In the present study, a facile in situ approach for constructing tunable amphiphilic or hydrophilic antifouling membrane surfaces was demonstrated by exquisitely manipulating the microphase separation and surface segregation behavior of the tailor-made ternary amphiphilic block copolymers during the commonly utilized wet phase inversion membrane-formation process. Under dead-end filtration for oily wastewater treatment, the membrane with amphiphilic surface exhibited over 99.5% retention ratio of chemical oxygen demand (COD) without appreciable membrane fouling: the water permeation flux was slightly decreased during operation (total flux decline was 6.8%) and almost completely recovered to the initial value (flux recovery ratio was more than 99.0%) after simple hydraulic washing. While for the proteins-containing wastewater treatment, the membrane with hydrophilic surface exhibited about 52.6% COD retention ratio and superior antifouling performance: only 17.0% total flux decline and also more than 99.0% flux recovery ratio. Hopefully, the present approach can be developed as a competitive platform technology for the preparation of robust and versatile antifouling membrane, leading to the high process efficiency of wastewater treatments.

The first total synthesis of an arcutine-type C20-diterpenoid alkaloid arcutinine has been achieved in both racemic and asymmetric forms. Construction of the C4 quaternary center and the pyrrolidine E ring in an early stage proved to be important for achieving the successful synthesis of the target alkaloid. Strategically, an asymmetric conjugate addition/aldol cascade and a decarboxylative allylation reaction allowed the establishment of the vicinal all-carbon quaternary stereocenters at C4 and C5. Furthermore, a sequence consisting of an intramolecular aza-Wacker cyclization, an oxidative dearomatization/intramolecular Diels–Alder cycloaddition cascade, and a ketyl-olefin cyclization enabled the assembly of the core structure and led to the total synthesis of arcutinine.

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ObjectivesIn China, the rate of downward referral is relatively low, as most people are unwilling to be referred from hospitals to community health systems (CHSs). The aim of this study was to explore the effect of doctors' and patients' practices and attitudes on their willingness for downward referral and the relationship between downward referral and sociodemographic characteristics.MethodsDoctors and patients of 13 tertiary hospitals in Shanghai were stratified through random sampling. The questionnaire surveyed their sociodemographic characteristics, attitudes towards CHSs and hospitals, understanding of downward referral, recognition of the community first treatment system, and downward referral practices and willingness. Descriptive statistics, χ2 test and stepwise logistic regression analysis were employed for statistical analysis.ResultsOnly 20.8% (161/773) of doctors were willing to accept downward referrals, although this proportion was higher among patients (37.6%, 326/866). Doctors' willingness was influenced by education, understanding of downward referral, and perception of health resources in hospitals. Patients' willingness was influenced by marital status, economic factors and recognition of the community first treatment system. Well-educated doctors who do not consider downward referral would increase their workloads and those with a more comprehensive understanding of hospitals and downward referral process were more likely to make a downward referral decision. Single-injury patients fully recognising the community first treatment system were more willing to accept downward referral. Patients' willingness was significantly increased if downward referral was cost-saving. A better medical insurance system was another key factor for patients to accept downward referral decisions, especially for the floating population.ConclusionsTo increase the rate of downward referral, the Chinese government should optimise the current referral system and conduct universal publicity for downward referral. Doctors and patients should promote understandings of downward referral. Hospitals should realise the necessity of downward referral, effectively reduce workloads and provide continuing education for doctors. Increasing monetary reimbursement is urgent, as is improving the medical insurance system.