Popular Opinion Leader intervention for HIV stigma reduction in health care settings.

This study used the Popular Opinion Leader (POL) model to reduce stigma among service providers. The authors focused on the dissemination of intervention messages from trained POL providers to their peer providers and the change of intervention outcome over time. The sample included 880 service providers from 20 intervention hospitals. The levels of message diffusion, prejudicial attitude toward people living with HIV (PLH), and avoidance intent to serve PLH were self-reported at baseline, 6 months, and 12 months. At 6 months, POL providers showed a significantly higher level of message diffusion and lower levels of prejudicial attitude and avoidance intent than non-POL providers. However, such discrepancies diminished at 12 months. The results support the utility of the POL model in stigma reduction interventions. The observed changes were documented not only in POLs but also in non-POLs after a certain period of time. This finding informed the design and implementation of future stigma reduction efforts and POL intervention programs

An intervention to improve provider-patient interaction at methadone maintenance treatment in China.

BackgroundThis study evaluated an intervention aiming to improve methadone maintenance therapy (MMT) service providers' interaction with their patients in China.MethodsSixty-eight MMT clinics were randomized to either an intervention or a control condition. Providers in the intervention group attended three group training sessions to enhance their communication skills. Trained providers were encouraged to practice the taught communication skills through provider-initiated individual sessions with their patients. A total of 418 service providers completed assessments from baseline to 24-month. Linear mixed-effects regression models were used to compare self-reported short-term and sustained improvement in provider-patient interaction between the intervention and the control conditions.ResultsThe intervention group service providers perceived significantly greater short-term and sustained improvement in provider-patient interaction compared to the control group service providers (estimated difference (±SE): 1.20 (0.24) and 1.35 (0.33), respectively; p-values < 0.0001). Providers' baseline job satisfaction was significantly associated with a greater perceived improvement in provider-patient interaction for both periods (reg. coef. (±SE): 0.02 (0.01) and 0.04 (0.01) for short-term and sustained periods, respectively; p-values < 0.01).ConclusionStudy findings suggest that the intervention could be beneficial for improving perceived provider-patient interaction in MMT programs. Service providers' job satisfaction should be addressed in training programs for the improvement of provider-patient interaction

Report on Provider-Client Interaction From 68 Methadone Maintenance Clinics in China.

Provider-client interaction is an integral of clinical practice and central to the delivery of high-quality medical care. This article examines factors related to the provider-client interaction in the context of methadone maintenance treatment (MMT). Data were collected from 68 MMT clinics in China. In total, 418 service providers participated in the survey. Linear mixed effects regression models were performed to identify factors associated with provider-client interaction. It was observed that negative attitude toward drug users was associated with lower level of provider-client interaction and less time spent with each client. Other factors associated with lower level of interaction included being female, being younger, being a nurse, and fewer years in medical field. Higher provider-client interaction was associated with provider reported job satisfaction. The findings of this study call for a need to address provider negative attitudes that can impact provider-client interaction and the effectiveness of MMT. Future intervention efforts targeting MMT providers should be tailored by gender, provider type, and medical experiences

An intervention trial targeting methadone maintenance treatment providers to improve clients' treatment retention in China.

BackgroundService providers including doctors, nurses, and other healthcare professionals play an essential role in methadone maintenance treatment (MMT). This study evaluated the impact of an intervention targeting MMT providers on their clients' treatment retention.MethodsThis study was conducted in 68 MMT clinics in five provinces of China with 36 clients randomly selected from each clinic. The clinics were randomized to intervention or control condition. The MMT CARE intervention started with group sessions to enhance providers' communication skills. The trained providers were encouraged to conduct individual sessions with clients to promote treatment engagement. The outcomes, which include client retention (main outcome) and their reception of provider-delivered individual sessions (process outcome), were measured over a 24-month period.ResultsSignificantly fewer intervention clients dropped out from MMT than control clients during the study period (31% vs. 41%; p < 0.0001). Dropout hazard was significantly lower in the intervention condition compared to the control condition (HR = 0.71, 95% CI: 0.57, 0.89). More intervention clients had individual sessions than control clients (93% vs. 70%; p < 0.0001). Having individual sessions was associated with a significantly lower dropout hazard (HR = 0.30, 95% CI: 0.23, 0.40). The intervention clients had a significantly lower dropout hazard than the control clients if they started the individual sessions during the first six months (HR = 0.68, 95% CI: 0.51, 0.90).ConclusionsThe MMT CARE intervention focusing on provider capacity building has demonstrated efficacy in reducing clients' treatment dropout. This study sheds light on MMT service improvement in China and other global community-based harm reduction programs

Job Satisfaction Among Methadone Maintenance Treatment Clinic Service Providers in Jiangsu, China: A Cross-sectional Survey.

ObjectiveService providers' job satisfaction is critical to the stability of the work force and thereby the effectiveness of methadone maintenance treatment (MMT) programs. This study aimed to explore MMT clinic service providers' job satisfaction and associated factors in Jiangsu, China.MethodsThis secondary study used baseline data of a randomized interventional trial implemented in Jiangsu, China. A survey was conducted among 76 MMT service providers using the computer-assisted self-interview (CASI) method. Job satisfaction responses were assessed via a 30-item scale, with a higher score indicating a higher level of job satisfaction. Perceived institutional support and perceived stigma due to working with drug users were measured using a 9-item scale. Correlation and multiple linear regression analyses were performed to identify factors associated with job satisfaction.ResultsCorrelation analyses found a significant association between job satisfaction and having professional experience in the prevention and control of HIV, other sexually transmitted infections, or other infectious diseases (P = 0.046). Multiple regression analyses revealed that working at MMT clinics affiliated with Center for Disease Control and Prevention sites was associated with a lower level of job satisfaction (P = 0.014), and perception of greater institutional support (P = 0.001) was associated with a higher level of job satisfaction.ConclusionJob satisfaction among MMT clinic service providers was moderate in our study. Our findings suggest that institutional support for providers should be improved, and that acquisition of additional expertise should be encouraged

The effect of an information intervention on the career commitment of medical students: evidence from a randomized experiment

IntroductionThe needs-based shortage of healthcare workers is severe worldwide and it would be exacerbated if many medical students switch to other careers after graduation. Maintaining and improving the career commitment of medical students, which could be a feasible, effective, and scalable way to reduce the attrition rate, is essential in medical education. We designed a randomized experiment to test whether an information intervention based on role modeling could enhance medical students’ career commitment.MethodsIn the randomized experiment, the sample (N = 36,482) was divided into the treatment group (N = 18,070) and the control group (N = 18,412). The intervention information consisted of image-text messages on Zhong Nanshan, who is an inspiring role model for he went to the frontline of COVID-19 in the most critical circumstances and received praise and affirmation from the public. Α difference-in-differences model was employed to identify the effect of the information intervention. Heterogeneous treatment effects were identified using sub-sample analyses.ResultsThe results showed that the information intervention statistically significantly reduced medical students’ dropout intention by 2.7 percentage points (95% CI: −0.037 to −0.016, t = −4.95, p < 0.001), equivalent to 14.6% of the control group mean. This estimate indicates that the information intervention could significantly increase the career commitment of medical students. Finally, male and senior students were influenced more than their female and junior counterparts, which can be explained by their relatively high dropout intention.ConclusionRole model-based information intervention improves the career commitment of medical students. The underlying behavioral model is that, when students use a role model as their reference point, they consider dropout as a substantial welfare loss. Role modeling is an effective way to improve the career commitment of medical students, especially for males and senior students

Evolution of long-term ecological security pattern of island city and its influencing factors—a case study in Pingtan Island

Introduction: As the global urbanization process accelerates, the contradiction between economic development demands and ecological protection becomes increasingly prominent.Methods: In this study, we simulated the evolution of the ecological security pattern (ESP) of Pingtan Island from 2000 to 2020 by extracting the ecological sources using Remote Sensing Ecological Index (RSEI), and identifying the ecological corridors and key nodes by combining with Linkage Mapping (LM) and Circuit Theory. In addition, Geodetector was utilized to identify these major determinants affecting RSEI.Results: The results showed 1) From 2000 to 2020, the ecological environmental quality (EEQ) of Pingtan Island continued to improve, and the mean value of RSEI gradually increased from 0.47 to 0.51. 2) Univariate analysis showed that elevation and slope were the most significant factors affecting the spatial variability of the RSEI, with the interaction between slope and proportion of built-up area having a significant effect on EEQ. 3) The number and extent of ecological sources were expanded year by year with significant spatial variability. At the same time, the number and range of ecological corridors also underwent phase adjustment. 4) Further exploration of ESP of Pingtan Island in 2020 identified 32 ecological pinch points (EPPs) and 52 ecological barrier points (EBPs), which were mainly located within or near the ecological corridors, indicating key areas for future ecological restoration efforts.Discussion: These insights help to enhance urban spatial planning and ecosystem restoration on Pingtan Island and provide a blueprint for ESP development in comparable island urban environments

Association analysis of important agronomical traits of maize inbred lines with SSRs

Abstract The genetic markers of important traits are evaluated in order to improve the maize inbred lines. Ninety-four maize inbred lines were used to assess the genetic and phenotypic diversity and make association analysis of 26 agronomical traits with 204 genome-wide SSR markers, which were divided into five subpopulations by a model based population structure analysis. The population consisted of 94 maize inbred lines, presented high genetic diversity and significant linkage disequilibrium (LD), and could be used in the detection of genome-wide SSR marker-phenotype association. Although a total of 106 loci were associated with the trait of the mean results of two years at P<0.01 level, thirty-nine association loci were detected with an MLM association analysis model to existing significant association (P<0.05) with 17 traits in two years, simultaneously, in which there were three loci associated with PH, four loci with AD, five loci with KRN, three loci with HKW, etc. Five association loci were new discovery, which were bnlg2162, bnlg1118, phi077, umc1161 with BYC, and bnlg1118 with GLN. The strongest association loci were umc1917 with AD and HKW (P<0.01), umc2025 with CD (P<0.0001), etc. The number of associated loci detected on chromosome 1 was thirteen, which was more than chromosome 2 and 5(5), and more than chromosome 4(4), etc. The above results were useful for genetic improvement and molecular maker-assisted breeding in maize

Implementation of TCP/NC protocol simulation based on OMNET++

Abstract-TCP protocol has an awful performance in the wireless network because of the instability, high BER and long RTT of the wireless link. How to make wireless transmission more reliable and efficient has become a hot topic among relative researches. TCP/NC is a recently proposed protocol based on network coding and capable of achieving much higher throughput than TCP over lossy wireless Links. In this paper, network coding and TCP/NC are outlined firstly. And then simulation realization of TCP/NC protocol in OMNET++ is described. The performance evaluation of TCP/NC is conducted in OMNET++. The results show that TCP/NC offers significant better performance than TCP without affecting the fairness of data flow

P2X7 Integrates PI3K/AKT and AMPK-PRAS40-mTOR Signaling Pathways to Mediate Tumor Cell Death

Background: Extracellular adenosine triphosphate (ATP) functions as a novel danger signal that boosts antitumor immunity and can also directly kill tumor cells. We have previously reported that chronic exposure of tumor cells to ATP provokes P2X7-mediated tumor cell death, by as yet incompletely defined molecular mechanisms. Methodology/Principal Findings Here, we show that acute exposure of tumor cells to ATP results in rapid cytotoxic effects impacting several aspects of cell growth/survival, leading to inhibition of tumor growth in vitro and in vivo. Using agonist and antagonist studies together with generation of P2X7 deficient tumor cell lines by lentiviral shRNA delivery system, we confirm P2X7 to be the central control node transmitting extracellular ATP signals. We identify that downstream intracellular signaling regulatory networks implicate two signaling pathways: the known P2X7-PI3K/AKT axis and remarkably a novel P2X7-AMPK-PRAS40-mTOR axis. When exposed to high levels of extracellular ATP, these two signaling axes perturb the balance between growth and autophagy, thereby promoting tumor cell death. Conclusions: Our study defines novel molecular mechanisms underpinning the antitumor actions of P2X7 and provides a further rationale for purine-based drugs in targeted cancer therapy