Client Acceptability for Integrating Antiretroviral Therapy in Methadone Maintenance Therapy Clinics in Sichuan, China.

BackgroundUsing methadone maintenance therapy (MMT) clinics to deliver antiretroviral therapy (ART) has proven to be effective for promoting treatment initiation and adherence in drug users living with HIV.ObjectivesThe objective of this study was to investigate the HIV-positive client acceptability of integrated ART services and to identify the reasons for and factors associated with service acceptability.MethodsA total of 86 HIV-positive MMT clients were recruited from 12 MMT clinics in Sichuan Province, China. They participated in a cross-sectional survey that queried their willingness to receive seven different types of MMT-based ART services. The reasons for their willingness/unwillingness to accept these services were documented. The association between service acceptability and background characteristics was examined.ResultsThe most accepted integrated services were ART-related counseling (75.6%) and referral (73.2%). Concerns regarding the provider's lack of ART expertise and confidentiality issues were common barriers for the acceptance of MMT-based ART services. A trust relationship with MMT providers was a reason for service acceptance. Service acceptability was associated with a poorer perceived health status. Conclusions/Importance: ART-related services, based on the client perspective, can be delivered at MMT clinics. However, service provider training and the protection of confidentiality must be strengthened for the effective implementation of integrated service delivery

Hybrid Hierarchical Collision Detection Based on Data Reuse

To improve the efficiency of collision detection between rigid bodies in complex scenes, this paper proposes a method based on hybrid bounding volume hierarchies for collision detection. In order to improve the simulation performance, the method is based on weighted oriented bounding box and makes dense sampling on the convex hulls of the geometric models. The hierarchical bounding volume tree is composed of many layers. The uppermost layer adopts a cubic bounding box, while lower layers employ weighted oriented bounding box. In the meantime, the data of weighted oriented bounding box is reused for triangle intersection check. We test the method using two scenes. The first scene contains two Buddha models with totally 361,690 triangle facets. The second scene is composed of 200 models with totally 115, 200 triangle facets. The experiments verify the effectiveness of the proposed method

Distributed adaptive e-assessment in a higher education environment

The rapid growth of Information Communication Technology (ICT) has promoted the development of paperless assessment. Most of the e-Assessment systems available nowadays, whether as an independent system or as a built-in module of a Virtual Learning Environment (VLE), are fixed-form e-Assessment systems based on the Classical Test Theory (CTT). In the meantime, the development of psychometrics has also proven the potential for e-Assessment systems to benefit from adaptive assessment theories. This research focuses on the applicability of adaptive e-Assessment in daily teaching and attempts to create an extensible web-based framework to accommodate different adaptive assessment strategies for future research. Real-data simulation and Monte Carlo simulation were adopted in the study to examine the performance of adaptive e-Assessment in a real environment and an ideal environment respectively. The proposed framework employs a management service as the core module which manages the connection from distributed test services to coordinate the assessment. The results of this study indicate that adaptive e-Assessment can reduce test length compared to fixed-form e-Assessment, while maintaining the consistency of the psychometric properties of the test. However, for a precise ability measurement, even a simple adaptive assessment model would demand a sizable question bank with ideally over 200 questions on a single latent trait. The requirements of the two categories of stakeholders (pedagogical researchers and educational application developers), as well as the variety and complexity of adaptive models, call for a framework with good accessibility for users, considerable extensibility and flexibility for implementing different assessment models, and the ability to deliver excessive computational power in extreme cases. The designed framework employs a distributed architecture with cross-language support based on the Apache Thrift framework to allow flexible collaboration of users with different programming language skills. The framework also allows different functional components to be deployed distributedly and to collaborate over a networ

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

Numerical simulation of fatigue crack growth.

This thesis describes the advances made by the author on the direct modelling of the fatigue growth of planar cracks A versatile step-by-step 3D finite element technique has been developed, which calculates the stress intensity factors at a set of points on the crack front according to linear elastic fracture mechanics principles and then applies a fatigue crack growth la\v to this set of points to obtain a new crack profile The software DUCK developed has a good capability of automatic remeshing so that the fatigue propagation of arbitrary shaped cracks can be conveniently followed The stress intensity factor calculation using the 3D finite element method has been improved and widely verified to be of good accuracy generally, which provides an important guarantee for the fatigue growth prediction. Several major problems associated with the stress intensity factor calculation, such as crack front definition, free surface layer and mesh abutting the crack front, as well as J-integral path independence, have been discussed A variety of cracked geometries of either theoretical or practical significance have been modelled by the numerical technique, including internal defects in infinite solids, surface cracks in finite thickness plates, round bars and pressure vessels, and initially multiple surface small cracks. Many results useful for the fatigue assessment of each kind of crack, such as stress intensity factor variations, fatigue shape changes and fatigue lives, have been obtained. By comparing with existing numerical methods and some limited experimental data found in the literature, it is shown that the numerical simulation technique is reliable and can predict the fatigue propagation of complex crack configurations, which is seldom possible for methods with assuming crack front configurations Meanwhile, due to the highly automated procedure or the technique, it has become straightforward to model the fatigue growth of practical cracked components, as demonstrated by the computations in this thesis. It is believed that such a numerical simulation technique has a great potential and will play an useful role in the area of fatigue study and assessmen

Reconstructing parton distribution function based on maximum entropy method

A new method based on the maximum entropy principle for reconstructing the parton distribution function (PDF) from moments is proposed. Unlike traditional methods, the new method no longer needs to introduce any artificial assumptions. For the case of moments with errors, we introduce Gaussian functions to soften the constraints of moments. A series of tests are conducted to comprehensively evaluate the validity and reconstruction efficiency of this new method. And these tests indicate that our method is reasonable and can achieve high-quality reconstruction with at least the first six moments as input. Finally, we select a set of lattice QCD results regarding moments as input and provide reasonable reconstruction results.Comment: 6 pages, 8 figure

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