Adapting a generic tuberculosis control operational guideline and scaling it up in China: a qualitative case study

<p>Abstract</p> <p>Background</p> <p>The TB operational guideline (the <it>deskguide</it>) is a detailed action guide for county TB doctors aiming to improve the quality of DOTS, while the China national TB policy guide is a guide to TB control that is comprehensive but lacks operational usability for frontline TB doctors. This study reports the process of deskguide adaptation, its scale-up and lessons learnt for policy implications.</p> <p>Methods</p> <p>The deskguide was translated, reviewed, and revised in a working group process. Details of the eight adaptation steps are reported here. An operational study was embedded in the adaptation process. Two comparable prefectures were chosen as pilot and control sites in each of two participating provinces. In the pilot sites, the deskguide was used with the national policy guide in routine in-service training and supervisory trips; while in the control sites, only the national policy guide was used. In-depth interviews and focus groups were conducted with 16 county TB doctors, 16 township doctors, 17 village doctors, 63 TB patients and 57 patient family members. Following piloting, the deskguide was incorporated into the national TB guidelines for county TB dispensary use.</p> <p>Results</p> <p>Qualitative research identified that the deskguide was useful in the daily practice of county TB doctors. Patients in the pilot sites had a better knowledge of TB and better treatment support compared with those in the control sites.</p> <p>Conclusion</p> <p>The adaptation process highlighted a number of general strategies to adapt generic guidelines into country specific ones: 1) local policy-makers and practitioners should have a leading role; 2) a systematic working process should be employed with capable focal persons; and 3) the guideline should be embedded within the current programmes so it is sustainable and replicable for further scale-up.</p

Artificial Macrophage with Hierarchical Nanostructure for Biomimetic Reconstruction of Antitumor Immunity

Highlights An artificial macrophage with hierarchical nanostructure (BaSO4@ZIF-8/TRF NMΦ) is constructed as an alternative to immunoactive macrophages. The Zn2+ chemical messenger as an “artificial cytokine” is released from the artificial macrophage to induce tumor anoikis and enhance immunogenicity. The artificial macrophage can efficiently capture tumor antigens for antigen presentation and T cell activation to fabricate long-term antitumor immunity, successfully mimicking the basic functions of natural immunoactive macrophage

Ultrasensitive and fast photoresponse in graphene/silicon-on-insulator hybrid structure by manipulating the photogating effect

The hybrid structures of graphene with semiconductor materials based on photogating effect have attracted extensive interest in recent years due to the ultrahigh responsivity. However, the responsivity (or gain) was increased at the expense of response time. In this paper, we devise a mechanism which can obtain an enhanced responsivity and fast response time simultaneously by manipulating the photogating effect (MPE). This concept is demonstrated by using a graphene/silicon-on-insulator (GSOI) hybrid structure. An ultrahigh responsivity of more than 107 A/W and a fast response time of 90 µs were obtained. The specific detectivity D* was measured to be 1.46 ⨯ 1013 Jones at a wavelength of 532 nm. The Silvaco TCAD modeling was carried out to explain the manipulation effect, which was further verified by the GSOI devices with different doping levels of graphene in the experiment. The proposed mechanism provides excellent guidance for modulating carrier distribution and transport, representing a new route to improve the performance of graphene/semiconductor hybrid photodetectors

MOF-Templated Fabrication of Hollow Co₄N@N-Doped Carbon Porous Nanocages with Superior Catalytic Activity

Metallic Co₄N catalysts have been considered as one of the most promising non-noble materials for heterogeneous catalysis because of their high electrical conductivity, great magnetic property, and high intrinsic activity. However, the metastable properties seriously limit their applications for heterogeneous water phase catalysis. In this work, a novel Co-metal–organic framework (MOF)-derived hollow porous nanocages (PNCs) composed of metallic Co₄N and N-doped carbon (NC) were synthesized for the first time. This hollow three-dimensional (3D) PNC catalyst was synthesized by taking advantage of Co-MOF as a precursor for fabricating 3D hollow Co₃O₄@C PNCs, along with the NH₃ treatment of Co-oxide frames to promote the in situ conversion of Co-MOF to Co₄N@NC PNCs, benefiting from the high intrinsic activity and electron conductivity of the metallic Co₄N phase and the good permeability of the hollow porous nanostructure as well as the efficient doping of N into the carbon layer. Besides, the covalent bridge between the active Co₄N surface and PNC shells also provides facile pathways for electron and mass transport. The obtained Co₄N@NC PNCs exhibit excellent catalytic activity and stability for 4-nitrophenol reduction in terms of low activation energy (<i>E</i>_a = 23.53 kJ mol^–1), high turnover frequency (52.01 × 10²⁰ molecule g^–1 min^–1), and high apparent rate constant (<i>k</i>_app = 2.106 min^–1). Furthermore, its magnetic property and stable configuration account for the excellent recyclability of the catalyst. It is hoped that our finding could pave the way for the construction of other hollow transition metal-based nitride@NC PNC catalysts for wide applications

Adverse reactions due to directly observed treatment strategy therapy in Chinese tuberculosis patients: a prospective study.

BACKGROUND: More than 1 million tuberculosis (TB) patients are receiving directly observed treatment strategy (DOTS) therapy in China every year. As to the profile of adverse drug reactions (ADRs) due to DOTS therapy, no consensus has been reached. There is no report regarding ADRs due to DOTS therapy with a large Chinese TB population. This study aimed to determine the incidence and prognosis of ADRs due to DOTS therapy, and to evaluate their impact on anti-TB treatment in China. METHODS: A prospective population-based cohort study was performed during 2007-2008. Sputum smear positive pulmonary TB patients who received DOTS therapy were included and followed up for six to nine months in 52 counties of four regions in China. The suspected ADRs were recorded and reviewed by Chinese State Food and Drug Administration. RESULTS: A total of 4304 TB patients were included in this study. 649 patients (15.08%) showed at least one ADR and 766 cases in total were detected. The incidence (count) of ADR based on affected organ was: liver dysfunction 6.34% (273), gastrointestinal disorders 3.74% (161), arthralgia 2.51% (108), allergic reactions 2.35% (101), neurological system disorders 2.04% (88), renal impairment 0.07% (3) and others 0.05% (2). Most cases of ADRs (95%) had a good clinical outcome, while two with hepatotoxicity and one with renal impairment died. Compared with patients without ADRs, patients with ADRs were more likely to have positive smear test results at the end of the intensive phase (adjusted OR, 2.00; 95%CI, 1.44-2.78) and unsuccessful anti-TB outcomes (adjusted OR, 2.58; 95%CI, 1.43-4.68). CONCLUSIONS: The incidence of ADRs due to DOTS therapy was 15.08%. Those ADRs had a substantial impact on TB control in China. This highlighted the importance of developing strategies to ameliorate ADRs both to improve the quality of patient care and to control TB safely

Socio-behavioral and clinical characteristics along with HIV sero-positivity among participating tuberculosis (TB) patients in three provinces of China, 2010 (N = 1032).

<p>Socio-behavioral and clinical characteristics along with HIV sero-positivity among participating tuberculosis (TB) patients in three provinces of China, 2010 (N = 1032).</p

Factors correlated with HIV infection among TB patients in three provinces of China, 2010 (N = 1032).

<p><b>*</b>Model 1 adjusted for site, genders and areas of residence.</p><p>#: Model 2 adjusted for sites, genders, areas of residence, age and annual income.</p><p><a href="mailto:@" target="_blank">@</a>: The model did not work well.</p><p>Boldfaced figures indicated statistically significant results at α = 0.05.</p

Baseline Characteristics of 4304 Chinese tuberculosis patients.

<p>IQR, inter-quartile range.</p