG method, which do hold for second-order elliptic problems, uniformly in time for the semidiscretization by the same method of Schrödinger equations provided that enough regularity is satisfied. Thus, if the approximations are piecewise polynomials of degree r, the approximations to the wave function and the flux converge with order r + 1. The suitably chosen projection of the wave function into a space of lower polynomial degree superconverges with order r + 2 for r ≥ 1 uniformly in time. The application of element-by-element postprocessing of the approximate solution which provides an approximation of the potential convergence with order r + 2 for r ≥ 1 in L2 is also uniformly in time

Effective Improving the Detection Limit of Tris(2,3-dibromopropyl) Isocyanurate by Bis-amino in O-phenylenediamine

A facile approach for ultrasensitively sensing tris(2,3-dibromopropyl) isocyanurate (TBC) was reported. Based on coupling molecularly imprinting with electropolymerization of ο-phenylenediamine (OPD), which is electro-active monomers, the poly-OPD film was deposited in an OPD solution by potentiodynamic cycling of potential (scan rate is 50mV/s) on a glassy carbon electrode. Using K3[Fe(CN)6] as an electro-active marker, the properties of the TBC imprinting electrode were investigated by differential pulse voltammetry and amperometric i-t curve and exhibited an excellent imprinting effect. The results showed that a linear relationship between the value of peak current and the TBC concentration was found in the range of 1.4×10−12~6.7×10−12 mol/L and a low detection limit of 6.26×10−13 mol/L for TBC determination

Effective Improving the Detection Limit of Tris(2,3-dibromopropyl) Isocyanurate by Bis-amino in

A facile approach for ultrasensitively sensing tris(2,3-dibromopropyl) isocyanurate (TBC) was reported. Based on coupling molecularly imprinting with electropolymerization of ο-phenylenediamine (OPD), which is electro-active monomers, the poly-OPD film was deposited in an OPD solution by potentiodynamic cycling of potential (scan rate is 50mV/s) on a glassy carbon electrode. Using K3[Fe(CN)6] as an electro-active marker, the properties of the TBC imprinting electrode were investigated by differential pulse voltammetry and amperometric i-t curve and exhibited an excellent imprinting effect. The results showed that a linear relationship between the value of peak current and the TBC concentration was found in the range of 1.4×10−12~6.7×10−12 mol/L and a low detection limit of 6.26×10−13 mol/L for TBC determination

Plasma Engineering of Co₄N/CoN Heterostructure for Boosting Supercapacitor Performance

Supercapacitor electrode materials play a decisive role in charge storage and significantly affect the cost and capacitive performance of the final device. Engineering of the heterostructure of metal–organic framework (MOF)-derived transition metal nitrides (TMNs) can be conducive to excellent electrochemical performance owing to the synergistic effect, optimized charge transport/mass transfer properties, and high electrical conductivity. In this study, a Co4N/CoN heterostructure was incorporated into a nitrogen-doped support by radio-frequency (RF) plasma after simple pyrolysis of Co-based formate frameworks (Co-MFFs), with the framework structure well retained. Plasma engineering can effectively increase the ratio of Co4N in the Co4N/CoN heterostructure, accelerating the electron transfer rate and resulting in a rough surface due to the reduction effect of high-energy electrons and the etching effect of ions. Benefiting from the plasma modification, the obtained electrode material Co4N/CoN@C-P exhibits a high specific capacitance of 346.2 F·g−1 at a current density of 1 A·g−1, approximately 1.7 times that of CoN/Co4N@C prepared by pyrolysis. The specific capacitance of Co4N/CoN@C-P reaches 335.6 F·g−1 at 10 A·g−1, approximately 96.9% of that at 1 A·g−1, indicating remarkable rate capability. Additionally, the capacitance retention remains at 100% even after 1000 cycles, suggesting excellent cycling stability. The rational design and plasma engineering of the TMN heterostructures at the nanoscale are responsible for the excellent electrochemical performance of this novel composite material

Bioorg. Med. Chem. Lett.

A clear and powerful chromatographic approach to purify polyethylene glycol derivatives at a preparative scale was reported, which was based on the polystyrene-divinylbenzene beads with ethanol/water as eluants. The validity of this method was verified with the reaction mixture of mPEG-Glu and mPEG propionaldehyde diethylacetal (ALD-PEG) as the model. The target products were one-step achieved with the purity of &gt; 99% on the polymer resins column at gram scale. The method developed was free from such disadvantages as utility of toxic solvent and narrow application scope, which was combined with conventional approaches. The method developed provided an appealing and attractive alternative methods for purification of PEG derivatives at a preparative scale. (c) 2007 Elsevier Ltd. All rights reserved.A clear and powerful chromatographic approach to purify polyethylene glycol derivatives at a preparative scale was reported, which was based on the polystyrene-divinylbenzene beads with ethanol/water as eluants. The validity of this method was verified with the reaction mixture of mPEG-Glu and mPEG propionaldehyde diethylacetal (ALD-PEG) as the model. The target products were one-step achieved with the purity of > 99% on the polymer resins column at gram scale. The method developed was free from such disadvantages as utility of toxic solvent and narrow application scope, which was combined with conventional approaches. The method developed provided an appealing and attractive alternative methods for purification of PEG derivatives at a preparative scale. (c) 2007 Elsevier Ltd. All rights reserved