A Peer-to-Peer Approach to Implementation of a Chronic Disease Management Program

Background: Peer-to-peer (P2P) learning occurs when individuals from similar social groups or professions help each other to learn new knowledge skills or problem solving. Peer-to-peer learning is used across many disciplines but has not been widely studied in primary care or chronic disease management. This study explored the use of an interprofessional P2P approach to support the implementation of a chronic disease management program in primary care for patients with chronic obstructive pulmonary disease (COPD), known as Best Care COPD (BCC). Methods and findings: A single descriptive case study design was used to explore P2P learning implementation approach. Focus groups and key informant interviews were held with providers involved in implementation (n = 26). Three key components of the P2P approach were identified: 1) an interprofessional team, 2) iterative peer-led training, and 3) continuous peer connection. Three recommendations are provided to support future P2P efforts: 1) enlist a champion in each profession, 2) build a P2P community, and 3) implement succession planning. Conclusion: This article provides an empirical example of the use of a P2P approach in primary care program implementation. The results will inform the future implementation of programs for chronic disease management as well as the continued sustainability of the BCC program

Effects of different serum-free culture systems on the biological function of hUC-MSCs

Objective To evaluate the effects of three different serum-free culture systems on the biological function of human umbilical cord mesenchymal stem cells （hUC-MSC） cultured in vitro. Methods Three strains of umbilical cord tissues were obtained，divided into 3 experimental groups and cultured to the 3rd generation （P3） in three different serum-free culture systems （Group A： serum-free culture system synthesized by pure chemical components，group B： serum-free culture system consisting of platelet lysate+basic culture medium，group C： serum-free culture system consisting of fibrinogen coating+recombinant human protein）. The cell proliferation，cell phenotype，three-line differentiation and immunomodulatory function were compared. Results All the cells in three groups were long and flat fusiform，adherent to the wall and uniform in size. The proliferation curve trend was similar，and the proliferation ability of P2 and P3 generations in groups A and B was better than that in group C （both P <0.05）. The cells in three experimental groups all met the requirements of the International Stem Cell Society for identification of hUC-MSC cell surface markers. The expression levels of CD29 and CD90 in P3 generations in groups A and B were higher than those in group C （all P < 0.05），and all three experimental groups had the ability of three-line differentiation. Compared with the control group，the proliferation rate of T lymphocytes in P3 generation and the proportion of cytokines secreted by Th1 and Th17 cell subsets were significantly decreased in the three experimental groups，and the proportion of regulatory T cells （CD4+ CD25+ FOXP3+） was significantly increased in the three experimental groups，but there was no statistical significance among three experimental groups （all P > 0.05）.Conclusions The hUC-MSC in three groups can maintain basic biological characteristics and immunomodulatory activity. The proliferation ability and expression levels of cell surface markers in groups A and B are superior to those in group C

Cases report: MRI findings of asymptomatically familial subependymal heterotopia with filamin A gene abnormality

Subependymal heterotopia (SEH) is a rare neuronal migration disorder consisting of gray matter nodules along the lateral ventricular walls and is often associated with other brain malformations. Despite most SEH cases showing epilepsy during their lifetimes, very few patients with asymptomatically familial SEH tend to cause misdiagnosis or missed diagnosis. We present four familial SEH cases without any positive symptoms and medical history, including two fetuses, who were diagnosed by MRI and confirmed by genetic testing with mutation of filamin A. This report emphasizes the role of MRI in the recognition of SEH at an early age of gestation and in asymptomatically familial SEH. MRI provides a fast, repeatable, reliable, and cheap choice for detecting and screening familial SEH

Ecological Management and Land Rehabilitation in Mining Areas from the Perspective of Actor-Network Theory—A Case Study of Lizuizi Coal Mine in China

Ecological damage in mining areas largely affects the regional ecological environment and ecological security. In China, ecological restoration in mining areas is urgent, as its environmental protection lags behind economic and social development. Recent studies on environmental governance in China focus on each participant’s logic of action. It suggests that cooperation among each participant is important. Thus, a fundamental question arises: how can we effectively organize various actors in environmental governance? Unlike theories that focus only on human factors, the actor-network theory considers both human and non-human actors. Within the framework of ANT, ecological restoration governance can take good care of both people and nature. To the best of our knowledge, the actor-network theory has not been used to analyze ecological restoration and land rehabilitation in mining areas. In this paper, the Lizuizi Coal Mine in Huainan of China is taken as a research object. By using the actor-network theory, we analyze the stability of the actor network and governance problems in different stages of ecological restoration of Lizuizi Coal Mine. It is concluded that the participation of the residents in ecological restoration is insufficient, and should be improved. Suggestions are provided accordingly. Our paper provides a theory basis for ecological construction in other ecologically damaged areas and resource-based cities. Further in-depth studies are necessary to strengthen the participation of social forces and the bundling collection of interests in governance

The Influence of Government Regulation on Farmers’ Green Production Behavior—From the Perspective of the Market Structure

To clarify the factors influencing the green production behavior of peach farmers, this paper uses the survey data of 741 peach farmers in 19 provinces and cities in China, it uses a multiple ordered probit model to empirically analyze the impact of the government regulations on the green production behavior of peach farmers, from the perspective of the market structure. This paper also analyzes its intermediary role in this process, and it analyzes the possible heterogeneity at both the planting scale and the regional level. The results show the following: (1) Government regulation has a positive and significant impact on the green production behavior of peach farmers. Specifically, government supervision and inspection, alongside green subsidies, can positively promote the implementation of green production behavior by peach farmers, but government publicity and training have not played a good role. (2) The market structure plays a partial intermediary role, rather than a complete intermediary role, in the government regulation affecting the green production behavior of peach farmers. (3) The impact of the government regulation on the green production behavior of peach farmers is heterogeneous. Specifically, compared with small farmers, the impact on large-scale farmers is higher; however, the influence of the three methods of government regulation on the green production behavior of peach farmers varies from region to region. Therefore, in order to promote the implementation of green production, the government should introduce appropriate local policies, strongly support new agricultural business entities, draw clear guidelines for the market, and play the role of “night watchman”