Barriers and facilitators to primary care management of type 2 diabetes in Shijiazhuang City, China: a mixed methods study.

BACKGROUND: The prevalence of type 2 diabetes (T2DM) in China is over 10%, affecting around 114 million people. Despite the inclusion of T2DM in the National Basic Public Health Service Program (NBPHSP), most people with T2DM experience challenges in achieving optimal management targets. This study aimed to identify barriers and facilitators of diabetes management from the perspectives of primary health care (PHC) service providers and recipients. METHODS: This mixed-methods study was conducted in Shijiazhuang City, Hebei Province, China. A quantitative PHC facility assessment survey was conducted in all administrative districts and qualitative in-depth interviews were conducted in one district to government officials, medical staff, patients with T2DM, and their family members. Interviews were thematically analyzed, and all findings were synthesized using Michie's COM-B theory. RESULTS: A total of 197 village/community level PHC facilities and 66 township/street level PHC facilities answered the survey, and 42 in-depth interviews were conducted. The key facilitators stemmed from the NBPHSP policy, which standardized the basic infrastructure, medical equipment, and medication for the PHC facilities, provided training on NCD prevention and control, and compensated the PHC workers. However, we identified a detrimental cycle among PHC providers characterized by inadequate capacity, overwhelming workloads, insufficient income, limited career development opportunities, and challenges in attracting young talents. Although patients were covered by the national medical insurance schemes, they experienced capability constraints primarily driven by low education levels, advanced age, low health literacy, and a proliferation of misinformation. These factors influenced patients' motivation to be actively engaged in care and contributed to inertia to intensify treatment and achieve their clinical management goals. CONCLUSION: This study identifies several major facilitators and barriers from the perspectives of both PHC providers and patients with T2DM. Our findings suggest there are substantial opportunities to strengthen the NBPHSP, including improving the capacity and the income level of the PHC providers, attracting and retaining skilled health workers in rural areas, supporting patients to improve their health literacy and take a more active role in their health care, and improving access to high-quality care through digital health approaches. TRIAL REGISTRATION: ClinicalTrials.gov (record NCT02726100, 03/22/2016).

Understanding the Electrochemical Extraction of Lithium from Ultradilute Solutions.

The electrochemical extraction of lithium (Li) from aqueous sources using electrochemical means is a promising direct Li extraction technology. However, to this date, most electrochemical Li extraction studies are confined to Li-rich brine, neglecting the practical and existing Li-lean resources, with their overall extraction behaviors currently not fully understood. More still, the effect of elevated sodium (Na) concentrations typically found in most Li-lean water sources on Li extraction is unclear. Hence, in this work, we first understand the electrochemical Li extraction behaviors from ultradilute solutions using spinel lithium manganese oxide as the model electrode. We discovered that Li extraction depends highly on the Li concentration and cell operation current density. Then, we switched our focus on low Li to Na ratio solutions, revealing that Na can dominate the electrostatic screening layer, reducing Li ion concentration. Based on these understandings, we rationally employed pulsed electrochemical operation to restructure the electrode surface and distribute the surface-adsorbed species, which efficiently achieves a high Li selectivity even in extremely low initial Li/Na concentrations of up to 1:20,000.

Comprehensive workplace intervention for cancer prevention in China (WECAN): protocol for a stepped-wedge, cluster-randomised controlled trial.

INTRODUCTION: Cancer is the second leading cause of death across the globe with the majority of deaths occurring in low-income and middle-income countries. Evidence has shown that the cancer burden can be substantially reduced by avoiding behavioural risk factors through comprehensive intervention strategies, including workplace health promotion, which has shown to be cost-effective in developed countries while rarely conducted in developing countries. This study aims to explore a feasible and sustainable approach to the prevention and control of cancer in China by developing an evidence-based comprehensive workplace health model equipped with a smartphone application for implementation. METHODS AND ANALYSIS: This study is designed as a stepped-wedge, cluster-randomised controlled trial. We will recruit 15 workplaces from three cities in China. A total of 750 employees will be randomly selected for evaluation that includes five rounds of survey conducted every 6 months. After the second evaluation, workplaces will be randomly allocated to start the intervention sequentially every 6 months in three steps with five workplaces per step. A mobile application 'Healthy Workplace' will be developed to support the intervention. On-line and off-line health-related activities will be carried out among employees. Employers will provide supportive policies, environment and benefits to facilitate the adoption of healthy behaviours. The primary outcome is the change of Healthy Lifestyle Index Score, which consists of five components including smoking, alcohol drinking, physical activity, diet and body mass index. ETHICS AND DISSEMINATION: The study has been approved by Queen Mary University of London Ethics of Research Committee (QMERC22.257) and Chinese Centre for Disease Control and Prevention Institutional Review Board (202210). Written informed consent is required from all participants. Results will be disseminated through presentations, publications and social media. TRIAL REGISTRATION NUMBER: ChiCTR2200058680.

Prevalence of obstructive sleep apnea syndrome in hospitalized patients with type 2 diabetes in Beijing, China.

AIMS/INTRODUCTION: To estimate the prevalence, and patient clinical and demographic profile, as well as risk factors associated with obstructive sleep apnea syndrome (OSAS) in hospitalized patients with type 2 diabetes mellitus in Beijing, China. MATERIALS AND METHODS: Hospitalized adult patients with type 2 diabetes mellitus were consecutively screened and invited for an overnight polysomnography from four hospitals in Beijing, China, from May 2016 to February 2017. We used the American Academy of Sleep Medicine 2012 polysomnography recording techniques and scoring criteria to identify the type of apnea and the severity of OSAS. The χ2 -test was used to evaluate differences between groups regarding the prevalence, and demographic and other clinical parameters. RESULTS: A total of 735 patients were found eligible for the study, of whom 309 patients completed the overnight polysomnography. The mean age of the patients was 58.2 ± 10.9 years, and most (67.3%) were men. The prevalence of overall (apnea hypopnea index ≥5/h), moderate-to-severe (apnea hypopnea index ≥15/h) and severe (apnea hypopnea index ≥30/h) OSAS was 66.3% (95% confidence interval 60.8-71.6%), 35.6% (95% confidence interval 30.3-41.2%) and 16.5% (95% confidence interval 12.5-21.1%), respectively. Central and mixed apnea contributed 12% to all sleep-disordered breathing. With the aggravation of OSAS, the combined prevalence for central, mixed and obstructive apnea increased from 57% to 70%. We found OSAS to be associated with older age, obesity, self-reported snoring and apnea, and diabetes complications. CONCLUSIONS: Guidelines on screening and treatment of OSAS among hospitalized patients with diabetes are needed to direct the routine practice for diabetes endocrinologists for optimal clinical care of such patients.

Controllable incorporation of oxygen in MoS2 for efficient adsorption of Hg2+ in aqueous solutions.

Molybdenum disulfide (MoS2) was incorporated controllably by oxygen in order to modify the hydrophobic surfaces and thus to improve the adsorption of Hg2+ on MoS2 in aqueous solutions in this work. The experimental results indicated that the incorporation of oxygen could dramatically improve the adsorption of Hg2+ on MoS2. With 11% oxygen atom incorporation, the adsorption rate and capacity increased over 17 times and 21 folds, respectively, compared with that without oxygen incorporation. This vast improvement was found to be contributed to that the incorporation of oxygen would greatly enhance the complexation between S atoms and Hg2+ on MoS2 surfaces, resulting in the great increase of the Hg2+ adsorption. The increase of the adsorption capacity with increasing incorporated oxygen reached a plateau, which might be due to the saturation of covalent bond. In addition, the incorporation of oxygen atom greatly enhanced the hydrophilicity of MoS2 surfaces, facilitating the hydrated Hg2+ ions to approach to MoS2 surfaces. This finding might provide a highly potential adsorbent for efficiently removing Hg2+ from water.

Purification and rapid dissolution of potassium sulfate in aqueous solutions.

Water soluble potassium sulfate dissolves rapidly and completely in water. Its main characteristics are purity and dissolution rate. In this study, the purification and rapid dissolution of potassium salt (K2SO4) separated from potassium brine deposits collected from Lop Nur basin of China (referred to as LN K2SO4) were studied for utilization in agricultural farming as a potash fertilizer. First, the dissolving-crystallizing process was conducted to remove the insoluble content and improve the purity of K2SO4. Second, physical modification of K2SO4 surfaces was accomplished based on the Noyes-Whitney equation. The results showed that the water insoluble content could be completely removed and the purity of K2SO4 reached 100% in the purification process. The dissolution rate was significantly improved with the help of environmentally-friendly additives such as sodium tripolyphosphate (STPP)/urea phosphate (UP). These additives ameliorated the diffusion coefficient (D) and the diffusion layer thickness (h) for K2SO4. Results also demonstrated that a larger K2SO4 surface area (S) induced a higher dissolution rate.

Controlling Chain Conformations of High-k Fluoropolymer Dielectrics to Enhance Charge Mobilities in Rubrene Single-Crystal Field-Effect Transistors.

A novel photopatternable high-k fluoropolymer, poly(vinylidene fluoride-bromotrifluoroethylene) P(VDF-BTFE), with a dielectric constant (k) between 8 and 11 is demonstrated in thin-film transistors. Crosslinking P(VDF-BTFE) reduces energetic disorder at the dielectric-semiconductor interface by controlling the chain conformations of P(VDF-BTFE), thereby leading to approximately a threefold enhancement in the charge mobility of rubrene single-crystal field-effect transistors.

Determinants of antihypertensive adherence among patients in Beijing: Application of the health belief model.

OBJECTIVES: This study was aimed to determine the factors associated with antihypertensive adherence based on the Health Belief Model (HBM). METHODS: A cross-sectional study was conducted in a rural area of China in 2014. The questionnaire included information about demographics, a scale based on the HBM, and the four-item Morisky Medication Adherence Scale. RESULTS: 745 hypertensive patients participated in the study (345 men, 400 women). Patients' mean age was 56.4±10.8years. The prevalence of adherence was 43.5%. Structural equation modeling showed that men, older participants, and those with greater knowledge of hypertension showed better medication adherence than did other participants. Based on the HBM, higher levels of self-efficacy and perceived severity and a lower level of perceived barriers were associated with better antihypertensive adherence. Self-efficacy was one of the most important mediating variables affecting antihypertensive adherence. CONCLUSIONS: Antihypertensive adherence was not optimal among patients in Beijing. Given that many factors are associated with medication adherence, individualized intervention strategies should be carried out in Beijing, China, especially in community settings. PRACTICE IMPLICATIONS: Medication adherence can be improved by enhancing patients' self-efficacy because it was the most important influence and mediating variable.

How to achieve better effect of peer support among adults with type 2 diabetes: A meta-analysis of randomized clinical trials.

OBJECTIVES: To study the effects of peer support on glycemic control and examine effects of different providers and types of support, intervention duration and effect duration.

pH-controlled selective etching of Al2O3 over ZnO.

We describe pH-controlled selective etching of atomic layer deposition (ALD) Al2O3 over ZnO. Film thickness as a function of etch exposure was measured by spectroscopic ellipsometry. We find that alkaline aqueous solutions with pH between about 9 and 12 will etch Al2O3 at useful rate with minimal attack of ZnO. Highly selective etching of Al2O3 over ZnO (selectivity >400:1) and an Al2O3 etch rate of ∼50 nm/min can be obtained using a pH 12 etch solution at 60 °C.