Establishment and validation of an adherence prediction system for lifestyle interventions in non-alcoholic fatty liver disease

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the most common liver disease worldwide,affecting about 1/4th of the global population and causing a huge global economic burden.To date,no drugs have been approved for the treatment of NAFLD,making the correction of unhealthy lifestyles the principle method of treatment.Identifying patients with poor adherence to lifestyle correction and attempting to improve their adherence are therefore very important.AIM To develop and validate a scale that can rapidly assess the adherence of patients with NAFLD to lifestyle interventions.METHODS The Exercise and Diet Adherence Scale(EDAS)was designed based on com-pilation using the Delphi method,and its reliability was subsequently evaluated.Demographic and laboratory indicators were measured,and patients completed the EDAS questionnaire at baseline and after 6 months.The efficacy of the EDAS was evaluated in the initial cohort.Subsequently,the efficacy of the EDAS was internally verified in a validation cohort.RESULTS The EDAS consisted of 33 items in six dimensions,with a total of 165 points.Total EDAS score correlated significantly with daily number of exercise and daily reduction in calorie intake(P<0.05 each),but not with overall weight loss.A total score of 116 was excellent in predicting adherence to daily reduction in calorie intake(>500 kacl/d),(sensitivity/specificity was 100.0%/75.8%),while patients score below 97 could nearly rule out the possibility of daily exercise(sensitivity/specificity was 89.5%/44.4%).Total EDAS scores≥116,97-115,and<97 points were indicative of good,average,and poor adherence,respectively,to diet and exercise recommendations.CONCLUSION The EDAS can reliably assess the adherence of patients with NAFLD to lifestyle interventions and have clinical application in this population.

Patient satisfaction and follow-up adherence to glaucoma case management clinic in China

AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a total of 119 patients completed a Patient Satisfaction Questionnaire-18 and a sociodemographic questionnaire.Clinical data was obtained from the case management system.Follow-up adherence was defined as completing each follow-up within±30d of the scheduled time set by ophthalmologists during the study period.RESULTS:Average satisfaction scored 78.65±7,with an average of 4.39±0.58 across the seven dimensions.Age negatively correlated with satisfaction(P=0.008),whilst patients with follow-up duration of 2 or more years reported higher satisfaction(P=0.045).Multivariate logistics regression analysis revealed that longer follow-up durations were associated with lower follow-up adherence(OR=0.97,95%CI,0.95-1.00,P=0.044).Additionally,patients with suspected glaucoma(OR=2.72,95%CI,1.03-7.20,P=0.044)and those with an annual income over 100000 Chinese yuan demonstrated higher adherence(OR=5.57,95%CI,1.00-30.89,P=0.049).CONCLUSION:The case management model proves effective for glaucoma patients,with positive adherence rates.The implementation of this model can be optimized in the future based on the identified factors and extended to glaucoma patients in more hospitals.

Validation of adherence prediction system for lifestyle interventions in nonalcoholic fatty liver disease

This editorial delves into the research article by Zeng et al published in the latest issue of World Journal of Gastroenterology.The manuscript contributes significantly to addressing the global health issue of nonalcoholic fatty liver disease(NAFLD)by introducing and validating the Exercise and Diet Adherence Scale(EDAS).The article effectively conveys the importance of the study,highlighting the prevalence of NAFLD,the lack of approved drugs for its treatment,and the crucial role of lifestyle correction.The use of the Delphi method for scale development and the subsequent evaluation of its reliability add scientific rigor to the methodology.The results demonstrate that the scale is correlated with key lifestyle indicators,which makes it a promising tool for assessing patient adherence to interventions.The identification of specific score thresholds for predicting adherence to daily calorie intake and exercise adds practical value to the scale.The differentiation among scores indicative of good,average,and poor adherence enhances its clinical applicability.In conclusion,the manuscript introduces EDAS,a valuable instrument that can contribute substantially to the field of NAFLD research and clinical practice.

Adherence to Pharmacotherapy in Post-Menopausal Women with Hypertension or Metabolic Syndrome: Real World Experience

Background: Adherence to medications is dependent upon a variety of factors, including individual characteristics of the patient, interactions with health care providers, and medication complexity. Even though several studies were conducted to test intervention strategies, results are uncertain. Aim: The aim of the study is to assess if a tailored combined intervention strategy improves medication adherence in a large population of post-menopausal women affected by hypertension or metabolic syndrome. Methods: We enrolled 6833 patients aged 50 to 69 years, 85.7% with hypertension, and 14.3% with metabolic syndrome. A network between patients, general practitioners, and cardiologists was established. Interventions included education, adequate information to patients, a simplified scheme of treatment, and periodic adherence assessment. These were either delivered as healthcare provider supports or using modern technology. Medication adherence was estimated by the proportion of days covered for all classes of drugs after the index date. Results: Non-adherent hypertensive women were 297 (5%), and those with metabolic syndrome were 73 (7.4%) (p Conclusions: The rate of non-adherence in both settings of postmenopausal women was 7.7%, much lower than that described in the literature. This rate was increased in patients with metabolic syndrome;probably it is related to the complexity of the therapeutic scheme or to a poor consciousness of the disease. Therefore, implementing a tailored combined intervention can improve significantly patients’ adherence to medical therapy.

Factors of Adherence to Concurrent Tuberculosis Treatment and Antiretroviral Therapy among HIV-TB Co-Infected Individuals in the East Region, Cameroon in the COVID-19 Era: A Retrospective Cohort Study

Context/Objectives: Tuberculosis (TB) and HIV co-infection is a serious health problem in Cameroon. The problems associated with poor adherence to treatment are on the increase worldwide. This problem can be observed in all situations where patients are required to administer their own medication, whatever the type of illness. The general objective of this study was to assess the factors affecting adherence to treatment among HIV-TB co-infected patients in health facilities in the East Region in the COVID context. Method: A retrospective cohort study before and during COVID-19 was conducted in HIV care units in 13 health districts in the East Region of Cameroon. Data were collected using a questionnaire recorded in the Kobo Collect android application, analyzed using SPSS version 25 software and plotted using Excel. Results: The pre-COVID-19 cohort compared to the during-COVID-19 cohort had a 1.90 risk of not adhering to treatment (OR: 1.90, CI {1.90 - 3.37}) and the difference was statistically significant at the 5% level (p-value = 0.029). Frequency of adherence was 65.4% (140/214). Adherence before COVID-19 was 56.9% whereas during COVID-19, it was 74.3%. Conclusion: The implementation of targeted interventions in the COVID-19 context, using evidence-based data and integrating the individual needs of HIV-TB co-infected patients, improved adherence to concurrent anti-tuberculosis treatment and antiretroviral therapy during the COVID-19 Era.

Anisotropic etching mechanisms of 4H-SiC:Experimental and first-principles insights

Molten-alkali etching has been widely used to reveal dislocations in 4H silicon carbide(4H-SiC),which has promoted the identification and statistics of dislocation density in 4H-SiC single crystals.However,the etching mechanism of 4H-SiC is limited misunderstood.In this letter,we reveal the anisotropic etching mechanism of the Si face and C face of 4H-SiC by combining molten-KOH etching,X-ray photoelectron spectroscopy(XPS)and first-principles investigations.The activation energies for the molten-KOH etching of the C face and Si face of 4H-SiC are calculated to be 25.09 and 35.75 kcal/mol,respectively.The molten-KOH etching rate of the C face is higher than the Si face.Combining XPS analysis and first-principles calculations,we find that the molten-KOH etching of 4H-SiC is proceeded by the cycling of the oxidation of 4H-SiC by the dissolved oxygen and the removal of oxides by molten KOH.The faster etching rate of the C face is caused by the fact that the oxides on the C face are unstable,and easier to be removed with molten alkali,rather than the C face being easier to be oxidized.

Insulin therapy in type 2 diabetes: Insights into clinical efficacy, patient-reported outcomes, and adherence challenges

Insulin therapy plays a crucial role in the management of type 2 diabetes as the disease progresses.Over the past century,insulin formulations have undergone significant modifications and bioengineering,resulting in a diverse range of available insulin products.These products show distinct pharmacokinetic and pharmacodynamic profiles.Consequently,various insulin regimens have em-erged for the management of type 2 diabetes,including premixed formulations and combinations of basal and bolus insulins.The utilization of different insulin regimens yields disparate clinical outcomes,adverse events,and,notably,patient-reported outcomes(PROs).PROs provide valuable insights from the patient’s perspective,serving as a valuable mine of information for enhancing healthcare and informing clinical decisions.Adherence to insulin therapy,a critical patient-reported outcome,significantly affects clinical outcomes and is influenced by multiple factors.This review provides insights into the clinical effectiveness of various insulin preparations,PROs,and factors impacting insulin therapy adherence,with the aim of enhancing healthcare practices and informing clinical decisions for individuals with type 2 diabetes.

Scientific principles for accelerating the Sustainable Development Goals

The Sustainable Development Goals(SDGs)are significantly off-course as we reach the midpoint of their 2030 deadline.From a scientific perspective,the critical challenge in achieving the SDGs lies in the need for more scientific principles to understand the complex socio-ecological systems(SES)and their interactions influencing the 17 SDGs.Here,we propose a scientific framework to clarify the common scientific principles and the rational treatment of diversity under these principles.The framework’s core is revealing the complex mechanisms underlying the achievement of each Sustainable Development Goal(SDG)and SDG interactions.Building upon the identified mechanisms,complex SES models can be established,and the implementation of SDGs can be formulated as a multi-objective optimization problem,seeking a compromise in competition between essential costs and desired benefits.Our framework can assist countries,and even the world in accelerating progress towards the SDGs.

Healthcare Worker-Related Factors Contributing to Tuberculosis Treatment Non-Adherence among Patients in Kisumu East Sub-County

Background: Treatment non-adherence poses significant risks to health outcomes and impedes the health system’s efficiency, hence curtailing progress towards the end Tuberculosis (TB) strategy under SDG 3.3. Despite interventions to address TB treatment non-adherence, Kenya still reports high TB treatment non-adherence rates of 35% and consequently poor treatment outcome rates. Health Care Workers (HCWs) play a critical role in linking the population to health services, yet little is known of their influence on patients’ TB treatment non-adherence in Kenya. Objective: To analyze HCW-related factors associated with TB treatment non-adherence among patients in Kisumu East Sub-County. Methods: Health facility-based analytical cross-sectional mixed-method study. A Semi-structured questionnaire on treatment adherence and patients’ perceptions of HCWs during the clinic visit was administered to 102 consenting adult (out of a total census of 107 adults) drug-susceptible TB patients. 12 purposively selected HCWs by rank from 6 health facilities participated in Key Informant Interview sessions. Medication adherence was measured using the Morisky Medication Adherence Scale and then expressed as a dichotomous variable. Quantitative analysis utilized STATA version 15.1 while qualitative deductive thematic analysis was done using NVIVO version 14. Results: TB treatment non-adherence rate of 26% (CI: 18% - 36%) was recorded. Overall, patients who felt supported in dealing with the illness were 8 times more likely to adhere to treatment compared to those who were not (aOR = 7.947, 95% CI: 2.214 - 28.527, p = 0.001). Key HCW related factors influencing adherence to treatment included: friendliness (cOR = 4.31, 95% CI: 1.514 - 12.284, p = 0.006), respect (cOR = 6.679, 95% CI: 2.239 - 19.923, p = 0.001) and non-discriminatory service (cOR = 0.1478, 95% CI: 0.047 - 0.464, p = 0.001), communication [adequacy of consultation time (cOR = 6.563, 95% CI: 2.467 - 17.458, p = 0.001) and patients’ involvement in their health decisions (cOR = 3.02 95% CI: 1.061 - 8.592, p = 0.038)] and education and counselling (cOR = 4.371, 95% CI: 1.725 - 11.075, p = 0.002). Conclusion: The study results underline importance of patient-centered consultation for TB patients and targeted education and counselling for improved treatment adherence.

Effectiveness of Short Message Service Support on Adherence to Chemotherapy Treatment among Patients Attending Cancer Treatment Facilities in Kenya

Introduction: Cancer is a chronic debilitating disease that unnerves patients, communities, and nations. At some point in cancer patient’s disease experience, chemotherapy is used, and the patient is expected to adhere to treatment to improve survival and quality of life. Methods: This multisite Cluster Randomized Trial (CRT) evaluated the effectiveness of mobile phone Short Message Service (SMS) support on the adherence to treatment schedules among adult cancer patients in Kenya. Data was collected using questionnaires. Ethical approvals were obtained from relevant Ethical Review Boards (ERBs). Results: The mean adherence was 83%. There was a significant difference between treatment arms in relation to the adherence. The intervention arm had a higher mean adherence difference, M = 3.913, 95% CI 2.632-5.193, t (402) = 6.006, p ≤ 0.001), with Cohen’s d = 0.60. Although not significant, (χ2dd = 0.151, df = 1, p = 2.064), more women were perfect adheres than males. Perfect adherers were satisfied with SMS support (χ2dd = 7.620, df = 1, p = 0.06), were in the intervention arm (χ2dd = 22.942, df = 1, p ≤ 0.001), and had trust in the care provider (χ2dd = 10.591 p ≤ 0.001). SMS support was not significant in the multivariate analysis but had an estimated effect size of 0.958 (z = 1.424, p = 0.154, CI = 0.242-3.781), indicating that mean adherence was slightly better in the presence of the intervention. Conclusions: SMS-support intervention has demonstrated superiority in influencing adherence. Further, health system-related factors have a significant influence on the adherence to chemotherapy treatment. Interventions to re-design health systems that are responsive to unmet care needs of cancer patients must be explored. .

Design Principles and Mechanistic Understandings of Non-Noble-Metal Bifunctional Electrocatalysts for Zinc-Air Batteries

Zinc-air batteries(ZABs)are promising energy storage systems because of high theoretical energy density,safety,low cost,and abundance of zinc.However,the slow multi-step reaction of oxygen and heavy reliance on noble-metal catalysts hinder the practical applications of ZABs.Therefore,feasible and advanced non-noble-metal elec-trocatalysts for air cathodes need to be identified to promote the oxygen catalytic reaction.In this review,we initially introduced the advancement of ZABs in the past two decades and provided an overview of key developments in this field.Then,we discussed the work-ing mechanism and the design of bifunctional electrocatalysts from the perspective of morphology design,crystal structure tuning,interface strategy,and atomic engineering.We also included theoretical studies,machine learning,and advanced characterization technologies to provide a comprehensive understanding of the structure-performance relationship of electrocatalysts and the reaction pathways of the oxygen redox reactions.Finally,we discussed the challenges and prospects related to designing advanced non-noble-metal bifunctional electrocatalysts for ZABs.

Effective roles of exercise and diet adherence in non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease(NAFLD)is characterized by symptoms of excessive fat accumulation and steatosis in the liver without alcohol intake in patients.The associated pathogenic mechanism is not completely understood and there are no specific drugs for patients with NAFLD.Exercise and diet adherence are the best options for the management of NAFLD patients.Questionnaire associated analysis models of adherence to these interventions are used to assess their effectiveness in the management of NAFLD patients using specificity,sensitivity,and so on.Studies have indicated that the relative ratio of NAFLD can be reduced by physical activity with diet control.In the future,the pathogenesis of NAFLD should be clarified with stratified efforts to develop appropriate drugs,and both exercise and diet adherence should be optimized using better questionnaire design and evaluation models for patients with NAFLD.

Principles of Shiology——Revealing the Basic Rules of Human Shiance

The objective principles of shiology are mainly reflected in three fields as food acquisition, eaters' health and shiance order. Most of the objective principles in the field of food acquisition have been revealed by agronomy and foodstuff science. This research mainly focuses on 10 principles in the field of eaters' health and shiance order and in addition, there are also five lemmas that extend from the above principles. The 10 principles are the core theory of the shiology knowledge system, which play an important role in the objective principles revealed by human beings and constitute one of the basic principles of human civilization. Compared with the scientific principles of mathematics, physics, chemistry and economics, the principles of shiology have three characteristics as popularity, practicability and survivability. The principles of shiology in the field of eaters' health are all around us, and everyone can understand and master them. Using the principles of shiology can improve the healthy life span of 8 billion people. The principles of shiology in the field of shiance order is an important tool of social governance, which can reduce human social conflicts, reduce social involution, improve overall efficiency of social operation, and maintain the sustainable development of human beings.

International law obligations for the disposal of Fukushima nuclear-contaminated water under the principles of nuclear safety

The disposal of contaminated water from Japan’s Fukushima nuclear power plant is a significant international nuclear safety issue with considerable cross-border implications.This matter requires compliance not only with the law of the sea but also with the principles of nuclear safety under international law.These principles serve as the overarching tenet of international and China’s domestic nuclear laws,applicable to nuclear facilities and activities.The principle of safety in nuclear activities is fully recognized in international and domestic laws,carrying broad legal binding force.Japan’s discharge of nuclear-contaminated water into the sea violates its obligations under the principle of safety in nuclear activities,including commitments to optimum protection,as low as reasonably practicable,and prevention.The Japanese government and the International Atomic Energy Agency(IAEA)have breached the obligation of optimum protection by restricting the scope of assessments,substituting core concepts,and shielding dissenting views.In the absence of clear radiation standards,they have acted unilaterally without fulfilling the obligation as low as reasonably practicable principle.The discharge of Fukushima nuclear-contaminated water poses an imminent and unpredictable risk to all countries worldwide,including Japanese residents.Japan and the IAEA should fulfill their obligations under international law regarding disposal,adhering to the principles of nuclear safety,including optimum protection,the obligation as low as reasonably practicable,and prevention through multilateral cooperation.Specifically,the obligation to provide optimum protection should be implemented by re-evaluating the most reliable disposal technologies and methods currently available and comprehensively assessing various options.The standard of the obligation as low as reasonably practicable requires that the minimization of negative impacts on human health,livelihoods,and the environment should not be subordinated to considerations of cutting costs and expenses.Multilateral cooperation should be promoted through the establishment of sound multilateral long-term monitoring mechanisms for the discharge of nuclear-contaminated water,notification and consultation obligations,and periodic assessments.These obligations under international law were fulfilled after the accidents at the Three Mile Island and Chernobyl nuclear power plants.The implications of the principles of nuclear safety align with the concept of building a community of shared future for nuclear safety advocated by China.In cases of violations of international law regarding the disposal of nuclear-contaminated water that jeopardize the concept of a community of a shared future for nuclear safety,China can also rely on its own strength to promote the implementation of due obligations through self-help.

Four Dimensions of Integrating Chinese Culture Into College English Teaching From the Perspective of Tyler’s Basic Principles

Integrating Chinese culture into college English can not only enhance students’humanities literacy and cultivate their cultural confidence,but also facilitate the inheritance and international dissemination of Chinese culture.Taking Tyler’s curriculum framework as the starting point,this paper analyzes some factors that affect the integration of Chinese culture into the college English teaching and proposes some strategies for the integration of Chinese culture into college English teaching by innovating teaching objectives,enriching teaching contents,transforming modes of course delivery,and reconstructing the assessment system.

Research on Teaching Methods of Flight Control Principles

With the rapid development of China’s civil aviation industry,the teaching method of operating knowledge of flight principles has changed greatly,which creates a good implementation environment to improve the safety of civil aviation in our country.At present,the main training content of air route transport pilots in China is basic aviation theory,initial flight training,airline modification,etc.The principles of flight control are an important part of basic aviation theoretical knowledge training,which will involve a large number of flight technology training content,instructors will also be based on the pilot type.Teaching flight control theory and practical knowledge requires relatively high theoretical learning ability of students,and the learning effect of this part of theoretical knowledge will directly affect the quality of subsequent learning,but also directly affect the effectiveness of flight training.This paper focuses on the analysis of the basic concepts of flight control,studies the existing problems in the teaching of flight control principles,summarizes the teaching measures of flight control principles,aiming to provide a reference to teaching personnel.

Research on the Course of Principles of Concrete Structure Design

Nowadays,education and teaching have become a hot topic,and teaching in colleges and universities is facing a brand-new development direction.Principles of Concrete Structure Design,as one of the main courses,transmits professional knowledge for students,enhances the students’professional ability,and further carries out in-depth research on the course to bring a better teaching effect for students.The article mainly focuses on the research of the principles of concrete structure design course,conducts an analysis of the teaching characteristics of the principles of concrete structure design course,and reasonably sets the teaching content from the optimization of the course teaching objectives;innovative course teaching methods can deepen the effect of knowledge understanding;reform of experimental practice teaching can lay down the effect of the internalization of knowledge,etc.The in-depth description and discussion of the relevant aspects of the research aim to provide guidelines for related research.

First-Principles Investigation of Charge Transfer Mechanism of B-Doped 3C-SiC Semiconductor Material

This study delves into the charge transfer mechanism of boron (B)-doped 3C-SiC through first-principles investigations. We explore the effects of B doping on the electronic properties of 3C-SiC, focusing on a 12.5% impurity concentration. Our comprehensive analysis encompasses structural properties, electronic band structures, and charge density distributions. The optimized lattice constant and band gap energy of 3C-SiC were found to be 4.373 Å and 1.36 eV respectively, which is in agreement with previous research (Bui, 2012;Muchiri et al., 2018). Our results show that B doping narrows the band gap, enhances electrical conductivity, and influences charge transfer interactions. The charge density analysis reveals substantial interactions between B dopants and surrounding carbon atoms. This work not only enhances our understanding of the material’s electronic properties, but also highlights the importance of charge density analysis for characterizing charge transfer mechanisms and their implications in the 3C-SiC semiconductors.

Initial medication adherence in newly diagnosed glaucoma patients:three adherence measures

AIM:To determine initial medication adherence in newly diagnosed glaucoma patients treated with anti-glaucoma drugs.METHODS:This retrospective and observational study included all patients diagnosed with glaucoma in the Primary Health Care units in Portugal during the years 2012 and 2013,which in consequence received a first prescription for anti-glaucoma drugs.Data was collected from electronic prescribing records of the primary care units and from pharmacy claims records.Initiation of glaucoma treatment and early discontinuation were measured,and the combination of(non)-initiation and early discontinuation accounted for initial medication(non)-adherence.RESULTS:A total of 3548 new glaucoma patients(40.1%male;59.9%female)were included.The 1133(31.9%)patients were initially classified as non-users,since there was no pharmacy claim found for their first prescription for glaucoma treatment.Additionally,277(11.5%)patients early discontinued their treatment,acquiring only their first prescription.Overall,the initial medication non-adherence rate was 39.7%since 1410 patients either didn’t initiate treatment or discontinued it early.CONCLUSION:This study,reveals a major opportunity to improve glaucoma treatment and its control,since a large proportion of patients fail to engage with their prescribed therapy,which implies that implementation of individual or group strategies that enable patients with glaucoma to correctly perform their treatment is still needed.

Lithium nitrate regulated carbonate electrolytes for practical Li-metal batteries: Mechanisms, principles and strategies

Li-metal batteries(LMBs)regain research prominence owing to the ever-increasing high-energy requirements.Commercially available carbonate electrolytes exhibit unfavourable parasitic reactions with Limetal anode(LMA),leading to the formation of unstable solid electrolyte interphase(SEI)and the breed of Li dendrites/dead Li.Significantly,lithium nitrate(LiNO_(3)),an excellent film-forming additive,proves crucial to construct a robust Li_(3)N/Li_(2)O/Li_(x)NO_(y)-rich SEI after combining with ether-based electrolytes.Thus,the given challenge leads to natural ideas which suggest the incorporation of LiNO_(3) into commercial carbonate for practical LMBs.Regrettably,LiNO_(3) demonstrates limited solubility(~800 ppm)in commercial carbonate electrolytes.Thence,developing stable SEI and dendrite-free LMA with the incorporation of LiNO_(3) into carbonate electrolytes is an efficacious strategy to realize robust LMBs via a scalable and cost-effective route.Therefore,this review unravels the grievances between LMA,LiNO_(3)and carbonate electrolytes,and enables a comprehensive analysis of LMA stabilizing mechanism with LiNO_(3),dissolution principle of LiNO_(3) in carbonate electrolytes,and LiNO_(3) introduction strategies.This review converges attention on a point that the LiNO_(3)-introduction into commercial carbonate electrolytes is an imperious choice to realize practical LMBs with commercial 4 V layered cathode.