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BackgroundAs an innovative approach to providing web-based health care services from physical hospitals to patients at a distance, e-hospitals (ie, extended care hospitals through the internet) have been extensively developed in China. This closed health care delivery chain was developed by combining e-hospitals with physical hospitals; treatment begins with web-based consultation and registration, and then, patients are diagnosed and treated in a physical hospital. This approach is promising in its ability to improve accessibility, efficiency, and quality of health care. However, there is limited research on end users’ acceptance of e-hospitals and the effectiveness of strategies aimed to prompt the adoption of e-hospitals in China. ObjectiveThis study aimed to provide insights regarding the adoption of e-hospitals by investigating patients’ willingness to use e-hospitals and analyzing the barriers and facilitators to the adoption of this technology. MethodsWe used a pretested self-administered questionnaire and performed a cross-sectional analysis in 1032 patients across three hierarchical hospitals in West China from June to August 2019. Patients’ sociodemographic characteristics, medical history, current disease status, proficiency with electronic devices, previous experience with web-based health services, willingness to use e-hospitals, and perceived facilitators and barriers were surveyed. Multiple significance tests were employed to examine disparities across four age groups, as well as those between patients who were willing to use e-hospitals and those who were not. Multivariate logistic regression was also performed to identify the potential predictors of willingness to use e-hospitals. ResultsOverall, it was found that 65.6% (677/1032) of participants were willing to use e-hospitals. The significant predictors of willingness to use e-hospitals were employment status (P=.02), living with children (P

Transnational and transracial Chinese adoption narratives hold important power for their ability to construct, reify, and legitimize structures of belonging and modes of kinship in adoptive families. However, the storytellers--who [...]

Objective To investigate vaccine hesitancy leading to underimmunization and a measles outbreak in Rwanda and to develop a conceptual, community-level model of behavioural factors. Methods Local immunization systems in two Rwandan communities (one recently experienced a measles outbreak) were explored using systems thinking, human-centred design and behavioural frameworks. Data were collected between 2018 and 2020 from: discussions with 11 vaccination service providers (i.e. hospital and health centre staff); interviews with 161 children's caregivers at health centres; and nine validation interviews with health centre staff. Factors influencing vaccine hesitancy were categorized using the 3Cs framework: confidence, complacency and convenience. A conceptual model of vaccine hesitancy mechanisms with feedback loops was developed. Findings A comparison of service providers' and caregivers' perspectives in both rural and peri-urban settings showed that similar factors strengthened vaccine uptake: (i) high trust in vaccines and service providers based on personal relationships with health centre staff; (ii) the connecting role of community health workers; and (iii) a strong sense of community. Factors identified as increasing vaccine hesitancy (e.g. service accessibility and inadequate follow-up) differed between service providers and caregivers and between settings. The conceptual model could be used to explain drivers of the recent measles outbreak and to guide interventions designed to increase vaccine uptake. Conclusion The application of behavioural frameworks and systems thinking revealed vaccine hesitancy mechanisms in Rwandan communities that demonstrate the interrelationship between immunization services and caregivers' vaccination behaviour. Confidencebuilding social structures and context-dependent challenges that affect vaccine uptake were also identified. Objectif Analyser l'hesitation vaccinale menant a une Immunisation insuffisante et a une epidemie de rougeole au Rwanda, mais aussi developper un modele conceptuel de facteurs comportementaux a l'echelle communautaire. Methodes Nous avons examine les systemes d'immunisation locaux dans deux communautes rwandaises (l'une ayant recemment subi une epidemie de rougeole) en utilisant la pensee systemique, une approche centree sur l'humain et des cadres comportementaux. Les donnees ont ete recoltees entre 2018 et 2020 aupres de plusieurs sources: les discussions avec 11 prestataires de services lies a la vaccination (hopitaux et centres medicaux); des entretiens avec 161 aides-soignants du departement pediatrique dans divers centres medicaux; et enfin, neuf entretiens de validation avec le personnel des centres medicaux. Nous avons classe les facteurs conditionnant l'hesitation vaccinale conformement a la regle des 3 C: confiance (confidence), sous-estimation du danger (complacency) et commodite (convenience). Un modele conceptuel des mecanismes d'hesitation vaccinale assorti de boucles de retroaction a egalement ete elabore. Resultats D'apres une comparaison entre les perspectives des prestataires de services et aides-soignants, tant en milieu rural que periurbain, des facteurs similaires renforcent la prise vaccinale: (i) un degre de confiance eleve envers les vaccins et les prestataires de services, fonde sur les relations entretenues avec le personnel des centres medicaux; (ii) le role d'intermediaire joue par les agents de sante communautaires; et enfin, (iii) un fort sentiment d'appartenance a la collectivite. Les facteurs qui ont tendance a accroitre l'hesitation vaccinale (parmi lesquels figurent l'accessibilite aux services et l'absence de suivi adequat) varient entre prestataires de services et aides-soignants, ainsi que selon les milieux. Le modele conceptuel pourrait servir a identifier les moteurs de la recente epidemie de rougeole, et orienter les actions destinees a ameliorer la prise vaccinale. Conclusion Lapplication des cadres comportementaux et de la pensee systemique ont revele les mecanismes qui sous-tendent l'hesitation vaccinale au sein des communautes rwandaises, et qui prouvent la correlation entre les services d'immunisation et le comportement des aides-soignants en la matiere. Nous avons egalement decouvert des structures sociales de restauration de la confiance ainsi que des defis qui, en fonction du contexte, ont un impact sur la prise vaccinale. Objetivo Estudiar la reticencia a las vacunas que ha causado la falta de vacunacion y la aparicion de un brote de sarampion en Ruanda, y desarrollar un modelo conceptual a nivel comunitario de los factores de comportamiento. Metodos Se analizaron los programas locales de vacunacion en dos comunidades de Ruanda (una de las que experimento un brote de sarampion hace poco) mediante el uso de marcos de pensamiento sistemico, de diseno centrado en el ser humano y de comportamiento. Los datos se recopilaron entre 2018 y 2020 a partir de conversaciones con 11 proveedores de servicios de vacunacion (es decir, personal de hospitales y de centros sanitarios); entrevistas con 161 cuidadores de ninos en centros sanitarios; y 9 entrevistas de validacion con personal de centros sanitarios. Los factores que influyen en la reticencia a la vacunacion se clasificaron mediante el modelo de las 3 C: confianza, complacencia y conveniencia. Asimismo, se elaboro un modelo conceptual de los mecanismos de reticencia a la vacunacion que incluye ciclos de retroalimentacion. Resultados Una comparacion entre las perspectivas de los proveedores de servicios y de los cuidadores, tanto en entornos rurales como periurbanos, indico que factores similares reforzaban la adopcion de las vacunas: i) la gran confianza en las vacunas y en los proveedores de servicios gracias a las relaciones personales con el personal del centro sanitario; ii) el rol de conexion de los profesionales sanitarios de la comunidad; y iii) el gran sentido de pertenencia a la comunidad. Los factores identificados que aumentan la reticencia a las vacunas (por ejemplo, la accesibilidad a los servicios y el seguimiento insuficiente) difieren entre los proveedores de servicios y los cuidadores y entre los distintos entornos. El modelo conceptual se podria utilizar para explicar los factores que influyeron en el reciente brote de sarampion y para orientar las intervenciones disenadas con el objetivo de aumentar la adopcion de vacunas. Conclusion La aplicacion de marcos de comportamiento y del pensamiento sistemico revelo mecanismos de reticencia a las vacunas en las comunidades de Ruanda que evidencian la interrelacion entre los servicios de vacunacion y el comportamiento de vacunacion de los cuidadores. Tambien se identificaron las estructuras sociales de fomento de la confianza y los desafios especificos del contexto que afectan a la adopcion de las vacunas., Introduction Rwanda has a strong immunization system, (1) a well-organized vaccine supply system and a well-functioning community health worker (CHW) programme. (2) As a result, national immunization coverage rates are [...]

EARLY CHINESE ADOPTION: THE HONG KONG PROJECT The history of Chinese international adoption is closely linked in many ways to the broader history of Asian international adoption. In Global Families: [...]

Sun Yatsen, Robert Wilcox and Their Failed Revolutions, Honolulu and Canton 1895 Dynamite on the Tropic of Cancer, by Patrick Anderson (Routledge, 2021) In his book Sun Yatsen, Robert Wilcox [...]

The Twisted Gastrulation (TSG) protein is one of five secreted proteins required to pattern the dorsal part of the early Drosophila embryo. Unlike the Decapentaplegic (DPP) protein that is required to pattern the entire dorsal half of the embryo, TSG is needed only to specify the fate of the dorsal midline cells. Here we have misexpressed the tsg gene with different promoters to address its mechanism of action and relationship to DPP. When expressed in a ventral stripe of cells, TSG protein can diffuse to the dorsalmost cells and can rescue the dorsal midline cells in tsg mutant embryos. Despite elevated levels that exceed that exceed those needed for biological activity, there was no change in dorsal midline or lateral cell fates under any conditions tested. We conclude that TSG does not modulate an activity gradient of DPP. Instead, it functions in a permissive rather than instructive role to elaborate cell fates along the dorsal midline after peak levels of DPP activity have 'primed' cells to respond to TSG. The interaction between TSG and DPP defines a novel type of combinatorial synergism.

Members of the Achaete-scute family of basic helix-loop-helix transcription factors are involved in cell fate specification in vertebrates and invertebrates. We have isolated and characterized a cnidarian achaete-scute homolog, CnASH, from Hydra vulgaris, a representative of an evolutionarily ancient branch of metazoans. There is a single achaete-scute gene in Hydra, and the bHLH domain of the predicted gene product shares a high degree of amino acid sequence similarity with those of vertebrate and Drosophila Achaete-scute proteins. In Hydra, CnASH is expressed in a subset of the interstitial cells as well as differentiation intermediates of the nematocyte pathways. In vitro translated CnASH protein can form heterodimers with the Drosophila bHLH protein Daughterless, and these dimers bind to consensus Achaete-scute DNA binding sites in a sequence-specific manner. Ectopic expression of CnASH in wild-type late third instar Drosophila larvae and early pupae leads to the formation of ectopic sensory organs, mimicking the effect of ectopic expression of the endogenous achaete-scute genes. Expression of CnASH in flies that are achaete and scute double mutants gives partial rescue of the mutant phenotype, comparable to the degree of rescue obtained by ectopic expression of the Drosophila genes. These results indicate that the achaete-scute type of bHLH genes for cell fate specification, as well as their mode of action, arose early and have been conserved during metazoan evolution.

Nicotine delivery and subjective effects are determinants of the ability of potentially less harmful tobacco products such as heated tobacco products (HTPs) to support adult smokers in switching away from cigarettes, and therefore to support tobacco harm reduction. This open-label, randomised, crossover, clinical study in 24 healthy adult smokers study assessed nicotine pharmacokinetics and subjective effects of the Pulze Heated Tobacco System (HTS; Pulze HTP device and three iD stick variants—Intense American Blend, Regular American Blend and Regular Menthol) compared with subjects' usual brand cigarettes (UBC). Cmax and AUCt were highest for UBC and significantly lower for each Pulze HTS variant. Cmax and AUCt were significantly higher for Intense American Blend compared with Regular American Blend, while AUCt was significantly higher for Intense American Blend compared with Regular Menthol. Median Tmax was lowest (i.e., nicotine delivery was fastest) for subjects' usual brand cigarettes and similar across the iD stick variants, although no between-product differences were statistically significant. All study products reduced urges to smoke; this effect was greatest for cigarettes although this was not statistically significant. Product evaluation scores for each Pulze HTS variant in the domains of 'satisfaction', 'psychological reward' and 'relief' were similar, and lower than those for UBC. These data demonstrate that the Pulze HTS effectively delivers nicotine and generates positive subjective effects, including satisfaction and reduced urge to smoke. This supports the conclusion that the Pulze HTS may be an acceptable alternative to cigarettes for adult smokers while having a lower abuse liability than cigarettes. [ABSTRACT FROM AUTHOR]