Accessibility and Rationality of In-home Self-medication among Acute Disease Patients in Gansu Province：a Household Survey

BackgroundSelf-medication behavior often occurs in acutely ill patients, which may lead to a greatly increased risk of adverse drug events. There are few surveys on the accessibility and rationality of in-home self-medication among acute disease patients against a background of implementing multiple policies associated with China's healthcare reform initiated in 2009, and the available surveys mainly focus on central and eastern China.ObjectiveTo investigate the accessibility and rationality of in-home self-medication among acute disease patients in Gansu, offering evidence for standardizing in-home medication, and improving accessibility and rationality of in-home self-medication in this group.MethodsBy use of multistage stratified random sampling, 1 080 households were selected from five cities in Gansu Province from June to December 2018. They were invited to attend a survey guided by the WHO Household Survey to Measure Access to and Use of Medicines for understanding the morbidity in household members in the past two weeks, use and accessibility of medicines for treating acute diseases using a questionnaire developed by our research team. The survey results were statistically analyzed. Spearman correlation analysis was used to analyze the correlation between acute diseases, accessibility and availability of medicines for treating acute diseases and the number of drugs and antibiotics.ResultsOut of the 1 080 households, 1 071 (99.17%) effectively responded to the survey. The prevalence of acute diseases in family members living in these households in the past two weeks was 36.32% (389/1 071) . In this study, we only included the youngest family member with acutely disease in each household, that is, 389 cases in all. Of them, 350 (89.97%) had an acute upper respiratory infection; 355 (91.26%) had the behavior of seeing a doctor or buying drugs; 355 (91.26%) were on medication for treating acute diseases. Among all cases on medication, 279 (78.59%) used combination therapy, 93 (26.20%) had four or more medications simultaneously, and 151 (42.54%) were on antibiotics. Among all antibiotics users, 133 (79.17%) took antibiotics recommended by doctors, and 136 (80.95%) used β- Lactam antibiotics. In terms of medicine accessibility, 334 (85.86%) of acute disease patients were able to reach the nearest medical facility within 15 minutes; 354 (91.00%) and 329 (84.58%) reported that the required drugs were available at the public medical facilities and pharmacy, respectively. Among all cases on medication, 349 (98.31%) had medical insurance, but only 64 (18.34%) were reimbursed; 42 (11.83%) reported that the spending on medicines accounted for over 20% of the total household spending. There were statistically significant differences between patients in urban and rural areas at the avenues of seeing a doctor or buying drugs, types of antibiotics used, 15 minutes proximity to the nearest medical facility, accessibility to drugs at pharmacies, drug reimbursement rates, and spending over 20% of total household expenditure on drugs for acute illnesses (P<0.05) . Spearman correlation analysis showed that accessibility to drugs at the pharmacy was positively correlated with the number of drugs taken (rs=0.145, P<0.05) .ConclusionThe accessibility to drugs among acute diseases patients in Gansu Province is high. However, there are also issues among patients, including high prevalence of combination therapy and antibiotics intake, low proportion of patients who are reimbursed by medical insurance, as well as urban and rural differences in medicine accessibility. Therefore, to regulate residents' self-medication behaviors, it is suggested that relevant government departments give priority to actions to raise residents' awareness levels of rational medication and health insurance, medical professionals' capabilities and supervision of antibiotics use

Contextualizing the Revised Patient Perception of Patient-Centeredness (Pppc-R) Scale in Primary Healthcare Settings: a Validity and Reliability Evaluation Study

BACKGROUND: An English version of the Patient Perception of Patient-Centeredness (PPPC) scale was recently revised, and it is necessary to test this instrument in different primary care populations. AIM: This study aimed to assess the validity and reliability of a Chinese version of the PPPC scale. DESIGN: A mixed method was used in this study. The Delphi method was used to collect qualitative and quantitative data to address the content validity of the PPPC scale by calculating the Content Validity Index, Content Validity Ratio, the adjusted Kappa, and the Item Impact Score. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were used to assess the construct validity of the PPPC scale through a cross-sectional survey. The internal consistency was also assessed. SETTING/PARTICIPANTS: In the Delphi consultation, seven experts were consulted through a questionnaire sent by email. The cross-sectional survey interviewed 188 outpatients in Guangzhou city and 108 outpatients in Hohhot City from community health service centers or stations face-to-face. RESULTS: The 21 items in the scale were relevant to their component. The Item-level Content Validity Index for each item was higher than 0.79, and the average Scale-level content validity index was 0.97 in each evaluation round. The initial proposed 4-factor CFA model did not fit adequately. Still, we found a 3-factor solution based on our EFA model and the validation via the CFA model (model fit: [Formula: see text], P \u3c 0.001, RMSEA = 0.044, CFI = 0.981; factor loadings: 0.553 to 0.888). Cronbach\u27s α also indicated good internal consistency reliability: The overall Cronbach\u27s α was 0.922, and the Cronbach\u27s α for each factor was 0.851, 0.872, and 0.717, respectively. CONCLUSIONS: The Chinese version of the PPPC scale provides a valuable tool for evaluating patient-centered medical service quality

Using the Rheological Index to Quantitatively Evaluate the Mechanical Performance of High-Elasticity Modified Asphalt

High-elasticity modified asphalt is widely used in OGFC and bridge deck paving due to its high viscosity and strong displacement recovery capacity. It can improve the high-temperature deformation resistance and elastic recovery ability of the pavement. Especially in bridge deck pavement, high-elastic modified asphalt can inhibit the formation of reflective cracks and extend the service life. In order to quantitatively evaluate properties of the high-elasticity modified asphalt, rheological properties are studied by using a dynamic shear rheometer (DSR) test. The parameters were fitted with the Burgers model, and the constitutive equation was established. The 3 s elastic recovery rate E r was proposed to quantitatively evaluate the elastic recovery of high-elasticity modified asphalt. The experimental results show that the instantaneous modulus of elasticity G 0 and the delayed modulus of elasticity G 1 can be used to evaluate the elastic capacity. E r can quantitatively evaluate the elastic resilience of high-elasticity modified asphalt. The correlation coefficient between the test results of high-elasticity modified asphalt and those of impact toughness evaluation reached 0.9966, and the 3 s elastic recovery rate E r could be used to evaluate the elastic recovery ability of high-elasticity modified asphalt.</jats:p

Using the Rheological Index to Quantitatively Evaluate the Mechanical Performance of High-Elasticity Modified Asphalt

High-elasticity modified asphalt is widely used in OGFC and bridge deck paving due to its high viscosity and strong displacement recovery capacity. It can improve the high-temperature deformation resistance and elastic recovery ability of the pavement. Especially in bridge deck pavement, high-elastic modified asphalt can inhibit the formation of reflective cracks and extend the service life. In order to quantitatively evaluate properties of the high-elasticity modified asphalt, rheological properties are studied by using a dynamic shear rheometer (DSR) test. The parameters were fitted with the Burgers model, and the constitutive equation was established. The 3 s elastic recovery rate Er was proposed to quantitatively evaluate the elastic recovery of high-elasticity modified asphalt. The experimental results show that the instantaneous modulus of elasticity G0 and the delayed modulus of elasticity G1 can be used to evaluate the elastic capacity. Er can quantitatively evaluate the elastic resilience of high-elasticity modified asphalt. The correlation coefficient between the test results of high-elasticity modified asphalt and those of impact toughness evaluation reached 0.9966, and the 3 s elastic recovery rate Er could be used to evaluate the elastic recovery ability of high-elasticity modified asphalt

Optimizing plant density and balancing NPK inputs in combination with innovative fertilizer product for sustainable maize production in North China Plain.

Abstract Excessive NPK inputs but low grain yield and high environmental impact are common in maize production in North China Plain (NCP). The objective of our study was to test whether a combined strategy of optimizing plant density, balancing NPK input, and innovating one-time fertilizer products could achieve a more sustainable maize production in NCP. Thus, a field experiment was conducted at Luanna County NCP with the treatments of unfertilized control (CK), farmer practice (FP, conventional plant density and NPK input), conventional one-time urea-based coated fertilizer (CF, optimized plant density and NPK input), and five newly designed innovative one-time NPK fertilizers of ammonium sulphate and urea synergy (IF, optimized plant density and NPK input), innovative fertilizer with various additives of urea inhibitors (IF+UI), double inhibitors (IF+DI), micro-organisms (IF+MI), and trace elements (IF+TE). The grain yield, nitrogen sustainability indicators (nitrogen use efficiency NUE, partial factor productivity of nitrogen PFPN, and nitrogen surplus), and cost-benefits analysis were measured and calculated over the maize growing season of 2020. Results had shown that on average the five innovative fertilizers (IF, IF+UI, IF+DI, IF+MI, and IF+TE) and CF that had optimized plant density and NPK input achieved 13.5%, 98.6%, 105.9%, 37.4% higher yield, PFPN, NUE, net-benefits as well as 67.5% lower N surplus compared with FP respectively. Notably, the innovative fertilizer with various effective additives (IF+UI, IF+DI, IF+MI, and IF+TE) which can be commonly found in the fertilizer market hadn’t resulted in an improvement in yield and NUE rather a greater cost and small net benefits in comparison to IF. In summary, our study highlighted the effectiveness of the combined strategy of optimized plant density, balancing NPK input, and innovative NPK products on sustainable maize production in NCP, however, the innovative fertilizers with effective additives should be properly selected for better economic benefits.</jats:p

Optimizing plant density and balancing NPK inputs in combination with innovative fertilizer product for sustainable maize production in North China Plain

AbstractExcessive NPK inputs but low grain yield and high environmental impact are common issues in maize production in North China Plain (NCP). The objective of our study was to test whether a combined strategy of optimizing plant density, balancing NPK input, and innovating one-time fertilizer products could achieve a more sustainable maize production in NCP. Thus, a field experiment was conducted at Luanna County NCP with the treatments of unfertilized control (CK), farmer practice (FP, conventional plant density and NPK input), conventional one-time urea-based coated fertilizer (CF, optimized plant density and NPK input), and five newly designed innovative one-time NPK fertilizers of ammonium sulphate and urea synergy (IF, optimized plant density and NPK input), innovative fertilizer with various additives of urea inhibitors (IF + UI), double inhibitors (IF + DI), micro-organisms (IF + MI), and trace elements (IF + TE). The grain yield, N sustainability indicators (N use efficiency NUE, partial factor productivity of N PFPN, and N surplus), and cost-benefits analysis were examined over the maize growing season of 2020. Results had shown that on average the five innovative fertilizers (IF, IF + UI, IF + DI, IF + MI, and IF + TE) and CF that had optimized plant density and NPK input achieved 13.5%, 98.6%, 105.9%, 37.4% higher yield, PFPN, NUE, net-benefits as well as 207.1% lower N surplus compared with FP respectively. Notably, the innovative fertilizer with various effective additives (IF + UI, IF + DI, IF + MI, and IF + TE) which can be commonly found in the fertilizer market hadn’t resulted in a significant improvement in yield and NUE rather a greater cost and lower net benefits in comparison to IF. In summary, our study highlighted the effectiveness of the combined strategy of optimized plant density, balancing NPK input, and innovative NPK fertiliser on sustainable maize production in NCP, however, the innovative fertilisers with effective additives should be properly selected for better economic benefits.</jats:p

Towards the circular nitrogen economy - a global meta-analysis of composting technologies reveals much potential for mitigating nitrogen losses

Composting is an important technology to treat biowastes and recycle nutrients, but incurs nitrogen (N) losses that lower the value of the final products and cause pollution. Technologies aimed at reducing N losses during composting have inconsistent outcomes. To deepen insight into mitigation options, we conducted a global meta-analysis based on 932 observations from 121 peer-reviewed published studies. Overall, N losses averaged 31.4% total N (TN), 17.2% NH-N, and 1.4% NO-N, with NH-N accounting for 55% of TN losses. The primary drivers affecting N losses were composting method, type of biowaste, and duration of composting. N losses were significantly impacted by the carbon-to-nitrogen (C/N) ratio of the input materials (feedstock of nutrient dense biowastes and C-rich bulking agents), moisture content and pH. Our analysis revealed N-conserving optima with C/N ratios of 25-30, 60-65% moisture content and pH 6.5-7.0. In situ mitigation technologies that control feedstock and processing conditions reduced average N losses by 31.4% (TN), 35.4% (NH-N) and 35.8% (NO-N). Biochar and magnesium-phosphate salts emerged as the most effective N-conserving strategies, curbing losses of TN by 30.2 and 60.6%, NH by 52.6 and 69.4%, and NO by 66.2 and 35.4% respectively. We conclude that existing technologies could preserve ~0.6\ua0Tg of biowaste-N globally, which equates to 16% of the chemical N-fertilizer used in African croplands, or 39% of the annual global increases of 1.58\ua0Tg fertilizer-N. However, the adoption of N-conserving technologies is constrained by a lack of knowledge of best practice, suitable infrastructure, policies and receptive markets. To realize an N-conserving composting industry that supports sustainable practices and the circular nitrogen economy, stakeholders have to act collectively. Benefits will include lowering direct and indirect greenhouse gas emissions associated with agriculture, and facilitating the recarbonization of soils

Research and Evaluation on Dynamic Response Characteristics of Various Pavement Structures

In order to comprehensively analyze the dynamic response of full-depth asphalt pavement under moving load, a three-dimensional model of pavement structure and dynamic load moving zone are established based on ABAQUS finite element software. Based on the time history curves of different structures, the stress-strain states at the bottom of each structural layer in different structures under moving load are analyzed. The results show that the stress, strain, and shear stress of the middle layer of full-depth pavement are smaller than those of semirigid base pavement, and rutting is closely related to the deformation of this layer. The dynamic response results of the same structure at different speeds are similar, but the increase of the maximum speed will increase the shear stress at the bottom of the layer, and the road is more prone to longitudinal crack.</jats:p

Research and Evaluation on Dynamic Response Characteristics of Various Pavement Structures

In order to comprehensively analyze the dynamic response of full-depth asphalt pavement under moving load, a three-dimensional model of pavement structure and dynamic load moving zone are established based on ABAQUS finite element software. Based on the time history curves of different structures, the stress-strain states at the bottom of each structural layer in different structures under moving load are analyzed. The results show that the stress, strain, and shear stress of the middle layer of full-depth pavement are smaller than those of semirigid base pavement, and rutting is closely related to the deformation of this layer. The dynamic response results of the same structure at different speeds are similar, but the increase of the maximum speed will increase the shear stress at the bottom of the layer, and the road is more prone to longitudinal crack