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PURPOSE: State medical boards are charged through their medical practice acts to regulate physician practice and, when necessary, discipline physicians for incompetent or inappropriate behavior. Boards often authorize remedial continuing medical education (CME) as part of a disciplinary action; however, it is unclear how effective remedial CME is in reducing the likelihood of physicians receiving additional discipline. This study examined the relationship between physicians who were required to complete remedial CME as part of their first discipline by state medical boards and the likelihood of additional discipline. METHOD: The national-level sample included 4,061 MD-physicians whose first discipline included license restrictions, probation, or other conditions imposed by state medical boards between 2011 and 2015. A multivariate logistic regression model examined whether physicians required to complete remedial CME as part of their first discipline were less likely to receive additional discipline by boards within 5 years. RESULTS: Of the 4,061 physicians, 36% (n = 1,449) were required to complete remedial CME as part of their first discipline, and 35% (n = 1,426) received additional discipline within 5 years. After accounting for other factors, physicians who were required to complete remedial CME as part of their first discipline by boards were less likely to receive additional discipline (odds ratio = 0.597; 95% confidence interval = 0.513, 0.696; P < .001) within 5 years compared to physicians who were not required to complete remedial CME. CONCLUSIONS: Findings support remedial CME as a means to help reduce physician disciplinary recidivism in certain circumstances. Physicians required to complete remedial CME as part of their first discipline were less likely to receive additional discipline by state medical boards within 5 years.
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Innovation in surfactant structures is an effective way to prepare new soft materials with novel applications. In this study, we synthesized a double-tailed surfactant containing two quaternary ammonium head groups (Di-C12-N2). The Di-C12-N2 solution behavior was investigated by surface tension, fluorescence, rheology, and cryo-TEM methods. Although Di-C12-N2 contained a large double-tailed hydrophobic group, the solubility of Di-C12-N2 was â¼90 mmol L-1 at 25 °C with a Krafft temperature of â¼1 °C. The increase in Di-C12-N2 concentration in the solutions led to the formation of various aggregates, including spherical micelles, worm-like micelles, multi-layered vesicles, and a rare type of small toroidal micelles. The two quaternary ammonium head groups in Di-C12-N2 led to strong electrostatic interactions between molecules, which was critical for the formation of toroidal micelles. Moreover, with an added NaCl concentration of 40 mmol L-1, the viscosity of the 5 mmol L-1Di-C12-N2 solution increased by â¼1000 times compared to the pure 5 mmol L-1Di-C12-N2 solution, revealing the high sensitivity of the unique head groups to ionic strength. This study enriches the research on the self-assembly principles of surfactants and brings new potential applications for new soft materials.
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BACKGROUND: Diabetic kidney disease (DKD) is an important microvascular complication of diabetes mellitus (DM). OBJECTIVE: This study aimed to develop predictive nomograms to estimate the risk of DKD in patients with type 2 diabetes mellitus (T2DM). METHODS: The medical records of patients with T2DM in our hospital from March 2022 to March 2023 were retrospectively reviewed. The enrolled patients were randomly selected for training and validation sets in a 7:3 ratio. The models for predicting risk of DKD were virtualized by the nomograms using logistic regression analysis. RESULTS: Among the enrolled 597 patients, 418 were assigned to the training set, while 179 were assigned to the validation set. Using the predictors included glycated hemoglobin A1c (HbA1c), high density lipoprotein cholesterol (HDL-C), presence of diabetic retinopathy (DR) and duration of diabetes (DD), we constructed a full model (model 1) for predicting DKD. And using the laboratory indexes of HbA1c, HDL-C, and cystatin C (Cys-C), we developed a laboratory-based model (model 2). The C-indexes were 0.897 for model 1 and 0.867 for model 2, respectively. The calibration curves demonstrated a good agreement between prediction and observation in the two models. The decision curve analysis (DCA) curves showed that the two models achieved a net benefit across all threshold probabilities. CONCLUSION: We successfully constructed two prediction models to evaluate the risk of DKD in patients with T2DM. The two models exhibited good predictive performance and could be recommended for DKD screening and early detection.
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Home- and community-based services (HCBS) may contribute to lowering mortality and enhancing quality of life among older adults. Limited research, however, has examined this relationship in the Chinese context. This study explored the longitudinal association between perceived availability of HCBS and all-cause mortality among Chinese older adults. This cohort study included 8,102 individuals aged 65 years and older from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. HCBS included daily life assistance, medical care services, emotional support and social services, and reconciliation and legal aid services. The association between perceived availability of HCBS and all-cause mortality was investigated using Cox proportional hazards models. Emotional support and social services were negatively associated with all-cause mortality (HR = 0.86, 95% CI: 0.78 ~ 0.95, P = .004). Daily life assistance, medical care services, and reconciliation and legal aid services were not significantly associated with all-cause mortality. Providing community-level emotional support and social services may reduce the risk of death. Focusing on the mental health and social well-being of older adults is just as important as caring for their physical health.
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Folium Sennae are widely used around the world, mainly in purging and removal of endogenous active substances, such as anthraquinone and its derivatives. However, the potential toxicity of anthraquinones to the liver, kidney, and intestinal limits the application of Folium Sennae. In this study, we aimed at safe regulation of Folium Sennae to degrade anthraquinones, boosting medicinal properties and reducing toxicity and potency with Monascus fermentation. Monascus strains H1102 for Folium Sennae fermentation were selected as the initial strain which was capable of producing high yields of functional pigment and low yields of hazardous citrinin. The anthraquinone degradation rate reached 41.2%, with 212.2 U mL-1 of the pigment and approximately 0.038 mg L-1 of the citrinin under optimal fermentation conditions followed by response surface streamlining, which met the requirements of reducing toxicity, increasing efficiency of Monascus fermented Folium Sennae. Furthermore, the Monascus/Folium Sennae culture had no observable toxic effect on HK-2 and L-02 cells in vitro and further inhibited cell apoptosis and necrosis. Overall, our results showed that Monascus fermentation could provide an alternative strategy for toxicity reduction of herbal medicines as well as efficacy enhancement.
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Innovations in molecular structures formed using bioresources are efficient means to prepare surfactant aggregates with unique properties. Here, a rosin-based amine oxide surfactant (R-11-3-AO) containing large hydrophobic groups was synthesized from rosin derivatives, namely, dehydroabietic acid and long-chain amino acids. Cryo-transmission electron microscopy showed that R-11-3-AO molecules formed extremely long wormlike micelles with a cross-sectional diameter of 4-5 nm at a concentration of approximately 7 mmol·L-1. A gel-like system was obtained at approximately 30 mmol·L-1 due to the dense entanglement of the wormlike micelles. The solutions also exhibited unique shear thickening behavior at a shear rate of approximately 10 s-1 even at high concentrations. The large hydrophobic group contained in R-11-3-AO is the origin of the strong van der Waals interactions between the surfactant molecules, resulting in the rapid growth of wormlike micelles. This rosin-based surfactant is the first recoverable amine oxide surfactant from solutions through the salting-out effect with high recovery rates. This work demonstrates the unique capabilities of rosin-based surfactants for forming wormlike micelles and provides opportunities for the development of surfactant recovery technologies.
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BACKGROUND: This mixed-methods study explores older people's intention of institutional care and its contributing contextual factors, and the meaning given to their intention by older adults in the transitioning Chinese society. METHODS: Guided by the extended Anderson model and frameworks of the ecological theory of aging, survey data collected from 1937 Chinese older adults were used. Transcripts from six focus group interviews were analyzed to incorporate the voices of the participants. RESULTS: Community environment and services, health services, financial services, and regional service organizations were related to the institutional care intention of older people. The qualitative analysis showed that the reported conflicting feelings about institutional care was driven by the lack of supporting resources and age-friendly environment. The findings of this study suggested that the reported intention of Chinese older adults for institutional care may not be an ideal choice but a compromise or, in some cases, a forced choice. CONCLUSIONS: Rather than treating the stated institutional intention as a simple expression of older Chinese people's likes or desires, the intention of institutional care should be understood within a framework that fully considers the influence of psycho-social factors and contextual organizations.
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Envejecimiento , Intención , Humanos , Anciano , Encuestas y Cuestionarios , Grupos Focales , ChinaRESUMEN
BACKGROUND: Long-term care facilities (LTCFs) were high-risk settings for COVID-19 outbreaks. OBJECTIVE: To assess the impacts of the COVID-19 pandemic on LTCFs, including rates of infection, hospitalisation, case fatality, and mortality, and to determine the association between control measures and SARS-CoV-2 infection rates in residents and staff. METHOD: We conducted a systematic search of six databases for articles published between December 2019 and 5 November 2021, and performed meta-analyses and subgroup analyses to identify the impact of COVID-19 on LTCFs and the association between control measures and infection rate. RESULTS: We included 108 studies from 19 countries. These studies included 1,902,044 residents and 255,498 staff from 81,572 LTCFs, among whom 296,024 residents and 36,807 staff were confirmed SARS-CoV-2 positive. The pooled infection rate was 32.63% (95%CI: 30.29 ~ 34.96%) for residents, whereas it was 10.33% (95%CI: 9.46 ~ 11.21%) for staff. In LTCFs that cancelled visits, new patient admissions, communal dining and group activities, and vaccinations, infection rates in residents and staff were lower than the global rate. We reported the residents' hospitalisation rate to be 29.09% (95%CI: 25.73 ~ 32.46%), with a case-fatality rate of 22.71% (95%CI: 21.31 ~ 24.11%) and mortality rate of 15.81% (95%CI: 14.32 ~ 17.30%). Significant publication biases were observed in the residents' case-fatality rate and the staff infection rate, but not in the infection, hospitalisation, or mortality rate of residents. CONCLUSION: SARS-CoV-2 infection rates would be very high among LTCF residents and staff without appropriate control measures. Cancelling visits, communal dining and group activities, restricting new admissions, and increasing vaccination would significantly reduce the infection rates.
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COVID-19 , Humanos , COVID-19/epidemiología , COVID-19/prevención & control , Cuidados a Largo Plazo , Pandemias/prevención & control , SARS-CoV-2 , Instituciones de Cuidados Especializados de EnfermeríaRESUMEN
A novel nonionic-anionic Bola surfactant (abbreviated as CH3O(EO)7-R11-COOH) was designed and synthesized by condensation of methyl polyoxyethylene (7) ether with 12-bromododecanoic acid. In neutral aqueous solution, the surfactant behaves as a nonionic one and can stabilize oil-in-water (O/W) conventional emulsions alone and costabilize O/W Pickering emulsions with positively charged alumina nanoparticles with n-decane as the oil. In alkaline solution, the carboxylic acid group is deprotonated, becoming anionic and the surfactant is converted to Bola form, which is an inferior emulsifier and does not adsorb on particle surfaces, resulting in demulsification of both kinds of emulsions. With strong hydrophilicity, both the Bola surfactant and the bare particles return to the aqueous phase after demulsification, which is therefore recyclable and reusable in accordance with sustainable chemistry and engineering. In acidic media between pH 3 and 6, the ethyleneoxy groups tend to desorb from particle surfaces, slightly reducing the hydrophobicity of the particles. However, Pickering emulsions are still stable but their droplet size increases on lowering the pH. The Pickering emulsions are therefore pH-responsive and size-controllable. This newly designed Bola surfactant is effective in preparing smart emulsions, which are extensively applied in heterogeneous catalysis, oil product transportation, emulsion polymerization, and new material preparation.
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Innovation in emulsion compositions is necessary to enrich emulsion formulations and applications. Herein, Pickering emulsions were prepared using silica nanoparticles and aliphatic primary amines with an oil-water ratio of 1:1 (v/v). Contact angle experiments revealed that the in situ hydrophobization of nanoparticles was caused by the surface adsorption of amine molecules. Notably, the interactions between amine compounds and the surface of silica nanoparticles were electrostatic attractions and mutual hydrogen bonding. The existence of hydrogen bonds was further confirmed by demulsification experiments using a chaotropic agent DMF and increasing temperatures. The hydrophobicity of silica nanoparticles can be effectively improved using most commercially available aliphatic primary amines such as n-hexylamine, n-octylamine, n-decylamine, dodecylamine, and tetradecylamine. The minimum concentrations of the aforementioned amines necessary for stabilizing the emulsions with 0.3 wt % silica nanoparticles are 3, 0.6, 0.3, 0.06, and 0.03 mM, respectively, decreasing significantly with increasing alkyl chain length. With the increase of the amine concentrations, the hydrophobicity of silica particles monotonically increased and finally resulted in the inversion of emulsions. The amine concentrations for emulsion phase inversion were 150, 40, 30, 20, and 20 mM, respectively, in the presence of 0.3 wt % silica nanoparticles. In this work, silica nanoparticles were hydrophobized using aliphatic primary amines. The composite stabilizers developed are useful for developing novel stimuli-responsive Pickering emulsions, while the synergistic effects introduced herein are also helpful in expanding the hydrophobization methods available for nanoparticles.
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Nanopartículas , Dióxido de Silicio , Emulsiones/química , Dióxido de Silicio/química , Nanopartículas/química , Interacciones Hidrofóbicas e Hidrofílicas , AminasRESUMEN
Wormlike micelles are conventional aggregates that exist in viscoelastic solutions. However, to achieve a solution with prominent viscoelasticity, rather high concentrations of surfactants are usually required due to the flexibility of aggregates in solution. If thread-like aggregates with rigidity can be formed by surfactants, the solutions are expected to show strong viscoelasticity at very low surfactant concentrations. Herein, A novel rosin-based quaternary ammonium surfactant with two head groups (abbreviated as R-11-3-DA) was synthesized. Cryogenic transmission electron microscopy (Cryo-TEM) images showed that flexible nanofibers with diameters of about 7-8 nm and lengths of over 1 µm were formed in the 1 : 1.5 R-11-3-DA : SL solutions. The rigidity of the aggregates seems to be inherited from the rigidity of the surfactant molecules. The novel aggregates endow the solutions with remarkable viscoelasticity at very low concentrations, with a critical overlap concentration of 0.01 wt% and a critical gelling concentration of 0.58 wt%. The rheological behavior of the solutions also shows excellent shear resistance and weak sensitivity to temperature below the critical gelation temperature (Tgel). This work reveals the advantages of viscoelastic solutions containing flexible nanofibers. The design principles of new molecular structures and system compositions can be applied to the preparation of smart soft materials based on the self-assembly of molecules.
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High concentrations of surfactants or gelators are usually necessary to prepare emulsions gels with unusual physicochemical properties. This situation may be improved by innovating the aggregate morphology in systems. Herein, a rosin-based molecule is designed and synthesized using dehydroabietic acid as the starting material (denoted as R-Lys-R). The molecule acts as an effective organogelator and can gelate several hydrocarbon compounds with a minimum gelation concentration of 0.2% (w/v). Analysis using atomic force microscopy (AFM) and circular dichroism (CD) reveals that in n-decane, R-Lys-R forms left-handed helical fibers with a cross-sectional diameter of approximately 15 nm. The directional hydrogen bonding of the amide group is helpful to the formation of aggregates. At concentrations of R-Lys-R above 2%, water-in-oil emulsions are transformed into emulsion gels owing to the aptitude of R-Lys-R in gelating the oil phase. The concentrations of the emulsifier can be adjusted to obtain emulsion gels with different formulations. This work reveals the potential of rosin derivatives for the formation of small molecular weight organogels and provides a novel method for the utilization of natural resources in soft materials and home care products.
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A novel multi-responsive surfactant (abbreviated as N+-8P8-N) was synthesized, in which one octyl trimethylamine group (quaternary ammonium) and one octyl dimethylamine group are connected to a benzene ring through ether bonds. This novel surfactant can stabilize conventional oil-in-water (O/W) emulsions alone, and O/W Pickering emulsions and novel oil-in-dispersion emulsions together with oppositely and similarly charged nanoparticles, respectively. In all cases rapid demulsification can be achieved through either pH or CO2/N2 triggers, by which the surfactant is reversibly converted between a normal cationic surfactant form (N+-8P8-N) and a strongly hydrophilic and surface-inactive bola form (N+-8P8-NH+). Notably, the bola form N+-8P8-NH+ dissolves in the aqueous phase alone or together with nanoparticles after demulsification without contamination of the oil phase, and the aqueous phase can be recycled many times triggered by pH or CO2/N2 in accordance with the principle of green chemistry. This newly designed re-usable smart surfactant is significant for the development of various temporarily stable emulsions, which are extensively applied in emulsion polymerization, new material synthesis, heterogeneous catalysis and oil transportation.
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Few studies have assessed the association between perceived availability of home- and community-based services (HCBSs) and self-reported depression among Chinese older adults, which the present study attempts to rectify. This cross-sectional study enrolled 11,941 participants aged 65 and older from the Chinese Longitudinal Healthy Longevity Survey 2018 wave. The 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) was used to evaluate depression, and perceived availability was measured for four categories of HCBSs: daily life assistance, medical care services, emotional support and social services, and other. These four categories and the number of services in each were used to represent the perceived availability of service provision. Binary logistic models were used to explore the relationship between perceived availability of HCBSs and depression in older adults. Perceived daily life assistance was found to be negatively associated with depression symptoms among Chinese older adults in both urban and rural areas [rural: OR (95%CI) = 0.66 (0.55-0.78), p < 0.001; urban: OR (95% CI) = 0.69(0.60-0.79), p < 0.001], while perceived levels of medical care services, emotional support and social services, and other were not associated with depression symptoms in rural or urban areas. Our primary finding was that providing daily life assistance at the community level may help to meet more older adults' daily needs, thus potentially decreasing the risk of depression.
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Servicios de Salud Comunitaria , Depresión , Anciano , China/epidemiología , Estudios Transversales , Depresión/epidemiología , Humanos , AutoinformeRESUMEN
The morphology and physicochemical properties of ordered molecular aggregates are closely related to surfactant molecules. Herein, a rosin-based amine oxide surfactant containing a large hydrophobic group (abbreviated R-10-AO) was synthesized from dehydroabietic acid, which is an important derivative of rosin. Cryogenic transmission electron microscopy (cryo-TEM) images and small-angle X-ray scattering (SAXS) showed that at a concentration of â¼5 mM, R-10-AO molecules formed flexible nanobelts with a thickness of only 2-3 nm. The width of these nanobelts was 50-150 nm and the length was more than 1 µm. The formation of the stable nanobelts arose from the strong van der Waals forces of the bulky hydrophobic portions of R-10-AO in solution, facilitating the stability of the asymmetrical aggregates. Rheological tests showed that the formed nanobelts were thermodynamically stable. The entanglement of these nanobelts led to significant viscoelasticity of the solutions. The zero-shear viscosity (η0) of the R-10-AO solution reached 10 Pa s at a concentration of 5 mM, which is much greater than that of most wormlike micellar solutions. This work provides the inspirations of preparing aggregates with novel properties using natural products.
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Abietanos , Tensoactivos , Dispersión del Ángulo Pequeño , Difracción de Rayos XRESUMEN
Newly structured pH-responsive smart surfactants (N+ -(n)-N, n=14, 16) from alkyl trimethylammonium bromides are reported. In neutral and alkaline media N+ -(n)-N behaves as a normal cationic surfactant and stabilizes conventional emulsions alone, as well as Pickering emulsions and oil-in-dispersion emulsions together with oppositely and similarly charged nanoparticles, respectively. In acidic media N+ -(n)-N becomes a hydrophilic Bola-type surfactant, N+ -(n)-NH+ , and is an inferior emulsifier either when used alone or together with charged nanoparticles, resulting in demulsification. N+ -(n)-NH+ returns to the aqueous phase alone or together with nanoparticles after demulsification without contaminating the oil phase, and the aqueous phase can be recycled when triggered by pH change. This protocol is a green process and leads to preparation of various temporarily stable emulsions which are often used in emulsion polymerization, heterogeneous catalysis, and oil transportation.
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The transition between a novel oil-in-dispersion emulsion and an oil-in-water (O/W) Pickering emulsion triggered by pH was achieved using alumina nanoparticles in combination with a cationic surfactant. In acidic and neutral aqueous media, positively charged particles and the surfactant both at very low concentrations costabilize an oil-in-dispersion emulsion with the surfactant adsorbed at droplet interfaces and particles dispersed in the aqueous phase between the droplets. In alkaline media, however, particles become negatively charged and are hydrophobized in situ by adsorption of the surfactant to become surface-active and stabilize an O/W Pickering emulsion. The transition between the two is also possible by lowering the pH. The transformation can be achieved several times in a mixture of 0.1 wt % nanoparticles and 0.01 mM surfactant. This transition is significant, since particles can be made to either adsorb at the oil-water interface, which is beneficial for applications like biphasic catalysis, or remain dispersed in the aqueous phase, which is favorable for their recovery and reuse.
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Acrylamide is a potent carcinogen and neurotoxin that is mainly formed by the Maillard reaction of asparagine with starch at high temperatures. In this work, a food safety immobilization system for L-asparaginase (L-ASNase) consisting of food-grade agarose (Aga) spheres and N-hydroxysuccinimide esters was developed to decrease the formation of acrylamide in a fluid food model system. L-asparaginase was successfully immobilized with a maximum immobilization efficiency of 68.43%. The immobilized enzymes exhibited superior storage stability and reusability with 93.21 and 72.25% of the initial activity retained after six consecutive cycles and storage for 28 days, indicating its high industrial application potential. Meanwhile, a simplified mathematical model of the enzyme reactor was developed and verified with experiments, which demonstrated its auxiliary role in the design and optimization of reactors. In addition, simulated fluidized food components were continuously catalyzed in the designed packed bed reactor, achieving a reduction rate of nearly 89%.
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The rational combination of natural molecules is expected to provide new soft material building blocks. Herein, a rosin-based amino acid surfactant was synthesized using dehydroabietic acid and l-serine as the starting materials (denoted as R-6-Ser). Supramolecular hydrogels were formed when ß-cyclodextrin (ß-CD) was mixed with R-6-Ser at molar ratios of over 0.5:1 and above certain concentrations. The hydrogels were investigated using rheometry, small-angle X-ray scattering, CD spectroscopy, and cryo-transmission electron microscopy (cryo-TEM). The ß-CD associated with the isopropyl benzyl group of the dehydroabietic acid unit in R-6-Ser and formed R-6-Ser@ß-CD complexes. The complexes and R-6-Ser self-assembled to form elongated right-handed rigid fibers with a diameter of approximately 7-8 nm, which were responsible for the elasticity of the hydrogels. This work demonstrated the feasibility of preparing supramolecular hydrogels from a diterpenoid-based surfactant and ß-CD and provides a new means of utilizing the secretions of pine trees.