Using standardized patients to assess the quality of type 2 diabetes care among primary care providers and the health system: Evidence from rural areas of western China

Background Improving type 2 diabetes (T2D) care is key to managing and reducing disease burden due to the growing prevalence of diabetes worldwide, but research on this topic, specifically from rural areas, is limited. This study uses standardized patients (SPs) to assess T2D care quality among primary care providers to access the healthcare system in rural China. Methods Using multi-stage random sampling, health facilities, providers, and households were selected. SPs were used to evaluate providers' T2D care quality and a questionnaire survey was used to collect patient sorting behaviors from households. Logistic regression was used to explore factors correlated with T2D care quality. Provider referral and treatment rates were combined with patient sorting behaviors to assess the overall quality of T2D management by rural China's healthcare system. Results A total of 126 providers, 106 facilities, and 750 households were enrolled into this study. During SP interactions, 20% of rural providers followed the national guidelines for T2D consultation, 32.5% gave correct treatment, and 54.7% provided lifestyle suggestions. Multi-variable regression results showed that providers who had earned practicing certificates (β = 1.56, 95% CI: 0.44, 2.69) and saw more patients (β = 0.77, 95%: 0.25, 1.28) were more likely to use a higher number of recommended questions and perform better examinations, whereas providers who participated in online training were less likely to practice these behaviors (β = −1.03, 95%: −1.95, −0.11). The number of recommended questions and examination (NRQE) was the only significant correlated factor with correct treatment (marginal effect = 0.05, 95%: 0.01, 0.08). Throughout the rural healthcare system, 23.7% of T2D patients were treated correctly.ConclusionThe quality of T2D care in rural western China, especially throughout the consultation and treatment process during a patient's first visit, is poor. Online training may not improve T2D care quality and low patient volume was likely to indicate poor care quality. Further research is needed to explore interventions for improving T2D care quality in rural China's healthcare system

Growth mechanism of carbon nanotubes from Co-W-C alloy catalyst revealed by atmospheric environmental transmission electron microscopy

High???melting point alloy catalysts have been reported to be effective for the structure-controlled growth of single-wall carbon nanotubes (SWCNTs). However, some fundamental issues remain unclear because of the complex catalytic growth environment. Here, we directly investigated the active catalytic phase of Co-W-C alloy catalyst, the growth kinetics of CNTs, and their interfacial dynamics using closed-cell environmental transmission electron microscopy at atmospheric pressure. The alloy catalyst was precisely identified as a cubic ??-carbide phase that remained unchanged during the whole CNT growth process. Rotations of the catalyst nanoparticles during CNT growth were observed, implying a weak interfacial interaction and undefined orientation dependence for the solid catalyst. Theoretical calculations suggested that the growth kinetics are determined by the diffusion of carbon atoms on the surface of the ??-carbide catalyst and through the interface of the catalyst-CNT wall

pH-responsive Vesicles with Tunable Membrane Permeability and Hydrodynamic Diameters from a Cross- linkable Amphiphilic Block Copolymer

A series of cross-linked, pH responsive vesicles with tunable diameters were prepared by self-assembly of poly (ethyleneoxide)-b-poly [2-(diethylamino) ethyl methacry‐ late-co-glycidyl methacrylate,PEO-b-P(DEA-co-GMA)] in a THF/water mixture. The copolymers were synthesized by the random copolymerization of DEA and GMA, initiated by PEO-Br. With an epoxy group and a tertiary amine in its structure, self-catalysed cross-linking was triggered easily by mild heating. The vesicles showed pH responsiveness as characterized by DLS, and tunable permeability can be understood accordingly. As the pH of the solvent changed from 9.8 to 7.4, the diameters of the vesicles increased. It was observed that the diameters at pH = 6.0 were compa‐ rable to those at pH = 7.4. This alteration may have occurred because of the protonation of the PDEA segment. This particular property has great potential and many applica‐ tions, since most drug-loading and controlled-release studies are conducted within this pH range

Influences of the thermophilic period on biodegradation and nitrogen loss in stimulated vegetable waste composting

Development of thermophilic composting with ultrahigh temperature (over 70 °C) would enable the vegetable wastes compost harmless, due to the inactivation of the potential viral pathogens. The present study respectively analyzed the influences of temperature (55 °C, 65 °C, and 75 °C), lasting time of temperature over 70 °C (12 h, 24 h, and 48 h), and duration over certain temperature (10 days over 50 °C, 5 days over 60 °C and 1 day over 70 °C), on biodegradation and nitrogen loss in composting, by controlling the temperature condition in stimulated composting system. The results showed that in the simulated condition, high temperature over 75 °C affected the microbial degradation of organic matter, but the activity of microorganisms could recover if the duration is no more than 24 h, which implied that the thermophilic stage of high temperature with short duration was able to inactivate the pathogenic organisms without affecting the composting process. More NH3 emission was observed in the stimulated composting of consistent 65 °C than 55 °C and 75 °C, while the TN loss rate was higher in the consistent 55 °C treatment. The NH3 emission amount was increased with the increase of the duration of 75 °C, while the TN loss rate was the lowest when the duration is 24 h. The results suggested that high temperature did not necessarily promote the emission of ammonia, and the influences on NH3 emission and TN loss rate did not always consistent. Furthermore, even the NH3 emission and TN loss rate were increased along with the temperature increase, the difference of the TN loss rate between the two treatments, over 60 °C 5 days and over 70 °C 1 day, was not significant. In conclusion, the thermophilic stage of the temperature over 70 °C with a short duration to inactivate the potential viral pathogens will not significantly increase the nitrogen loss and influence the composting process. Keywords: Composting, Thermophilic stage, Nitrogen loss, Ammonia, Vegetable waste

Study on the Application of Electronic Nose Technology in the Detection for the Artificial Ripening of Crab Apples

Ripening agents can accelerate the ripening of fruits and maintain a similar appearance to naturally ripe fruits, but the fruit flavor and quality will be changed compared to naturally ripe fruits. To find an efficient detection method to distinguish whether crab apples were artificial ripened, the naturally ripe and artificially ripe fruits were detected and analyzed using the electronic nose (e-nose) technique in this study. The fruit quality indexes of samples were determined by the traditional method as a reference. Significant differences were found between naturally ripe and artificially ripe fruits based on the analysis of soluble sugar content, titratable acidity content, sugar–acid ratio, soluble protein content, and soluble solids content. In addition, principal component analysis (PCA), linear discriminant analysis (LDA), support vector machine (SVM), and random forest (RF) analyses were performed on the electrical signals generated by the electronic nose sensor, respectively. The results showed that the RF is the best recognition algorithm for distinguishing which crab apples were naturally ripe or artificially ripe; the average recognition accuracy is 98.3%. On the other hand, the prediction models between the e-nose response data and fruit quality indexes were constructed by partial least squares regression (PLSR), which showed that the feature value of e-nose response curves extracted by wavelet transform was highly correlated with the quality indexes of fruits, the determination coefficients (R2) of regression models were higher than 0.91. The results demonstrated that the detection technology with an electronic nose could be used to test whether the fruit of the crab apple was artificially ripe, which is an economical and efficient method

Study on the Application of Electronic Nose Technology in the Detection for the Artificial Ripening of Crab Apples

Ripening agents can accelerate the ripening of fruits and maintain a similar appearance to naturally ripe fruits, but the fruit flavor and quality will be changed compared to naturally ripe fruits. To find an efficient detection method to distinguish whether crab apples were artificial ripened, the naturally ripe and artificially ripe fruits were detected and analyzed using the electronic nose (e-nose) technique in this study. The fruit quality indexes of samples were determined by the traditional method as a reference. Significant differences were found between naturally ripe and artificially ripe fruits based on the analysis of soluble sugar content, titratable acidity content, sugar–acid ratio, soluble protein content, and soluble solids content. In addition, principal component analysis (PCA), linear discriminant analysis (LDA), support vector machine (SVM), and random forest (RF) analyses were performed on the electrical signals generated by the electronic nose sensor, respectively. The results showed that the RF is the best recognition algorithm for distinguishing which crab apples were naturally ripe or artificially ripe; the average recognition accuracy is 98.3%. On the other hand, the prediction models between the e-nose response data and fruit quality indexes were constructed by partial least squares regression (PLSR), which showed that the feature value of e-nose response curves extracted by wavelet transform was highly correlated with the quality indexes of fruits, the determination coefficients (R2) of regression models were higher than 0.91. The results demonstrated that the detection technology with an electronic nose could be used to test whether the fruit of the crab apple was artificially ripe, which is an economical and efficient method

Strategies for the use of plant biomass obtained in the phytostabilisation of trace-element-contaminated soils

The recycling options of the plant biomass produced during the phytoremediation of contaminated soils include the production of renewable energy (such as biogas or thermal energy) and also of useful products such as compost. The presence of trace elements (TEs) and the nature of the organic matter can affect the biodegradability of the biomass. The biomass of four plant species, Silybum marianum, Piptatherum miliaceum, Nicotiana glauca and Helianthus annuus, grown in a pot experiment for the phytostabilisation of a TEs contaminated soil was studied for biodegradability by biological aerobic and anaerobic transformation and for thermal energy production by thermal analysis and differential scanning calorimetry. According to the aerobic degradation results, all these plant materials are adequate for recycling by composting, with S. marianum being the least recommended due to the lowest potentially-mineralisable carbon. However, S. marianum was suitable for biogas production through anaerobic digestion, as together with P. miliaceum it showed the best results for biogas production potential, whereas, N. glauca gave low biogas production, related to its high Pb, lignin and VS concentrations and C/N ratio. The species most suitable for thermal energy purposes were again S. marianum and P. miliaceum, since both exhibited high energy release in the high-temperature regions of the thermal profile. Contrastingly, H. annuus and N. glauca produced high losses of mass at temperatures below 200 °C, which may indicate flammability risks during handling and storage.The authors thank the Spanish Ministry of Economy and Competitiveness and EU FEDER Funds (ref.: CTM2013-48697-C2-1-R) and Fundación Séneca (Murcia Region, ref. 19460/PI/14) for financial support and Dr. D.J. Walker for the English revision of the manuscript. The stay of Ms. Chang in CEBAS-CSIC was supported by the Agri-Platform Intelligence Exchange (2015–2016) for Organic Wastes Resources Utilization and Greenhouse Gas Emission Reduction, Ministry of Sciences and Technology of China.Peer reviewe

Diffusion of a micronutrient home fortification program for infants and toddlers in a multi-ethnic population in rural western China

Abstract Background The micronutrient home fortification programs contribute to the prevention of childhood anemia. WHO suggested applying culturally appropriate strategies to implement the micronutrient home fortification programs in various communities. However, there is little knowledge on evidence-based effective diffusion strategies of the micronutrient home fortification programs in multi-ethnic populations. This study aims to examine the diffusion of a micronutrient home fortification program with micronutrient powder (MNP) in a multi-ethnic population by investigating factors associated with being an ‘early’ or a ‘later’ adopter of MNP. Methods We conducted a cross-sectional study in rural western China. Multistage sampling was used to select children’s caregivers in Han, Tibetan, and Yi ethnic communities (N = 570). The diffusion of innovations theory informed the data collection on caregivers’ decision process and was applied to classify participants into the MNP adopter categories of ‘leaders’, ‘followers’, ‘loungers’, and ‘laggards’. The ordered logistic regression model estimated the factors associated with the MNP adopter categories. Results Caregivers from the Yi ethnic subgroup were likely to adopt MNP relatively late (AOR = 1.67; 95%CI = 1.09, 2.54) compared with Han and Tibetan ethnic subgroups. Caregivers with more knowledge regarding the MNP feeding method (AOR = 0.71; 95%CI = 0.52, 0.97) and those with stronger self-efficacy in adopting MNP (AOR = 0.85; 95%CI = 0.76, 0.96) were more likely to adopt MNP earlier than others. The following messages and channels also tend to make caregivers adopt MNP earlier: hearing that ‘MNP was free’ from villagers (AOR = 0.45; 95%CI = 0.20, 0.98), and learning ‘MNP feeding method’ from township doctors (AOR = 0.16; 95%CI = 0.06, 0.48). Conclusions Disparities in adopting MNP existing among different ethnic groups require more effective diffusion strategies in disadvantaged minority ethnic groups. Enhancing self-efficacy in adopting MNP and knowledge on feeding method of MNP have the potential to make caregivers adopt MNP earlier. Peer networks and township doctors can be effective agencies to facilitate the diffusion and adoption of MNP

Adherence to micronutrient powder for home fortification of foods among infants and toddlers in rural China: a structural equation modeling approach

Abstract Background The WHO recommends daily use of micronutrient powder for infants and toddlers at risk of micronutrient deficiencies in low-and-middle-income countries. China has established a micronutrient powder distribution program in many rural townships and villages, yet adherence to micronutrient powder remains suboptimal; a little is known about the behavioral inputs that may influence adherence. This study examines direct and indirect behavioral inputs in micronutrient powder adherence among caregivers in rural western China following the Integrated Behavioral Model (IBM) framework. Methods Cross-sectional data were collected from April to May 2019 among 958 caregivers of children aged 6 to 24 months in six counties. Data were collected on micronutrient powder adherence behavior, direct behavioral inputs (knowledge and skills, intention, salience, environmental constraints, and habits), and indirect behavioral inputs (attitudes, perceived social norms, and personal agency). Structural equation modeling (SEM) adjusted for sociodemographic covariates was used to evaluate the IBM framework. Results Mean micronutrient powder adherence in the previous seven days was 53.02%, and only 22.86% of caregivers consistently fed micronutrient powder from the start of micronutrient powder distribution at six months of age. The SEM model revealed small- to medium-sized effects of salience (β = 0.440, P < 0.001), intention (β = 0.374, P < 0.001), knowledge and skills (β = 0.214, P < 0.001), personal agency (st. effect = 0.172, P < 0.001), environmental constraints (β=-0.142, P < 0.001), and caregiver generation (β = 0.119, P < 0.05) on micronutrient powder adherence. Overall, 54.7% of the variance in micronutrient powder adherence was explained by the IBM framework. Salience had the largest impact on micronutrient powder adherence (Cohen’s f 2 = 0.227). Compared to parent caregivers, grandparents had a higher degree of micronutrient powder adherence on average (P < 0.001), and behavioral inputs were consistent among both parent and grandparent caregivers. Conclusion There is a need to improve micronutrient powder adherence among rural caregivers. The IBM framework showed a high degree of explanatory power in predicting micronutrient powder adherence behavior. The findings suggest that increased reminders from doctors regarding micronutrient powder and coaching to improve personal agency in micronutrient powder feeding may increase adherence