HiCAR is a robust and sensitive method to analyze open-chromatin-associated genome organization.

The long-range interactions of cis-regulatory elements (cREs) play a central role in gene regulation. cREs can be characterized as accessible chromatin sequences. However, it remains technically challenging to comprehensively identify their spatial interactions. Here, we report a new method HiCAR (Hi-C on accessible regulatory DNA), which utilizes Tn5 transposase and chromatin proximity ligation, for the analysis of open-chromatin-anchored interactions with low-input cells. By applying HiCAR in human embryonic stem cells and lymphoblastoid cells, we demonstrate that HiCAR identifies high-resolution chromatin contacts with an efficiency comparable with that of in situ Hi-C over all distance ranges. Interestingly, we found that the "poised" gene promoters exhibit silencer-like function to repress the expression of distal genes via promoter-promoter interactions. Lastly, we applied HiCAR to 30,000 primary human muscle stem cells and demonstrated that HiCAR is capable of analyzing chromatin accessibility and looping using low-input primary cells and clinical samples.

Effectiveness of a comprehensive package based on electronic medication monitors at improving treatment outcomes among tuberculosis patients in Tibet: a multicentre randomised controlled trial.

BACKGROUND: WHO recommends that electronic medication monitors, a form of digital adherence technology, be used as a complement to directly observed treatment (DOT) for tuberculosis, as DOT is inconvenient and costly. However, existing evidence about the effectiveness of these monitors is inconclusive. Therefore, we evaluated the effectiveness of a comprehensive package based on electronic medication monitors among patients with tuberculosis in Tibet Autonomous Region (hereafter Tibet), China. METHODS: This multicentre, randomised controlled trial recruited patients from six counties in Shigatse, Tibet. Eligible participants had drug-susceptible tuberculosis and were aged 15 years or older when starting standard tuberculosis treatment. Tuberculosis doctors recruited patients from the public tuberculosis dispensary in each county and the study statistician randomly assigned them to the intervention or control group based on the predetermined randomised allocation sequence. Intervention patients received an electronic medication monitor box. The box included audio medication-adherence reminders and recorded box-opening data, which were transmitted to a cloud-based server and were accessible to health-care providers to allow remote adherence monitoring. A linked smartphone app enabled text, audio, and video communication between patients and health-care providers. Patients were also provided with a free data plan. Patients selected a treatment supporter (often a family member) who was trained to support patients with using the electronic medication monitor and app. Patients in the control group received usual care plus a deactivated electronic medication monitor, which only recorded and transmitted box-opening data that was not made available to health-care providers. The control group also had no access to the app or trained treatment supporters. The primary outcome was a binary indicator of poor monthly adherence, defined as missing 20% or more of planned doses in the treatment month, measured using electronic medication monitor opening data, and verified by counting used medication blister packages during consultations. We recorded other secondary treatment outcomes based on national tuberculosis reporting data. We analysed the primary outcome based on the intention-to-treat population. This trial is registered at ISRCTN, 52132803. FINDINGS: Between Nov 17, 2018, and April 5, 2021, 278 patients were enrolled into the study. 143 patients were randomly assigned to the intervention group and 135 patients to the control group. Follow-up ended when the final patient completed treatment on Oct 4, 2021. In the intervention group, 87 (10%) of the 854 treatment months showed poor adherence compared with 290 (37%) of the 795 months in the control group. The corresponding adjusted risk difference for the intervention versus control was -29·2 percentage points (95% CI -35·3 to -22·2; p<0·0001). Five of the six secondary treatment outcomes also showed clear improvements, including treatment success, which was found for 133 (94%) of the 142 individuals in the intervention arm and 98 (73%) of the 134 individuals in the control arm, with an adjusted risk difference of 21 percentage points (95% CI 12·4-29·4); p<0·0001. INTERPRETATION: The interventions were effective at improving tuberculosis treatment adherence and outcomes, and the trial suggests that a comprehensive package involving electronic medication monitors might positively affect tuberculosis programmes in high-burden and low-resource settings. FUNDING: TB REACH.

Strong mechanical anisotropy and an anisotropic Dirac state in 2D C5N3.

Two-dimensional (2D) carbon nitride materials have emerged as a versatile platform for the design of high-performance nanoelectronics, but strong anisotropy in 2D carbon nitrides has rarely been reported. In this work, a 2D carbon nitride with strong anisotropy composed of tetra-, penta-, and hexa-rings (named as TPH-C5N3) is proposed. This TPH-C5N3 exhibits both dynamical and mechanical stability. Furthermore, it also showcases remarkable thermal stability, reaching up to 2300 K, as evidenced by AIMD simulations conducted in an NVT environment utilizing the Nosé-Hoover thermostat. Significantly, TPH-C5N3 demonstrates high anisotropic ratios in its mechanical properties, positioning it as the frontrunner in the current carbon nitride systems. In addition, a Dirac cone with an anisotropic ratio of 55.8% and Fermi velocity of 7.26 × 105 m s-1 is revealed in TPH-C5N3. The nontrivial topological properties of TPH-C5N3 are demonstrated by a non-zero Z2 invariant and topologically protected edge states. Our study offers theoretical insights into an anisotropic 2D carbon nitride material, laying the groundwork for its design and synthesis.

Enhanced OER catalytic activity of single metal atoms supported by the pentagonal NiN2 monolayer: insight from density functional theory calculations.

Two-dimensional material-supported single metal atom catalysts have been extensively studied and proved effective in electrocatalytic reactions in recent years. In this work, we systematically investigate the OER catalytic properties of single metal atoms supported by the NiN2 monolayer. Several typical transition metals with high single atom catalytic activity, such as Fe, Co, Ru, Rh, Pd, Ir, and Pt, were selected as catalytic active sites. The energy calculations show that transition metal atoms (Fe, Co, Ru, Rh, Pd, Ir, and Pt) are easily embedded in the NiN2 monolayer with Ni vacancies due to the negative binding energy. The calculated OER overpotentials of Fe, Co, Ru, Rh, Pd, Ir and Pt embedded NiN2 monolayers are 0.92 V, 0.47 V, 1.13 V, 0.66 V, 1.25 V, 0.28 V, and 0.94 V, respectively. Compared to the 0.57 V OER overpotential of typical OER noble metal catalysts IrO2, Co@NiN2 and Ir@NiN2 exhibit high OER catalytic activity due to lower overpotential, especially for Ir@NiN2. The high catalytic activity of the Ir embedded NiN2 monolayer can be explained well by the d-band center model. It is found that the adsorption strength of the embedded TM atoms with intermediates follows a linear relationship with their d-band centers. Besides, the overpotential of the Ir embedded NiN2 monolayer can be further reduced to 0.24 V under -2% biaxial strain. Such findings are expected to be employed in more two-dimensional material-supported single metal atom catalyzed reactions.

How spin state and oxidation number of transition metal atoms determine molecular adsorption: a first-principles case study for NH3.

Understanding how the electronic state of transition metal atoms can influence molecular adsorption on a substrate is of great importance for many applications. Choosing NH3 as a model molecule, its adsorption behavior on defected SnS2 monolayers is investigated. The number of valence electrons n is controlled by decorating the monolayer with different transition metal atoms, ranging from Sc to Zn. Density-Functional Theory based calculations show that the adsorption energy of NH3 molecules oscillates with n and shows a clear odd-even pattern. There is also a mirror symmetry of the adsorption energies for large and low electron numbers. This unique behavior is mainly governed by the oxidation state of the TM ions. We trace back the observed trends of the adsorption energy to the orbital symmetries and ligand effects which affect the interaction between the 3σ orbitals (NH3) and the 3d orbitals of the transition metals. This result unravels the role which the spin state of TM ions plays in different crystal fields for the adsorption behavior of molecules. This new understanding of the role of the electronic structure on molecular adsorption can be useful for the design of high efficiency nanodevices in areas such as sensing and photocatalysis.

Association of Tumor Cell Metabolic Subtype and Immune Response With the Clinical Course of Hepatocellular Carcinoma.

AIM: Tumor metabolism plays an important role in tumorigenesis and tumor progression. This study evaluated the potential association of tumor cell metabolism and immune cell tumor infiltration with the clinical course of hepatocellular carcinoma (HCC). METHODS: Gene-wise normalization and principal component analysis were performed to evaluate the metabolic system. A tumor microenvironment score system of tumor immune cell infiltration was constructed to evaluate its association with metabolic subtypes. Finally, we analyzed the impact of metabolism and immune cell infiltration on the clinical course of HCC. RESULTS: A total of 673 HCC patients were categorized into cholesterogenic (25.3%), glycolytic (14.6%), mixed (10.4%), and quiescent (49.8%) types based on glycolysis and cholesterol biosynthesis gene expression. The subgroups including the glycolytic genotyping expression (glycolytic and mixed types) showed a higher mortality rate. The glycolytic, cholesterogenic, and mixed types were positively correlated with M0 macrophage, resting mast cell, and naïve B-cell infiltration (P = .013, P = .019, and P = .006, respectively). In TCGA database, high CD8+ T cell and low M0 macrophage infiltration were associated with prolonged overall survival (OS, P = .0017 and P < .0001, respectively). Furthermore, in glycolytic and mixed types, patients with high M0 macrophage infiltration had a shorter OS (P = .03 and P = .013, respectively), and in quiescent type, patients with low naïve B-cell infiltration had a longer OS (P = .007). CONCLUSIONS: Tumor metabolism plays a prognostic role and correlates with immune cell infiltration in HCC. M0 macrophage and CD8+ T cell appear to be promising prognostic biomarker for HCC. Finally, M0 macrophages may represent a useful immunotherapeutic target in patients with HCC.

Nitrate Radical Induced "Two in One" Interface Engineering toward High Reversibility of Zn Metal Anode.

Advanced interfacial engineering performs a forceful modulation effect on Zn2+ plating/stripping with simultaneous inhibition of hydrogen evolution reaction, chemical corrosion, and dendrite growth, which is responsible for high reversibility of Zn anode. Herein, a "two in one" interface engineering is developed to improve the reversibility of Zn anode, in which multi-functional Zn5 (NO3 )2 (OH)8 ·2H2 O layer and preferential Zn (002) texture are constructed simultaneously. Due to nucleophilicity to Zn2+ arising from electronegativity, the layer can accelerate the desolvation process of [Zn (H2 O)6 ]2+ and transfer kinetics of Zn2+ ions, leading to uniform nucleation and effective inhibition of water-induced side reactions. Meanwhile, the latter is beneficial to guiding   Zn (002)-preferred orientation deposition with compact structure. Consequently, the Zn electrodes with such complementary interface modulation exhibit prominent reversibility. With an area capacity of 1 mAh cm-2 at 1 mA cm-2 , the symmetric cell operates steadily for 4000 h. Highly reversible Zn anode is maintained even at 50 mA cm-2 . For full cells coupled with MnO2 cathode, impressive rate capability and cycling stability with a high capacity beyond 100 mAh g-1 at 1 A g-1 after 2000 cycles are achieved. The results provide new insights into Zn anodes with high reversibility for next-generation aqueous zinc ion batteries.

ZNF33A Promotes Tumor Progression and BET Inhibitor Resistance in Triple-Negative Breast Cancer.

Overexpression of ZNF33A (Krüppel-type zinc finger 33A) promotes carcinogenesis in several malignant tumors. However, the biochemical role and clinical importance of ZNF33A in triple-negative breast cancer (TNBC) still need to be explored. In this study, overexpression of ZNF33A in TNBC patient tissues and cell lines led to a worse prognosis. ZNF33A promoted cell growth and facilitated the resistance of cancer cells to inhibitors of bromodomain and extraterminal domain (BET) in TNBC. ZNF33A also promoted the induction of c-Myc, the primary player for the resistance to BET inhibitors in TNBC. In conclusion, ZNF33A may be a tumor growth-promoting factor associated with TNBC prognosis, and ZNF33A repression may sensitize TNBC cells to BET inhibitors.

Team-Based Diabetes Care in Ontario and Hong Kong: a Comparative Review.

PURPOSE OF REVIEW: There are gaps in implementing and accessing team-based diabetes care. We reviewed and compared how team-based diabetes care was implemented in the primary care contexts of Ontario and Hong Kong. RECENT FINDINGS: Ontario's Diabetes Education Programs (DEPs) were scaled-up incrementally. Hong Kong's Multidisciplinary Risk Assessment and Management Program for Diabetes Mellitus (RAMP-DM) evolved from a research-driven quality improvement program. Each jurisdiction had a mixture of non-team and team-based primary care with variable accessibility. Referral procedures, follow-up processes, and financing models varied. DEPs used a flexible approach, while the RAMP-DM used structured assessment for quality assurance. Each approach depended on adequate infrastructure, processes, and staff. Diabetes care is most accessible and functional when integrated team-based services are automatically initiated upon diabetes diagnosis within a strong primary care system, ideally linked to a register with supports including specialist care. Structured assessment and risk stratification are the basis of a well-studied, evidence-based approach for achieving the standards of team-based diabetes care, although flexibility in care delivery may be needed to meet the unique needs of some individuals. Policymakers and funders should ensure investment in skilled health professionals, infrastructure, and processes to improve care quality.

Novel three-dimensional TiO2 structure with a unique quasi-direct band gap for photocatalysts.

Motivated by fundamental interests and practical applications, three-dimensional (3D) photocatalysts are a fascinating area of research in clean energy. Based on first-principles calculations, we predicted three new 3D polymorphs of TiO2: δ-, ε-, and ζ-TiO2. Our results indicate that the band gaps of TiO2 decrease almost linearly with an increase in the coordination number of Ti. Moreover, δ-TiO2 and ζ-TiO2 are semiconductors, whereas ε-TiO2 is a metal, and the lowest energy of ζ-TiO2 is a quasi-direct band gap semiconductor with a distinctive band gap of 2.69 eV, calculated by the HSE06 level. In addition, the calculated imaginary part of the dielectric function indicates that the optical absorption edge is located in the visible light region, suggesting that the proposed ζ-TiO2 may be a good photocatalyst candidate. Importantly, ζ-TiO2 with the lowest energy is dynamically stable, and phase diagrams based on total energies at a specific pressure indicate that ζ-TiO2 can be synthesized from rutile TiO2 at high-pressure conditions.

Implementation Science Perspectives on Implementing Telemedicine Interventions for Hypertension or Diabetes Management: Scoping Review.

BACKGROUND: Hypertension and diabetes are becoming increasingly prevalent worldwide. Telemedicine is an accessible and cost-effective means of supporting hypertension and diabetes management, especially as the COVID-19 pandemic has accelerated the adoption of technological solutions for care. However, to date, no review has examined the contextual factors that influence the implementation of telemedicine interventions for hypertension or diabetes worldwide. OBJECTIVE: We adopted a comprehensive implementation research perspective to synthesize the barriers to and facilitators of implementing telemedicine interventions for the management of hypertension, diabetes, or both. METHODS: We performed a scoping review involving searches in Ovid MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, and Google Scholar to identify studies published in English from 2017 to 2022 describing barriers and facilitators related to the implementation of telemedicine interventions for hypertension and diabetes management. The coding and synthesis of barriers and facilitators were guided by the Consolidated Framework for Implementation Research. RESULTS: Of the 17,687 records identified, 35 (0.2%) studies were included in our scoping review. We found that facilitators of and barriers to implementation were dispersed across the constructs of the Consolidated Framework for Implementation Research. Barriers related to cost, patient needs and resources (eg, lack of consideration of language needs, culture, and rural residency), and personal attributes of patients (eg, demographics and priorities) were the most common. Facilitators related to the design and packaging of the intervention (eg, user-friendliness), patient needs and resources (eg, personalized information that leveraged existing strengths), implementation climate (eg, intervention embedded into existing infrastructure), knowledge of and beliefs about the intervention (eg, convenience of telemedicine), and other personal attributes (eg, technical literacy) were the most common. CONCLUSIONS: Our findings suggest that the successful implementation of telemedicine interventions for hypertension and diabetes requires comprehensive efforts at the planning, execution, engagement, and reflection and evaluation stages of intervention implementation to address challenges at the individual, interpersonal, organizational, and environmental levels.

Barriers and facilitators of implementing electronic monitors to improve adherence and health outcomes in tuberculosis patients: protocol for a systematic review based on the Consolidated Framework for Implementation Research.

BACKGROUND: Tuberculosis (TB) has been regarded as 'a relentless scourge', increasing morbidity and mortality and burdening vulnerable populations. Poor adherence to TB treatment and ineffective traditional interventions hinders TB control. A novel TB approach called 'electronic monitors', equipping medication boxes with daily audio or visual reminders for electronically monitoring medication intake, seems promising in improving adherence and health outcomes and overcoming the weaknesses of traditional interventions. However, no review has systematically examined and synthesized the influencing factors of implementing electronic monitors. Implementation research offers the means to analyse the influencing factors of the implementation and its process, fitting well with the aim of this review. Therefore, the widely recognized Consolidated Framework for Implementation Research (CFIR), which offers a common taxonomy for evaluating intervention implementation, will be adopted to systematically identify barriers and facilitators of the electronic monitors for improving adherence and health outcomes in patients with TB. METHODS AND ANALYSIS: The systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature research will be conducted in five electronic databases (Ovid MEDLINE, CINAHL, EMBASE, Cochrane Library and Web of Science) to identify the barriers and facilitators of implementing electronic monitors in patients with TB. The CFIR will be used as a guide for categorizing and synthesizing the barriers and facilitators. Study screening, data extraction, quality appraisal and data analysis will be conducted by two independent reviewers. The use of additional reviewers will solve any disagreements between the two reviewers. DISCUSSION: Given the increased prominence of TB epidemiology and the adherence problem of electronic monitors, there is a solid rationale for synthesizing the existing studies via the CFIR. The findings and conclusion of this review will lay bare the achievements and effectiveness of implementing electronic monitors, as well as the attendant gaps and limitations. Further strategies for facilitating the implementation of electronic monitors will also be explored. This review will be of essential significance for research and practice, supporting future academic research initiatives centred on patients with TB and aiding electronic monitor design in lowering the morbidity and mortality associated with TB disease. TRIAL REGISTRATION NUMBER: PROSPERO: CRD42023395747.

Mcl-1 inhibition overcomes BET inhibitor resistance induced by low FBW7 expression in breast cancer.

While the promise of bromodomains and extraterminal (BET) protein inhibitors (BETis) is emerging in breast cancer (BC) therapy, resistance in these cells to BETis conspicuously curbs their therapeutic potential. FBW7 is an important tumour suppressor. However, the role of FBW7 in BC is not clear. In the current study, our data indicated that the low expression of FBW7 contributes to the drug resistance of BC cells upon JQ1 treatment. shRNA-mediated FBW7 silencing in FBW7 WT BC cells suppressed JQ1-induced apoptosis. Mechanistically, it was revealed that this diminished FBW7 level leads to Mcl-1 stabilization, while Mcl-1 upregulation abrogates the killing effect of JQ1. Mcl-1 knockdown or inhibition resensitized the BC cells to JQ1-induced apoptosis. Moreover, FBW7 knockdown in MCF7 xenografted tumours demonstrated resistance to JQ1 treatment. The combination of JQ1 with a Mcl-1 inhibitor (S63845) resensitized the FBW7 knockdown tumours to JQ1 treatment in vivo. Our study paves the way for a novel therapeutic potential of BETis with Mcl-1 inhibitors for BC patients with a low FBW7 expression.

Effect modification of greenness on PM2.5 associated all-cause mortality in a multidrug-resistant tuberculosis cohort.

RATIONALE: Evidence for the association between fine particulate matter (PM2.5) and mortality among patients with tuberculosis (TB) is limited. Whether greenness protects air pollution-related mortality among patients with multidrug-resistant tuberculosis (MDR-TB) is completely unknown. METHODS: 2305 patients reported in Zhejiang and Ningxia were followed up from MDR-TB diagnosis until death, loss to follow-up or end of the study (31 December 2019), with an average follow-up of 1724 days per patient. 16-day averages of contemporaneous Normalised Difference Vegetation Index (NDVI) in the 500 m buffer of patient's residence, annual average PM2.5 and estimated oxidant capacity Ox were assigned to patients regarding their geocoded home addresses. Cox proportional hazards regression models were used to estimate HRs per 10 µg/m3 exposure to PM2.5 and all-cause mortality among the cohort and individuals across the three tertiles, adjusting for potential covariates. RESULTS: HRs of 1.702 (95% CI 1.680 to 1.725) and 1.169 (1.162 to 1.175) were observed for PM2.5 associated with mortality for the full cohort and individuals with the greatest tertile of NDVI. Exposures to PM2.5 were stronger in association with mortality for younger patients (HR 2.434 (2.432 to 2.435)), female (2.209 (1.874 to 2.845)), patients in rural (1.780 (1.731 to 1.829)) and from Ningxia (1.221 (1.078 to 1.385)). Cumulative exposures increased the HRs of PM2.5-related mortality, while greater greenness flattened the risk with HRs reduced in 0.188-0.194 on average. CONCLUSIONS: Individuals with MDR-TB could benefit from greenness by having attenuated associations between PM2.5 and mortality. Improving greener space and air quality may contribute to lower the risk of mortality from TB/MDR-TB and other diseases.

Water-Processable and Multiscale-Designed Vanadium Oxide Cathodes with Predominant Zn2+ Intercalation Pseudocapacitance toward High Gravimetric/Areal/Volumetric Capacity.

Layered vanadium oxides have great potential as cathode materials for recently surged aqueous zinc-ion batteries (AZIBs). However, achieving high energy/power densities simultaneously is challenging, and side reactions related to more frequently than disclosed Zn2+ /proton co-insertion mechanism aggravate stability concerns. Herein, an engineered binder-free cathode configuration based on water-processable and high packing-density sheet-shaped composites of carbon nanotubes network, surface poly(3,4-ethylenedioxythiophene) (PEDOT) bridging coating, and ultrasmall PEDOT-intercalated V2 O5 nanoflakes is developed, and therein, large pseudocapacitance via predominant (≈91%) Zn2+ intercalation is revealed. Besides competitive gravimetric/areal capacity, the binder-free cathodes exhibit high volumetric capacity of 1106.1 mAh cm-3 and high-rate capability of 180.0 mA g-1 at 30 A g-1 as well as long-cycling stability. Such combined level of performance and unwanted reaction mechanism are attributed to the contained multiscale material/electrode design formula from crystal structure modification to 3D architecture construction of whole electrode, which endows the binder-free cathodes with abundant accessible sites for Zn2+ storage, but the least hydroxyl terminated surface for H+ insertion, as well as highly conductive network for electron transfer and fast Zn2+ diffusion kinetics throughout the electrode. Combined with scalable fabrication protocols, this study opens up great opportunities for high-performance vanadium oxide cathodes practically applicable to AZIBs.

Creating Unidirectional Fast Ion Diffusion Channels in G/NiS2 -MoS2 Heterostructures for High-Performance Sodium-Ion Batteries.

Exploring novel electrode composites and their unique interface physics plays a significant role in tuning electrochemical properties for boosting the performance of sodium-ion batteries (SIBs). Herein, mixed-dimensional G/NiS2 -MoS2 heterostructures are synthesized in a low-cost meteorological vulcanization process. The stable graphene supporting layer and nanowire heterostructure guarantee an outstanding structural stability to tolerate certain volume changes during the charge/discharge process. The rational construction of NiS2 -MoS2 heterostructures induces abundant interfaces and unique ion diffusion channels, which render fast electrochemical kinetics and superior reversible capacities for high-performance SIBs. Interestingly, theoretical studies reveal that the anisotropic diffusion barriers create unidirectional "high-speed" channels, which can lead to ordered and fast Na+ insertion/extraction in designed heterostructures. G/NiS2 -MoS2 anode exhibits a high capacity of 509.6 mA h g-1 after 500 cycles and a coulombic efficiency >99% at 0.5 A g-1 , which also displays excellent cycling performance with the capacity of 383.8 mA h g-1 after the 1000 cycles at 5 A g-1 . Furthermore, full cells are constructed exhibiting a high capacity of 70 mA h g-1 at 0.1 A g-1 after 150 cycles and applied to light LEDs. This study provides a feasible strategy of constructing mixed-dimensional heterostructures for SIBs with excellent performance and a long service lifetime.

P-block atom modified Sn(200) surface as a promising electrocatalyst for two-electron CO2 reduction: a first-principles study.

Low activity and poor product selectivity of CO2 reduction have seriously hampered its further practical application. Introducing p-block atoms to the catalyst is regarded as a promising strategy due to the versatility of p orbitals and diversity of p-block elements. Here, we systematically studied the influence of p-block atom X (X = C, N, O, S, and Se) on CO2 catalytic properties on a Sn(200) surface by first-principles calculation. Our work shows that all the p-block atoms are relative stable with Ef in the range of -5.11 to -3.59 eV. Further calculation demonstrates that the diversity of the p-block atoms results in unique CO2 electrocatalytic activity and product selectivity. Interestingly, the p-block C atom shows bi-functional activity to form two-electron products HCOOH and CO, with the corresponding energy barriers remarkably low at about 0.19 eV and 0.28 eV. In particular, the p-block S(Se) atom appears to have striking HCOOH selectivity, with the energy barrier to form HCOOH only a quarter of that to form the CO product. This unusual behavior is mainly attributed to the adsorption strength and frontier orbital interaction between the p-block atom and intermediates. These findings can effectively provide a valuable insight into the design of highly efficient CO2 electrocatalyst.

Effects of Baduanjin exercise on cognitive function and cancer-related symptoms in women with breast cancer receiving chemotherapy: a randomized controlled trial.

PURPOSE: Cognitive decline is one of the main side effects of breast cancer patients after relevant treatment, but there is a lack of clear measures for prevention and management without definite mechanism. Moreover, postoperative patients also have a need for limb rehabilitation. Whether the cognitive benefits of Baduanjin exercise can improve the overall well-being of breast cancer patients remains unknown. METHODS: This randomized controlled trial was conducted on 70 patients with breast cancer receiving chemotherapy who were randomly assigned and allocated to (1:1) a supervised Baduanjin intervention group (5 times/week, 30 min each time) or a control group for 3 months. The effects of Baduanjin exercise intervention were evaluated by outcome measures including subjective cognitive function, symptoms (fatigue, depression, and anxiety), and health-related quality of life at pre-intervention (T0), 4 weeks (T1), 8 weeks (T2), and 12 weeks (T3). The collected data were analyzed by using an intention-to-treat principle and linear mixed-effects modeling. RESULTS: Participants in the Baduanjin intervention group had a significantly greater improvement in terms of FACT-Cog (F = 14.511; p < 0.001), PCI (F = 15.789; p < 0.001), PCA (F = 6.261; p = 0.015), and FACT-B scores (F = 8.900; p = 0.004) compared with the control group over the time. The exercise-cognition relationship was significantly mediated through the reduction of fatigue (indirect effect: ß = 0.132; 95% CI 0.046 to 0.237) and the improvement of anxiety (indirect effect: ß = - 0.075; 95% CI - 0.165 to -0.004). CONCLUSIONS: This pilot study revealed the benefits of Baduanjin exercise for subjective cognition and health-related quality of life of Chinese breast cancer patients receiving chemotherapy and outlined the underlying mediating mechanism of exercise-cognition. The findings provided insights into the development of public health initiatives to promote brain health and improve quality of life among breast cancer patients. TRIAL REGISTRATION NUMBER: ChiCTR 2,000,033,152.

Public expectations of good primary health care in China: a national qualitative study.

BACKGROUND: China is currently making efforts to transform the current hospital-centric service delivery system to people-centred primary health care (PHC)-based delivery system, with service delivery organized around the health needs and expectations of people. To help direct China's PHC reform efforts, a profile of high-quality PHC from the public's perspective is required. OBJECTIVES: To profile high-quality PHC from the perspective of the Chinese public. METHODS: Semistructured interviews were conducted in 6 provinces (Henan, Shandong, Zhejiang, Shaanxi, Shanxi, and Heilongjiang) in China. In total, 58 interviewees completed the recorded interview. For transcription, trained research assistant listened to the recording of the interviews, summarizing each 30-s segment in English. Next, thematic analysis was performed on the narrative summaries to identify thematic families. RESULTS: Seven themes and 16 subthemes were generated from the analysis of our interview data. In order of their frequency, the interviewees expressed a high expectation for interpersonal communication and technical quality; followed by access, comprehensive care, cost, continuity, and coordination. CONCLUSIONS: Using qualitative data from 6 provinces in China, knowledge was generated to reveal the public's views and expectations for high-quality PHC. Our results confirm the urgent need for quality improvement efforts to improve patient experience and technical quality. The government also needs to further improve the delivery system and medical training programme to better meet public expectation in these areas, especially in establishing an innovative integrated primary care model, and strengthening interpersonal and clinical competency training for family doctors.

Determinants of choice of usual source of care among older people with cardiovascular diseases in China: evidence from the Study on Global Ageing and Adult Health.

BACKGROUND: Cardiovascular diseases (CVD) are emerging as the leading contributor to death globally. The usual source of care (USC) has been proven to generate significant benefits for the elderly with CVD. Understanding the choice of USC would generate important knowledge to guide the ongoing primary care-based integrated health system building in China. This study aimed to analyze the individual-level determinants of USC choices among the Chinese elderly with CVD and to generate two exemplary patient profiles: one who is most likely to choose a public hospital as the USC, the other one who is most likely to choose a public primary care facility as the USC. METHODS: This study was a secondary analysis using data from the World Health Organization's Study on Global AGEing and Adult Health (SAGE) Wave 1 in China. 3,309 individuals aged 50 years old and over living with CVD were included in our final analysis. Multivariable logistic regression was built to analyze the determinants of USC choice. Nomogram was used to predict the probability of patients' choice of USC. RESULTS: Most of the elderly suffering from CVD had a preference for public hospitals as their USC compared with primary care facilities. The elderly with CVD aged 50 years old, being illiterate, residing in rural areas, within the poorest income quintile, having functional deficiencies in instrumental activities of daily living and suffering one chronic condition were found to be more likely to choose primary care facilities as their USC with the probability of 0.85. Among those choosing primary care facilities as their USC, older CVD patients with the following characteristics had the highest probability of choosing public primary care facilities as their USC, with the probability of 0.77: aged 95 years old, being married, residing in urban areas, being in the richest income quintile, being insured, having a high school or above level of education, and being able to manage activities living. CONCLUSIONS: Whilst public primary care facilities are the optimal USC for the elderly with CVD in China, most of them preferred to receive health care in public hospitals. This study suggests that the choice of USC for the elderly living with CVD was determined by different individual characteristics. It provides evidence regarding the choice of USC among older Chinese patients living with CVD.