Yifan Huang

This study aimed to investigate and compare the longitudinal impacts of mandatory clinical ethics consultation (CEC) on resource use and ethical conflicts among critically ill neurologic and non-neurologic patients. It also sought to identify relevant predictive factors and determine family member satisfaction with CEC. This combined retrospective and prospective cohort study was conducted at a tertiary academic medical centre. During the eight-year study period, 1,150 adult patients participated in this study (437 neurological and 713 non-neurological). In both groups, the ICU length of stay and days of ventilator use significantly decreased each year. Secular trends in the incidence rates of ethical conflicts significantly decreased each year in neurological patients. Neurological patients exhibited a greater decrease in resource usage and significantly higher incidence rates of ethical conflicts than non-neurological patients. Family members of both groups expressed high levels of satisfaction and agreed that CEC was beneficial. In the local healthcare context, the implementation of CEC policies may reduce resource usage, ethical conflicts, and improve the knowledge base of CEC and clinical teams, helping them in approaching the distinct issues raised by various patient characteristics. However, these findings should be interpreted with caution as their applicability to other healthcare systems may vary.

Tracking patient preferences is vital to medical decision-making, but evidence suggests that the standard method for tracking the preferences of incapacitated or incompetent patients (ie, surrogates) is inaccurate. Recent proposals suggest that artificial intelligence preference predictors (AIPPs) can improve preference tracking for these patients, but have faced significant objections. While many of these objections depend on unsettled empirical or technical assumptions, one prominent objection—that AIPPs rely inappropriately on impersonal information—seems to be an in-principle challenge to AIPPs. In this paper, we show that even granting an implausibly strong version of this objection, AIPPs may provide value to clinical decision-making. To show this, we develop suggestions that AIPPs may support best interest decision-making (BIDM) by improving the accuracy, consistency and speed of BIDM, and show that the prevalence of BIDM in the intensive care unit (ICU) grants this application of AIPPs significant moral and practical consequence. This not only clears a path to improve BIDM but also establishes a safe harbour—a relatively uncontroversial yet impactful space—in which proponents may develop AIPPs sufficently to resolve empirical and technical questions about their potential. We conclude by highlighting key questions for the application of AIPPs to BI determinations, setting an agenda for the deeper examination of a largely overlooked application of these tools.

Due to their unique properties, copper-based nanopesticides are emerging in the market. Thus, understanding their effect on crop plants is very important. Metabolomics can capture a snapshot of cellular metabolic responses to a stressor. We selected maize and cucumber as model plants for exposure to different doses of Cu2 nanopesticide. GC-TOF-MS-based metabolomics was employed to determine the metabolic responses of these two species. Results revealed significant differences in metabolite profile changes between maize and cucumber. Furthermore, the Cu2 nanopesticide induced metabolic reprogramming in both species, but in different manners. In maize, several intermediate metabolites of the glycolysis pathway and tricarboxylic acid cycle were up-regulated, indicating the energy metabolism was activated. In addition, the levels of aromatic compounds and their precursors were enhanced, indicating the activation of shikimate-phenylpropanoid biosynthesis in maize leaves, which is an antioxidant defense-related pathway. In cucumber, arginine and proline metabolic pathways were the most significantly altered pathway. Both species exhibited altered levels of fatty acids and polysaccharides, suggesting the cell membrane and cell wall composition may change in response to Cu2 nanopesticide. Thus, metabolomics helps to deeply understand the differential response of these plants to the same nanopesticide stressor.

© 2016 American Chemical Society.Layered transition metal chalcogenides with large spin orbit coupling have recently sparked much interest due to their potential applications for electronic, optoelectronic, spintronics, and valleytronics. However, most current understanding of the electronic structure near band valleys in momentum space is based on either theoretical investigations or optical measurements, leaving the detailed band structure elusive. For example, the exact position of the conduction band valley of bulk MoS2 remains controversial. Here, using angle-resolved photoemission spectroscopy with submicron spatial resolution, we systematically imaged the conduction/valence band structure evolution across representative chalcogenides MoS2, WS2, and WSe2, as well as the thickness dependent electronic structure from bulk to the monolayer limit. These results establish a solid basis to understand the underlying valley physics of these materials, and also provide a link between chalcogenide electronic band structure and their physical properties for potential valleytronics applications.

Previous studies have shown that changes in gray matter density and volume in the left primary motor cortex are significantly associated with changes in individuals’ verbal intelligence quotient, but not with their performance intelligence quotient. In the present study, we examined the effects of transcranial direct current stimulation over the left primary motor cortex on performance in intelligence tests. We chose four subtests of the Wechsler Adult Intelligence Scale-Chinese Revised version and randomized participants into anodal, cathodal, and sham groups. We found that anodal stimulation significantly improved performance in verbal intelligence subtests compared to cathodal and sham stimulation, while performance intelligence subtest scores did not change in any stimulation condition. These findings suggest that the excitation level of the left primary motor cortex has a unique effect on verbal intelligence.