Impact of blended treatment literacy and psychoeducation on methadone maintenance treatment outcomes in Yunnan, China

Background: Outcomes of methadone maintenance treatment (MMT) in the management of opioid dependency can be impaired by poor adherence and retention, concomitant drug use, poor adjustment of methadone dosage, and low levels of awareness regarding methadone among drug users, among other factors. This study investigated the effects of intensive blended treatment literacy and psychoeducation on treatment compliance, methadone dose, and heroin use among MMT clients in China. Methods: A total of 492 MMT clients who tested positive for urine morphine at least once during a 12-week intervention period preceding the study were recruited from 16 MMT clinics. Employing a client-centred approach, a blended treatment literacy and psychoeducation intervention was then implemented between March and June 2014, comprising (1) intensified methadone treatment literacy sessions; (2) participatory goal setting; (3) continuous adherence monitoring and support; and (4) engagement of both peers and doctors in delivering psychoeducation. Wilcoxon signed-rank test was used to compare urine morphine positive rates, daily methadone dosage, and the number of days that clients successfully accessed methadone before and during the intervention. Results: During the intervention, urine morphine positive rates reduced to 27 % from 49.3 % previously; p < 0.001. In response to client needs, methadone dosages increased among 74 % of participants, remained unchanged among 12.0 %, and reduced among 13.4 % during the intervention. In addition, the average daily methadone dose increased from 63.0 to 72.6 mg; p < 0.001, while the average number of days that clients successfully accessed methadone increased from 69.4 to 73.9 over a period of 12 weeks; p < 0.001. Conclusions: Blended treatment literacy and psychoeducation delivered by a combination of peers and doctors was associated with reduced heroin use, improved treatment adherence, and higher methadone doses among our sample of MMT clients

Robust self-propulsion in sand using simply controlled vibrating cubes

Much of the Earth and many surfaces of extraterrestrial bodies are composed of in-cohesive particle matter. Locomoting on granular terrain is challenging for common robotic devices, either wheeled or legged. In this work, we discover a robust alternative locomotion mechanism on granular media -- generating movement via self-vibration. To demonstrate the effectiveness of this locomotion mechanism, we develop a cube-shaped robot with an embedded vibratory motor and conduct systematic experiments on diverse granular terrains of various particle properties. We investigate how locomotion changes as a function of vibration frequency/intensity on granular terrains. Compared to hard surfaces, we find such a vibratory locomotion mechanism enables the robot to move faster, and more stable on granular surfaces, facilitated by the interaction between the body and surrounding granules. The simplicity in structural design and controls of this robotic system indicates that vibratory locomotion can be a valuable alternative way to produce robust locomotion on granular terrains. We further demonstrate that such cube-shape robots can be used as modular units for morphologically structured vibratory robots with capabilities of maneuverable forward and turning motions, showing potential practical scenarios for robotic systems

"Who has ever loved a drug addict? It's a lie. They think a 'teja' is as bad person": multiple stigmas faced by women who inject drugs in coastal Kenya.

BACKGROUND: A tenth of all people who inject drugs in Kenya are women, yet their social contexts and experiences remain poorly understood. This paper reports how multiple forms of stigma are experienced by women who inject drugs in coastal Kenya and the impact that they have on their ability to access essential health services. METHODS: In 2015, in-depth interviews and focus group discussions were held with 45 women who inject drugs in two coastal towns. These data were supplemented with in-depth interviews with five individual stakeholders involved in service provision to this population. Data were analyzed thematically using NVivo. RESULTS: Women who inject drugs experience multiple stigmas, often simultaneously. These included the external stigma and self-stigma of injection drug use, external gender-related stigma of being a female injecting drug user, and the external stigma of being HIV positive (i.e., among those living with HIV). Stigma led to rejection, social exclusion, low self-esteem, and delay or denial of services at health facilities. CONCLUSION: HIV and harm reduction programs should incorporate interventions that address different forms of stigma among women who inject drugs in coastal Kenya. Addressing stigma will require a combination of individual, social, and structural interventions, such as collective empowerment of injecting drug users, training of healthcare providers on issues and needs of women who inject drugs, peer accompaniment to health facilities, addressing wider social determinants of stigma and discrimination, and expansion of harm reduction interventions to change perceptions of communities towards women who inject drugs

Quantity Flexibility Contract Model for Emergency Procurement Considering Supply Disruption

Supply chain disruption risk usually poses a serious challenge to the management of emergency supplies procurement between the government and enterprises in cooperation. To research the impact of supply chain disruption on the supply and demand sides of emergency supplies for disaster relief, the emergency procurement model based on quantity flexibility contract is constructed. The model introduces a stockout disruption to measure the degree of supply chain disruption and uses per unit of material relief value to quantify government disaster relief benefits. Further, it analyzes the basic pricing strategy and the agreed order quantity between the government and enterprises, focusing on the negative impact of supply disruption on the government and enterprises. The model deduction and data analysis results show that supply disruption creates a “lose-lose” situation for governments and enterprises, reducing their benefits and willingness to cooperate. Finally, a sensitivity analysis is conducted on the case data to explain the decision-making changes in the contract price and flexibility parameters between the government and enterprises before and after the supply disruption

Understanding willingness to use oral pre-exposure prophylaxis for HIV prevention among men who have sex with men in China.

BACKGROUND: Oral pre-exposure prophylaxis (PrEP) is recommended as an additional prevention choice for men who have sex with men (MSM) at substantial risk of HIV. The aim of this study was to evaluate the extent, and reasons, for MSM's willingness to use oral PrEP in Wuhan and Shanghai, China. METHODS: Between May and December 2015, a cross-sectional survey was conducted among 487 MSM recruited through snowball sampling in physical locations frequented by MSM and through social media applications. Exploratory factor analysis was used to group reasons for being willing or not willing to use PrEP. Chi-square tests were used to explore bivariate associations between groupings of reasons for being willing or unwilling to use PrEP, and key sociodemographic and sexual-behavioral characteristics of MSM. RESULTS: Overall, 71.3% of respondents were willing to use PrEP. The most commonly reported reasons for being willing to use PrEP were preventing HIV infection (91.6%), taking responsibility for own sexual health (72.6%) and protecting family members from harm (59.4%). The main reasons for being unwilling to use PrEP were being worried about side effects (72.9%), the necessity of taking PrEP for long periods of time (54.3%) and cost (40.4%). Individual characteristics that influenced the type of reasons given for being willing or unwilling to use PrEP included being married to a woman, having a regular sex partner, rates of condom use with regular and casual sex partners, and the number of casual sex partners. CONCLUSION: The introduction of PrEP in China could benefit from promotion campaigns that emphasize its role in preventing HIV infection, in taking responsibility for own sexual health, and in protecting family members from potential harm. To reduce uptake barriers, it will be essential to provide accurate information to potential PrEP users about the mild and short-term nature of side effects, and the possibility of taking PrEP only during particular periods of life when the risk of HIV exposure might be highest

Barriers and facilitators of access to HIV, harm reduction and sexual and reproductive health services by women who inject drugs:role of community-based outreach and drop-in centers

There is limited data regarding women who inject drugs, and how harm-reduction services can be made more women-centered. This study explored experiences of Kenyan women who inject drugs, with regard to access to HIV, harm reduction and sexual and reproductive health (SRH) services. A total of 45 women who inject drugs and 5 key stakeholders participated in-depth interviews and focus group discussions. Thematic analysis of the data revealed that stigma, long distances, lack of confidentiality, user fees, multiple appointments, drug users’ unfamiliarity with health facilities, disconnect in communication with healthcare providers, and healthcare providers’ lack of understanding of women’s needs were factors that impede women’s access to health services. Community-based services, comprising of outreach and drop-in centers mitigate these barriers by building trust, educating women on their health and rights, linking women to health facilities, sensitizing health providers on the needs of women who inject drugs, and integrating women’s SRH services into community-based harm-reduction outreach. Inclusion of SRH services into community-based harm-reduction activities increased women’s interest and access to harm-reduction interventions. These findings underscore the need to strengthen community-based programming for women who inject drugs, and to integrate SRH services into needle and syringe exchange programs

Retention and mortality outcomes from a community-supported public–private HIV treatment programme in Myanmar

Introduction: There is a growing interest in the potential contribution the private sector can make towards increasing access to antiretroviral therapy (ART) in low- and middle-income settings. This article describes a public–private partnership that was developed to expand HIV care capacity in Yangon, Myanmar. The partnership was between private sector general practitioners (GPs) and a community-based non-governmental organization (International HIV/AIDS Alliance). Methods: Retrospective analysis of 2119 patient records dating from March 2009 to April 2015 was conducted. Outcomes assessed were immunological response, loss to follow-up, all-cause mortality, and alive and retained in care. Follow-up time was calculated from the date of registration to the date of death, loss to follow-up, transfer out, or if still alive and known to be in care, until April 2015. Cox proportional hazards model was used to identify predictors of loss to follow-up and mortality. Kaplan–Meier survival analysis was used to estimate survival function of being alive and retained in care. Results: The median number of patients for each of the 16 GPs was 42 (interquartile range (IQR): 25–227), and the median follow-up period was 13 months. The median patient age was 35 years (IQR: 30–41); 56.6% were men, 62 and 11.8% were in WHO Stage III and Stage IV at registration, respectively; median CD4 count at registration was 177 cells/mm3; and 90.7% were on ART in April 2015. The median CD4 count at registration increased from 122 cells/mm3 in 2009 to 194 cells/mm3 in 2014. Among patients on ART, CD4 counts increased from a median of 187 cells/mm3 at registration to 436 cells/mm3 at 36 months. The median time to initiation of ART among eligible patients was 29 days, with 93.8% of eligible patients being initiated on ART within 90 days. Overall, 3.3% patients were lost to follow-up, 4.2% transferred out to other health facilities, and 8.3% died during the follow-up period. Crude mortality rate was 48.6/1000 person-years; 42% (n=74) of deaths occurred during the pre-ART period and 39.8% (n=70) occurred during the first six months of ART. Of those who died during the pre-ART period, 94.5% were eligible for ART. In multivariate regression, baseline CD4 count and ART status were independent predictors of mortality, whereas ART status, younger age and patient volumes per provider were predictors of loss to follow-up. Probability of being alive and retained in care at six months was 96.8% among those on ART, 38.5% among pre-ART but eligible patients, and 20.0% among ART-ineligible patients. Conclusions: Effectively supported private sector GPs successfully administered and monitored ART in Myanmar, suggesting that community-supported private sector partnerships can contribute to expansion of HIV treatment and care capacity. To further improve patient outcomes, early testing and initiation of ART, combined with close clinical monitoring and support during the initial periods of enrolling in treatment and care, are required

Empirical analysis on fluctuation of pork price in China

Conference Name:2012 2nd International Conference on Consumer Electronics, Communications and Networks, CECNet 2012. Conference Address: Three Gorges, China. Time:April 21, 2012 - April 23, 2012.IEEEThe paper analyzes on fluctuation of pork price by presenting the VAR model and Impulse Response Function based on monthly data of the pork market from 2007 to 2011 in China. We impose our own interpretations on this problem and draw conclusions as follows: The fluctuation of pork price is not caused by the cost of pig breeding and circulation. External shocks especially epidemic outbreaks are the main reason. And the low degree of pig breeding organization has exacerbated the fluctuation of pork price. Therefore, in order to stabilize the supply of hogs to prevent large fluctuation of pork price, the government should pay special attention to epidemic surveillance and perfect the agricultural insurance system. With the long-term sight, the degree of organization of the pig breeding must be increased through encouraging large-scale breeding and promoting co-operative development of backyard farmers. 漏 2012 IEEE

Research on Efficiency of Physical Capital and Human Capital in China's Economic Growth

Conference Name:3rd International Conference on Manufacturing Science and Engineering (ICMSE 2012). Conference Address: Xiamen, PEOPLES R CHINA. Time:MAR 27-29, 2012.Research on economic growth in the past concerns only with physical capital and human capital in the absolute amount of effects at the expense of the efficiency of the present situation, we use the 1981-2008 China's annual time-series data, with uniform measurement to build econometric models to study China's economic growth in the efficiency of physical capital and human capital. Our research results indicate that in the long term, human capital is of much higher output efficiency than physical capital; In the short term, increased input ratio of human capital causes average labour output to grow sustainably, and increased input ratio of physical capital only between the lth and 2nd period dues to rapid increase in average labour output and then declined rapidly