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Background and objectivePsychological insulin resistance (PIR), which refers to the reluctance of diabetic patients to use insulin, is a frequently encountered clinical issue. Needle-free injection (NFI) offers advantages in terms of expediting insulin absorption and mitigating adverse reactions related to injection. To evaluate the effects of subcutaneous injection of insulin aspart 30 with NFI on PIR and insulin dosage in patients with type 2 diabetes mellitus (T2DM).MethodsSixty-four patients with T2DM participated in this randomized, prospective, open, crossover study. Insulin aspart 30 was administered subcutaneously to each subject via QS-P NFI and Novo Pen 5 (NP) successively. The effects of NFI on PIR were analyzed. Differences in insulin dosage, glycemic variability, and injection safety were compared at similar levels of glycemic control.ResultsAfter the administration of NFI, the insulin treatment attitude scale score decreased (53.7 ± 7.3 vs. 58.9 ± 10.7, p

People living with HIV and AIDS (PLWHA) deserve equitable and high-quality care. Current HIV and AIDS nursing education may not adequately prepare student nurses for the complexities of caring for PLWHA, and the perspectives of student nurses have not been sufficiently revealed in nursing education research. This study aimed to explore the viewpoints of student nurses with AIDS care experience on methods to improve their care willingness for PLWHA and to identify their educational and training needs. A descriptive qualitative study design was employed, interviewing 18 undergraduate student nurses from 14 tertiary hospitals across 7 provinces in China. Content analysis of transcripts revealed insightful suggestions for improving nursing students’ willingness, such as increased HIV and AIDS education and training, psychological preparation, positive role modeling, raising awareness about AIDS patients, and fostering nursing professionalism. Highlighted education and training needs include progress in HIV and AIDS treatment, preventive measures, psychological support for PLWHA, post-exposure protocols, and HIV-infected risk behaviors. These findings highlight the need for HIV and AIDS education, psychological support training, and stigma-reduction strategies. This study provides valuable insights that could inform policymakers, educators, and healthcare providers on preparing future nurses to meet the complex needs of PLWHA.

Abstract Aims This study aimed to assess student nurses' competence and attitude toward spiritual care and analysed the associated factors. Design Cross‐sectional study using an online survey. Methods From April 14 to June 14, 2018, a convenience sample of 938 student nurses were recruited from six schools of Nursing in Hunan Province, China. Data were collected by using the Chinese versions of the Spiritual Care Competence Scale (C‐SCCS) and the Spiritual Care Attitude Scale (C‐SCAS). Results The average total score on the C‐SCCS was 21.42 (±4.27) out of 30 and the C‐SCAS was 58.03 (±9.90) out of 75. Factors such as liking the nursing profession, attending a spiritual care course, participation in classroom learning or expert lecture, and supporting continuous and systematic training were the strongest predictors of higher spiritual care competence and attitude. A better attitude about spiritual care was a relatively moderate and significant predictor of higher spiritual care competence.

Abstract Background Caring for people living with HIV/AIDS (PLWHA) requires clinical experience and quality care delivery skills. This study aimed to explore the perceptions and experiences of nursing students in caring for PLWHAs. Methods This qualitative descriptive study interviewed 18 student nurses who had cared for PLWHAs from 14 tertiary hospitals across 7 provinces in China through semi-structured telephone interviews. Results Two themes emerged from the narratives: student nurses’ perceptions and attitudes toward PLWHAs and student nurses’ practical experiences with PLWHAs. Five theme clusters were revealed, namely “negative attitudes held before the care-giving,” “a series of psychological struggles in care-giving,” “favorable attitudes increased after the care-giving,” “consensus on care delivery for PLWHAs,” and “considerations regarding contamination reduction.” Conclusions Findings shed light on the development and changes in student nurses' perspectives on PLWHAs throughout their clinical experiences. Student nurses' perceptions and attitudes toward PLWHAs progressed through three distinct stages, and positive changes were observed after care-giving. Participants' perceptions and practical experiences with patients with AIDS enable patients to receive fair and high-quality care and provide valuable insights for nursing educators better prepare HIV nurses.

Amine acid transformation is an important chemical process in biological systems. As a well-developed and acknowledged tool, chiral aldehyde catalysis provides good catalytic activation and stereoselective control abilities in the asymmetric reaction of N-unprotected amino acid esters and amino acid esters analogs, in which the key to success is the design of the catalysts derived from chiral BINOL aldehyde, which is based on the face control of enolate intermediates. In this review, one of the co-catalytic systems that combined with a transition metal to form a multiplex catalytic system and the well-established multiplex stereocenters of chiral aldehyde catalysis have been reviewed. Finally, a novel organocatalysis is prospected.

Objective. To study the effect of liraglutide on the thickness of epicardial adipose tissue (EAT) in type 2 diabetes mellitus (T2DM) patients with abdominal obesity. Methods. Abdominal obesity T2DM patients with poor glycemic control were collected and treated with liraglutide. The changes of blood glucose, blood lipid, waist circumference, body mass index (BMI), and EAT thickness were compared after 3 months of treatment with liraglutide. Cardiac magnetic resonance imaging (MRI) was used to measure EAT thickness. Results. After 3 months of treatment with liraglutide, glycosylated hemoglobin (HbA1c) decreased from 9.81±1.46% to 6.94±1.29% (95%CI=2.14–3.59, p

Background With adverse events and injuries recurring in residential aged care facilities (RACFs), older adults’ safety in residential age care settings has attracted extensive attention from governments, researchers, and healthcare providers. Risk management is of utmost importance in reducing risks and improving the quality of care for older adults in long-term care. Although previous studies have made great efforts to explore risk management methods and technologies in RACFs, little is known about how managers identify and respond to risks in practice. Purpose This qualitative study aimed to elucidate the perceptions and experiences of managers involved in risk management in RACFs in China. Participants and methods This study used a phenomenological research design. We conducted semi-structured interviews with 13 managers across 11 RACFs in Changsha City, Hunan Province, China. Data were analysed using Colaizzi’s seven steps and NVivo 12 plus software. Results “Facilitation of an error-free culture” emerged as a central theme of managers’ perceptions of risk management. Four sub-themes were revealed, namely “creating an age-friendly physical environment,” “paying close attention to frail older adults,” “improving the competence of nursing staff,” and “building effective management programs.” Conclusion Facilitation of an error-free culture was of prime importance in risk management. Managers’ experiences can help RACFs to better manage risks, as well as provide new perspectives and approaches for RACFs to improve the quality and outcomes of care. This study developed initiatives for improving resident safety in RACFs and may foster interest in the developing these initiatives.

The treatment of wastewater from the iron and steel industry is difficult due to its complex and changeable characteristics. This paper introduces the application of polyvinylidene fluoride (PVDF)-pressurized ultrafiltration membrane with low packing density that produced via thermally induced phase separation (TIPS) in wastewater of iron and steel industry, to study the effects of packing density of ultrafiltration membrane modules as well as the membrane performance under different operation conditions, in order to provide guidance for the subsequent development of other ultrafiltration applications in wastewater of iron and steel. The results show a significant positive effect of smaller packing density on the transmembrane pressure difference (TMP) reducing and higher permeability. Under 30 min filtration cycle and 65 L m−2 h−1 (LMH) operation flux, the permeability can be stabilized to 200 L/(m2·h)/0.1 MPa, which is two times higher than that of the membrane module with 0.3 m2/m3 higher packing density under the same condition. It is obvious that compared with enhanced flux maintenance (EFM), chemically enhanced backwash (CEB) is a more effective cleaning method for iron and steel wastewater, which maintains TMP (30 kPa) without any significant increase under the premise of ensuring the high-flux (65 LMH) operation. The results also suggest reasonable parameters based on the test water quality, which include the filtration cycle and operation flux. The scanning electron microscopy (SEM) analysis and the turbidity of the permeate show that the ultrafiltration membrane has good intercept ability and high anti-pollution performance.

OBJECTIVE: To assess the efficacy and safety of sitagliptin compared with voglibose added to combined metformin and insulin in patients with newly diagnosed type 2 diabetes (T2DM). METHODS: In this 12-week prospective, randomized, parallel trial, 70 newly diagnosed T2DM patients with glycosylated hemoglobin (HbA1c) ≥9% and/or fasting plasma glucose (FPG) ≥11.1 mmol/L were randomized (1:1) to receive sitagliptin 100 mg per day + metformin + insulin glargine or voglibose 0.2 mg three times daily + metformin + insulin glargine. Change in HbA1c at week 12 was the primary endpoint. RESULTS: The mean baseline HbA1c was 11.0% in the patients. The changes in HbA1c from baseline were -6.00% in the sitagliptin group and -3.58% in the voglibose group, and the between-group difference was -2.42% (95% CI -1.91 to -2.93, p=0.02). The differences in FPG and homeostatic model assessment of β-cell function (HOMA-β) and the change in body weight between groups from baseline were -2.95 mmol/L (p=0.04), 43.91 (p=0.01) and -2.23 kg (p=0.01), respectively. One patient (2.9%) in the sitagliptin group and three patients (8.6%) in the voglibose group exhibited hypoglycemia. CONCLUSIONS: Sitagliptin added to combined metformin and insulin therapy showed greater efficacy and good safety regarding hypoglycemia in patients with newly diagnosed T2DM compared with voglibose.

In aquatic environments, organisms are exposed to mixtures of pollutants which may change the toxicity profile of each contaminant, compared to its toxicity alone. Carbamazepine (CBZ) and cadmium (Cd) are among the pollutants that co-occur in aquatic environments. To date, most research about their toxicity towards aquatic vertebrates is based on single exposure experiments. The present study aims to evaluate single and combined effects of CBZ and Cd on biomarkers in female Danio rerio (zebrafish) by exposing them to environmentally relevant concentrations of these two pollutants for ten days. Four kinds of biomarkers involved in antioxidant systems, energy metabolism, nervous system, and endocrine disruption, respectively, were studied. Our research results coincided with those of former studies in single exposure experiments. However, the combined exposure of CBZ and Cd exerted different responses from other studies in which these two contaminants were examined alone in zebrafish. The present study evidenced the need to conduct more coexposure studies to enhance the environmental relevance of these experimental results.

Carboxymethyl chitosan (CMCS), acrylamide, and methacryloxyethyltrimethyl ammonium chloride were used as co-monomers to produce a sludge dewatering agent carboxymethyl chitosan-graft-poly(acrylamide-methacryloxyethyltrimethyl ammonium chloride) (CCPAD) by UV-induced graft polymerization. Single-factor experiments and response surface methodology were employed to investigate and optimize the grafting rate, grafting efficiency, and intrinsic viscosity influenced by the total monomer concentration, CMCS concentration, cationic degree, pH value, and illumination time. The structure, surface morphology, and thermal stability of CCPAD were characterized by infrared spectroscopy, hydrogen nuclear magnetic resonance, X-ray diffraction, scanning electron microscopy, and differential thermal-thermogravimetry. The raw sludge with 97.9% water content was sourced from the concentrated tank of a sewage treatment plant and used in the sludge condition experiments. In addition, CCPAD was applied as the sludge conditioner to investigate the effects of cationic degree, intrinsic viscosity, and pH on the supernatant turbidity, moisture content, specific resistance to filtration, and sludge settling ratio. Moreover, the mechanism of sludge conditioning by CCPAD was discussed by examining the zeta potential and extracellular polymeric substance (EPS) content of the supernatant. The sludge dewatering results confirmed that CCPAD had excellent performance for improving sludge dewaterability.

This study investigated the effects of different types of fillers fed into membrane bioreactors (MBR) in greywater treatment for water purification effect, membrane fouling and microbial community structure. Two MBR systems of hollow fiber membrane and flat sheet organic membrane were running with floating sponge filler and fixing combination filler. The MBR systems with filler improved the removal rate of ammonia nitrogen, total nitrogen, and total phosphorus compared with that without filler, especially the effect of floating sponge filler was obvious (91.49%, 71.53%, and 72.35% in the flat sheet membrane system). The floating sponge filler also effectively improved the permeation performance of the MBR system, but the fixed type filler (combination filler) accelerated membrane fouling and reduced the permeation performance of the system. This finding may be due to the higher abundance of Gammaproteobacteria (relative abundance 38.3%) and Bacteroidia (relative abundance 8.35%) on the filler surface. Feeding fillers into MBR can improve the nitrogen removal capacity, effluent quality, and permeability of the system. However, it depends on the type and material of different fillers. [ABSTRACT FROM AUTHOR]

This study aims to investigated the effect of aeration mode on membrane bioreactors (MBRs) using a self-designed integrated hollow fiber MBR and flat sheet organic MBR for rural greywater treatment. The pollutant removal efficiency, characteristics of activated sludge and mixed liquor, and mechanisms of membrane fouling were systematically analyzed under intermittent aeration and continuous modes. The results indicate that the permeability of MBRs in intermittent aeration mode is higher than that in the continuous aeration mode when operating at the same aeration rate. Due to the higher extracellular polymeric substance (EPS) and soluble microbial product (SMP) concentrations. The removal rates of TN and TP by both MBRs at the intermittent aeration mode were higher than those in the continuous aeration mode due to the difference in the aeration environment. Compared to the flat-sheet organic membrane, the hollow-fiber membrane surface was more likely to form biofilms, which cause biological fouling.The relative abundance of Thermomonas showed a positive correlation with the EPS concentration, indicating that Thermomonas participates in EPS synthesis. This study provides a theoretical basis for evaluating the influence of aeration modes on MBRs,and would be a useful guide for the better control of membrane fouling and treatment of rural greywater. [ABSTRACT FROM AUTHOR]

Treating low C/N domestic sewage is one of the difficult tasks in wastewater treatment. This study investigated the treatment of low C/N domestic sewage under low dissolved oxygen condition via self-built biological contact oxidation reactor with composite packing and polyurethane suspension packing. Meanwhile, MiSeq high-throughput sequencing was performed on the microbial communities on the surface of the packing to analyze the changes in microbial community structure. The results showed that polyurethane suspension packing reactor had better removal efficacy on NH4 +-N, TN and COD than the combined packing reactor, and only the effluent indexes of polyurethane suspension packing reactor could reach the first-class A emission standard of Discharge standard of pollutants for municipal wastewater treatment plant (GB 18918-2002). The removal of biological phosphorus of the single-contact oxidation process was not ideal and could be combined with anaerobic reactor. The richness and diversity of the bacterial community in polyurethane suspension packing reactor was higher than those of composite packing reactor. Polyurethane suspension packing reactor contained relatively richer nitrification-related flora Nitrospira, which provide better growth and reproduction conditions for the denitrification-related flora Betaproteobacteria and Denitratisoma. The large amount of facultative heterotrophic bacteria in Proteobacteria had a significant effect on the removal of organic pollutants. This study provides a theoretical basis for subsequent in-depth research and practical application. [ABSTRACT FROM AUTHOR]

Toluene is an extensively used reagent that could cause water pollution and endanger human health. In this work, an O3/UV/ion-doped TiO2 nanotubes process was investigated to obtain the optimum TiO2 nanotubes for effective toluene decomposition. Photocatalytic activity is found to be influenced by the doped-ion type by affecting the ionic radius, valence state, and configuration of the dopant. The calcination temperature and doping concentration, which change the weight fractions of the anatase phase ( fA), the Brunauer-Emmett-Teller surface area (SBET), and the energy band gap (Eg) of the catalyst, also affect the photocatalytic activity. When TiO2 is doped with ions, SBET decreases and Eg becomes narrower. The photocatalytic activities of TiO2 for toluene removal increase after doping with Ag+, Al3+, Cu2+, Fe3+, Mn2+, Ni2+, V5+, and Zn2+. Moreover, the 1.0% Fe3+-doped TiO2 nanotubes calcined at 550 °C have the highest catalytic activity, with a toluene removal efficiency of 70.7%. [ABSTRACT FROM AUTHOR]