How to promote the hierarchical diagnosis and treatment system: A tripartite evolutionary game theory perspective.

Due to the disorderly access to medical care and inefficient use of health resources, the advancement of the hierarchical diagnosis and treatment is more valued in promoting health system reform. Hence, this article integrates prospect theory into an evolutionary game model of the local government health departments, the medical institutions, and the patients in the system promotion of the hierarchical diagnosis and treatment. The simulation shows the specific influencing mechanism of the psychological perceived value of game subjects. Then by introducing the stochastic evolutionary game model, the system promotion under different medical cultures is also discussed in detail. The results indicate that for local government health departments, the amount and duration of financial subsidies are the key factors influencing the game system's evolution. For medical institutions, participating in the hierarchical diagnosis and treatment system is relatively beneficial. For patients, the recovery rate in primary hospitals matters more than the cost of treatment. Changes in the risk sensitivity coefficient will cause the equilibrium of the game system to change. However, changes in the loss avoidance factor do not change the equilibrium and only have an impact on the speed of convergence. With the health departments' intervention, patients in rural medical culture are more inclined to support the hierarchical diagnosis and treatment system than those in urban or town medical culture. Therefore, in order to promote the hierarchical diagnosis and treatment system, this article recommends that more attention should be paid to the regulatory role of health departments and the participation improvement of medical institutions and patients.

N-Doped Hierarchically Porous CNT@C Membranes for Accelerating Polysulfide Redox Conversion for High-Energy Lithium-Sulfur Batteries.

To improve the structural design of electrodes and interlayers for practical applications of Li-S batteries, we report two scalable porous CNT@C membranes for high-energy Li-S batteries. The asymmetric CNT@C (1:2) membrane with both dense and macroporous layers can act as an Al-free cathode for current collection and high sulfur loading, while the symmetric CNT@C (1:1) membrane with hierarchically porous networks can be used as an interlayer to trap lithium polysulfides (LiPSs), thus weakening the shuttle effect by strong adsorption of the N atoms toward LiPSs. The doped N sites in carbon membranes are identified as bifunctional active centers that electrocatalytically accelerate the oxidation of Li2S and polysulfide conversion. First-principles calculations reveal that the pyridinic and pyrrolic N sites exhibit favorable reactivity for strong adsorption/dissociation of polysulfide species. They lead to greatly reduced energy and kinetic barrier for polysulfide conversion without weakening the polysulfide adsorption on the membrane. Using the synergistic circulation groove with the two membranes, the practical S loading can be tailored from 1.2 to 6.1 mg cm-2. The Li-S battery can deliver an areal capacity of 4.6 mA h cm-2 (684 mA h g-1) at 0.2 C even at an ultrahigh S loading of 6.1 mg cm-2 and a lean electrolyte to sulfur ratio of 5.3 µL mg-1. Our work for scalable membrane fabrication and structural design provides a promising strategy for practical applications of high-energy Li-S batteries.

Triple-Layered Carbon-SiO2 Composite Membrane for High Energy Density and Long Cycling Li-S Batteries.

Here we report a highly scalable yet flexible triple-layer structured porous C/SiO2 membrane via a facile phase inversion method for advancing Li-sulfur battery technology. As a multifunctional current-collector-free cathode, the conductive dense layer of the C/SiO2 membrane offers hierarchical macropores as an ideal sulfur host to alleviate the volume expansion of sulfur species and facilitate ion/electrolyte transport for fast kinetics, as well as spongelike pores to enable high sulfur loading. The triple-layer structured membrane cathode enables the filling of most sulfur species in the macropores and additional loading of a thin sulfur slurry on the membrane surface, which facilitates ion/electrolyte transport with faster kinetics than the conventional S/C slurry-based cathode. Furthermore, density functional theory simulations and visual adsorption measurements confirm the critical role of the doped SiO2 nanoparticles (∼10 nm) in the asymmetric C membrane in suppressing the shuttle effect of polysulfides via chemisorption and electrocatalysis. The rationally designed C/SiO2 membrane cathodes demonstrate long-term cycling stability of 300 cycles at a high sulfur loading of 2.8 mg cm-2 with a sulfur content of ∼75%. This scalable yet flexible self-supporting cathode design presents a useful strategy for realizing practical applications of high-performance Li-S batteries.

Multishelled Transition Metal-Based Microspheres: Synthesis and Applications for Batteries and Supercapacitors.

With the rapid growth of material innovations, multishelled hollow nanostructures are of tremendous interest due to their unique structural features and attractive physicochemical properties. Continued effort has been made in the geometric manipulation, composition complexity, and construction diversity of this material, expanding its applications. Energy storage technology has benefited from the large surface area, short transport path, and excellent buffering ability of the nanostructures. In this work, the general synthesis of multishelled hollow structures, especially with architecture versatility, is summarized. A wealth of attractive properties is also discussed for a wide area of potential applications based on energy storage systems, including Li-ion/Na-ion batteries, supercapacitors, and Li-S batteries. Finally, the emerging challenges and outlook for multishelled hollow structures are mentioned.

Novel Triple Tertiary Amine Polymer-Based Hydrogen Bond Network Inducing Highly Efficient Proton-Conducting Channels of Amphoteric Membranes for High-Performance Vanadium Redox Flow Battery.

A novel amphoteric membrane was designed by blending triple tertiary amine-grafted poly(2,6-dimethyl-1,4-phenylene oxide) (PPO-TTA) with sulfonated poly(ether ether ketone) (SPEEK) for vanadium redox flow batteries. An "acid-base pair" effect is formed by the combination of the tertiary amine group and sulfonic group, and extra nonbonding amine groups could be protonated. Both of them constitute a hydrogen bond network, which facilitates proton conduction and also hinders vanadium permeability because of the lowered swelling ratio and Donnan effect. All these contribute to improve the ion selectivity of the membrane while maintaining ionic conductivity. Compared with other amphoteric and SPEEK-based membranes, the membrane exhibits an excellent performance. The amphoteric membrane containing 15% PPO-TTA exhibits an ultralow vanadium permeability of 3.4 × 10-9 cm2 s-1 and a low area resistance of 0.39 Ω cm-2. Consequently, the cell assembled with this membrane shows excellent performances far superior to SPEEK and Nafion 212. The Coulombic efficiency and energy efficiency of the cell are 94.3-98.3 and 90.3-77.1% at 40-200 mA cm-2, respectively, and have no significant reductions after 200 cycles. This performance is at a high level among the amphoteric and SPEEK-based membranes reported in recent years. The cell's open circuit voltage is maintained for up to 165 h. In addition, the membrane's chemical stability is improved by the effective barrier to the vanadium ion.

Interpenetrated Networks between Graphitic Carbon Infilling and Ultrafine TiO2 Nanocrystals with Patterned Macroporous Structure for High-Performance Lithium Ion Batteries.

Interpenetrated networks between graphitic carbon infilling and ultrafine TiO2 nanocrystals with patterned macropores (100-200 nm) were successfully synthesized. Polypyrrole layer was conformably coated on the primary TiO2 nanoparticles (∼8 nm) by a photosensitive reaction and was then transformed into carbon infilling in the interparticle mesopores of the TiO2 nanoparticles. Compared to the carbon/graphene supported TiO2 nanoparticles or carbon coated TiO2 nanostructures, the carbon infilling would provide a conductive medium and buffer layer for volume expansion of the encapsulated TiO2 nanoparticles, thus enhancing conductivity and cycle stability of the C-TiO2 anode materials for lithium ion batteries (LIBs). In addition, the macropores with diameters of 100-200 nm in the C-TiO2 anode and the mesopores in carbon infilling could improve electrolyte transportation in the electrodes and shorten the lithium ion diffusion length. The C-TiO2 electrode can provide a large capacity of 192.8 mA h g-1 after 100 cycles at 200 mA g-1, which is higher than those of the pure macroporous TiO2 electrode (144.8 mA h g-1), C-TiO2 composite electrode without macroporous structure (128 mA h g-1), and most of the TiO2 based electrodes in the literature. Importantly, the C-TiO2 electrode exhibits a high rate performance and still delivers a high capacity of ∼140 mA h g-1 after 1000 cycles at 1000 mA g-1 (∼5.88 C), suggesting good lithium storage properties of the macroporous C-TiO2 composites with high capacity, cycle stability, and rate capability. This work would be instructive for designing hierarchical porous TiO2 based anodes for high-performance LIBs.

Multishelled NiO Hollow Microspheres for High-performance Supercapacitors with Ultrahigh Energy Density and Robust Cycle Life.

Multishelled NiO hollow microspheres for high-performance supercapacitors have been prepared and the formation mechanism has been investigated. By using resin microspheres to absorb Ni(2+) and subsequent proper calcinations, the shell numbers, shell spacing and exterior shell structure were facilely controlled via varying synthetic parameters. Particularly, the exterior shell structure that accurately associated with the ion transfer is finely controlled by forming a single shell or closed exterior double-shells. Among multishelled NiO hollow microspheres, the triple-shelled NiO with an outer single-shelled microspheres show a remarkable capacity of 1280 F g(-1) at 1 A g(-1), and still keep a high value of 704 F g(-1) even at 20 A g(-1). The outstanding performances are attributed to its fast ion/electron transfer, high specific surface area and large shell space. The specific capacitance gradually increases to 108% of its initial value after 2500 cycles, demonstrating its high stability. Importantly, the 3S-NiO-HMS//RGO@Fe3O4 asymmetric supercapacitor shows an ultrahigh energy density of 51.0 Wh kg(-1) at a power density of 800 W kg(-1), and 78.8% capacitance retention after 10,000 cycles. Furthermore, multishelled NiO can be transferred into multishelled Ni microspheres with high-efficient H2 generation rate of 598.5 mL H2 min(-1) g(-1)Ni for catalytic hydrolysis of NH3BH3 (AB).

Wavelength-tunable photoconductivity of dye-sensitized TiO2 nanoparticle films.

We report in this Letter that wavelength-tunable photodetectors (PDs) can be fabricated by dye-sensitized TiO2 nanoparticle film. The photoelectric response of the detectors is fast. The photocurrent intensity strongly depends on the absorption wavelength of the dye; thus the on/off ratio as a function of light wavelength can be tuned by absorbing different dye molecules. The corresponding mechanism is also discussed. The principle reported in this Letter can be used to fabricate full spectrum PDs with distinctive wavelength selectivity.

CT finding is an index in assessment of outcome in patients with diffuse traumatic brain swelling.

OBJECTIVE: To assess the relationship between the prognosis of the patients with diffuse traumatic brain swelling (DTBS) and the changes of the ventricles and the cisterns in CT scans. METHODS: The outcome of the patients with DTBS and the changes of the ventricles and the cisterns in CT scans were studied and analyzed in a group of 268 cases. We focused on the changes of the third ventricle and the basal cistern, age and Glasgow Coma Scale (GCS). RESULTS: Of 268 cases, there were changes of the third ventricle and/or the basal cistern in 124, 65 died. In l8 cases, the third ventricle and the basal cistern were both absent and l6 died (88.9%). The third ventricle changed significantly in 59 cases, 33 died (55.9%), while the basal cistern changed in 47 cases and 16 died (34%). Of the 124 patients with changes of the third ventricle and/or the basal cistern, 26 were children, 8 died; 98 adults, 57 died. CONCLUSIONS: For patients with DTBS, the outcome was in direct correlation with the change of the third ventricle and/or the basal cistern, the change of the third ventricle was much more important in assessment of the outcome than that of basal cisterns. There is no significant difference in, the incidence of DTBS between children and adults while the outcome of children is much better than that of adults. The patients with the changes of the third ventricle and the basal cistern accompanied with lower GCS scores have poor outcome.