Silvermankelley4668

Variation in outcomes of patients with community acquired pneumonia (CAP) has been reported in some, but not all, studies. Although some variation is expected, unwarranted variation in healthcare impacts patient outcomes and equity of care. The aim of this systematic review was to i) summarise current evidence on regional and inter-hospital variation in the clinical outcomes and process of care measures of patients hospitalised with CAP and ii) assess the strength of this evidence.

Databases were systematically searched from inception to February 2018 for relevant studies and data independently extracted by two investigators in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Included studies enrolled adults hospitalised with CAP and reported a measure of variation between two or more units in healthcare outcomes or process of care measures. Outcomes of interest were mortality, length of hospital stay (LOS) and re-admission rates. A structured syntidence of moderate quality for significant variation in length of stay and process of care measures but not for in-patient mortality or hospital re-admission. Evidence linking variation in outcomes with variation in process of care measures was limited; where present no difference in mortality was detected despite POC variation. Adjustment for natural variation within studies was lacking; the proportion of observed variation due to chance is not quantified by existing evidence.

There is consistent evidence of moderate quality for significant variation in length of stay and process of care measures but not for in-patient mortality or hospital re-admission. Evidence linking variation in outcomes with variation in process of care measures was limited; where present no difference in mortality was detected despite POC variation. selleck chemicals llc Adjustment for natural variation within studies was lacking; the proportion of observed variation due to chance is not quantified by existing evidence.Morphological stability is crucially important for the long-term stability of polymer solar cells (PSCs). Many high-efficiency PSCs suffer from metastable morphology, resulting in severe device degradation. Here, a series of copolymers is developed by manipulating the content of chlorinated benzodithiophene-4,8-dione (T1-Cl) via a random copolymerization approach. It is found that all the copolymers can self-assemble into a fibril nanostructure in films. By altering the T1-Cl content, the polymer crystallinity and fibril width can be effectively controlled. link2 When blended with several nonfullerene acceptors, such as TTPTT-4F, O-INIC3, EH-INIC3, and Y6, the optimized fibril interpenetrating morphology can not only favor charge transport, but also inhibit the unfavorable molecular diffusion and aggregation in active layers, leading to excellent morphological stability. The work demonstrates the importance of optimization of fibril network morphology in realizing high-efficiency and ambient-stable PSCs, and also provides new insights into the effect of chemical structure on the fibril network morphology and photovoltaic performance of PSCs.Neural networks based on memristive devices have achieved great progress recently. However, memristive synapses with nonlinearity and asymmetry seriously limit the classification accuracy. Moreover, insufficient number of training samples in many cases also have negative effect on the classification accuracy of neural networks due to overfitting. In this work, dropout neuronal units are developed based on stochastic volatile memristive devices of Ag/Ta2O5Ag/Pt. The memristive neural network using the dropout neuronal units effectively solves the problem of overfitting and mitigates the negative effects of the nonideality of memristive synapses, eventually achieves a classification accuracy comparable to the theoretical limit. The stochastic and volatile switching performances of the Ag/Ta2O5Ag/Pt device are attributed to the stochastical rupture of the Ag filament under high electrical stress in the Ta2O5 layer, according to the TEM observation and the kinetic Monte Carlo simulation.In the last decade, organoid technology has developed as a primary research tool in basic biological and clinical research. The reliance on poorly defined animal-derived extracellular matrix, however, severely limits its application in regenerative and translational medicine. Here, a well-defined, synthetic biomimetic matrix based on polyisocyanide (PIC) hydrogels that support efficient and reproducible formation of mammary gland organoids (MGOs) in vitro is presented. Only decorated with the adhesive peptide RGD for cell binding, PIC hydrogels allow MGO formation from mammary fragments or from purified single mammary epithelial cells. The cystic organoids maintain their capacity to branch for over two months, which is a fundamental and complex feature during mammary gland development. It is found that small variations in the 3D matrix give rise to large changes in the MGO the ratio of the main cell types in the MGO is controlled by the cell-gel interactions via the cell binding peptide density, whereas gel stiffness controls colony formation efficiency, which is indicative of the progenitor density. Simple hydrogel modifications will allow for future introduction and customization of new biophysical and biochemical parameters, making the PIC platform an ideal matrix for in depth studies into organ development and for application in disease models.Surfaces with tunable liquid adhesion have aroused great attention in past years. However, it remains challenging to endow a surface with the capability of droplet recognition and transportation. Here, a bioinspired surface, termed as TMAS, is presented that is inspired by isotropic lotus leaves and anisotropic butterfly wings. The surface is prepared by simply growing a triangular micropillar array on the pre-stretched thin poly(dimethylsiloxane) (PDMS) film. The regulation of mechanical stress in the PDMS film allows the fine tuning of structural parameters of the micropillar array reversibly, which results in the instantaneous, in situ switching between isotropic and various degrees of anisotropic droplet adhesions, and between strong adhesion and directional sliding of water droplets. TMAS can thus be used for robust droplet transportation and recognition of acids, bases, and their pH strengths. The results here could inspire the design of robust sensor techniques.Radiation therapy is one of the most prevalent procedures for cancer treatment, but the risks of malignancies induced by peripheral beam in healthy tissues surrounding the target is high. Therefore, being able to accurately measure the exposure dose is a critical aspect of patient care. Here a radiation detector based on an organic field-effect transistor (RAD-OFET) is introduced, an in vivo dosimeter that can be placed directly on a patient's skin to validate in real time the dose being delivered and ensure that for nearby regions an acceptable level of low dose is being received. This device reduces the errors faced by current technologies in approximating the dose profile in a patient's body, is sensitive for doses relevant to radiation treatment procedures, and robust when incorporated into conformal large-area electronics. A model is proposed to describe the operation of RAD-OFETs, based on the interplay between charge photogeneration and trapping.Geometric metasurfaces primarily follow the physical mechanism of Pancharatnam-Berry (PB) phases, empowering wavefront control of cross-polarized reflective/transmissive light components. However, inherently accompanying the cross-polarized components, the copolarized output components have not been attempted in parallel in existing works. Here, a general method is proposed to construct phase-modulated metasurfaces for implementing functionalities separately in co- and cross-polarized output fields under circularly polarized (CP) incidence, which is impossible to achieve with solely a geometric phase. By introducing a propagation phase as an additional degree of freedom, the electromagnetic (EM) energy carried by co- and cross-polarized transmitted fields can be fully phase-modulated with independent wavefronts. Under one CP incidence, a metasurface for separate functionalities with controllable energy repartition is verified by simulations and proof-of-principle microwave experiments. A variety of applications can be readily expected in spin-selective optics, spin-Hall metasurfaces, and multitasked metasurfaces operating in both reflective and transmissive modes.Hydrogels are excellent mimetics of mammalian extracellular matrices and have found widespread use in tissue engineering. Nanoporosity of monolithic bulk hydrogels, however, limits mass transport of key biomolecules. Microgels used in 3D bioprinting achieve both custom shape and vastly improved permissivity to an array of cell functions, however spherical-microbead-based bioinks are challenging to upscale, are inherently isotropic, and require secondary crosslinking. Here, bioinks based on high-aspect-ratio hydrogel microstrands are introduced to overcome these limitations. Pre-crosslinked, bulk hydrogels are deconstructed into microstrands by sizing through a grid with apertures of 40-100 µm. The microstrands are moldable and form a porous, entangled structure, stable in aqueous medium without further crosslinking. Entangled microstrands have rheological properties characteristic of excellent bioinks for extrusion bioprinting. Furthermore, individual microstrands align during extrusion and facilitate the alignment of myotubes. Cells can be placed either inside or outside the hydrogel phase with >90% viability. Chondrocytes co-printed with the microstrands deposit abundant extracellular matrix, resulting in a modulus increase from 2.7 to 780.2 kPa after 6 weeks of culture. This powerful approach to deconstruct bulk hydrogels into advanced bioinks is both scalable and versatile, representing an important toolbox for 3D bioprinting of architected hydrogels.The newest generation of cell-based technologies relies heavily on methods to communicate to the engineered cells using artificial receptors, specifically to deactivate the cells administered to a patient in the event of adverse effects. Herein, artificial synthetic internalizing receptors are engineered that function in mammalian cells in 2D and in 3D and afford targeted, specific intracellular drug delivery with nanomolar potency in the most challenging cell type, namely primary, donor-derived T cells. Receptor design comprises a lipid bilayer anchor for receptor integration into cell membrane and a small xenobiotic molecule as a recognition ligand. link3 Artificial receptors are successfully targeted by the corresponding antibody-drug conjugate (ADC) and exhibit efficient cargo cell entry with ensuing intracellular effects. Receptor integration into cells is fast and robust and affords targeted cell entry in under 2 h. Through a combination of the receptor design and the use of ADC, combined benefits previously made available by chimeric artificial receptors (performance in T cells) and the chemical counterpart (robustness and simplicity) in a single functional platform is achieved. Artificial synthetic receptors are poised to facilitate the maturation of engineered cells as tools of biotechnology and biomedicine.