Cluster randomised controlled trial to assess a tailored intervention to reduce antibiotic prescribing in rural China:study protocol

INTRODUCTION: Up to 80% of patients with respiratory tract infections (RTI) attending healthcare facilities in rural areas of China are prescribed antibiotics, many of which are unnecessary. Since 2009, China has implemented several policies to try to reduce inappropriate antibiotic use; however, antibiotic prescribing remains high in rural health facilities. METHODS AND ANALYSIS: A cluster randomised controlled trial will be carried out to estimate the effectiveness and cost effectiveness of a complex intervention in reducing antibiotic prescribing at township health centres in Anhui Province, China. 40 Township health centres will be randomised at a 1:1 ratio to the intervention or usual care arms. In the intervention group, practitioners will receive an intervention comprising: (1) training to support appropriate antibiotic prescribing for RTI, (2) a computer-based treatment decision support system, (3) virtual peer support, (4) a leaflet for patients and (5) a letter of commitment to optimise antibiotic use to display in their clinic. The primary outcome is the percentage of antibiotics (intravenous and oral) prescribed for RTI patients. Secondary outcomes include patient symptom severity and duration, recovery status, satisfaction, antibiotic consumption. A full economic evaluation will be conducted within the trial period. Costs and savings for both clinics and patients will be considered and quality of life will be measured by EuroQoL (EQ-5D-5L). A qualitative process evaluation will explore practitioner and patient views and experiences of trial processes, intervention fidelity and acceptability, and barriers and facilitators to implementation. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Biomedical Research Ethics Committee of Anhui Medical University (Ref: 20180259); the study has undergone due diligence checks and is registered at the University of Bristol (Ref: 2020-3137). Research findings will be disseminated to stakeholders through conferences and peer-reviewed journals in China, the UK and internationally. TRIAL REGISTRATION NUMBER: ISRCTN30652037

Extraction of chromium from tannery sewage sludge

The leather industry produces a large amount of tannery sewage sludge every year, which is a dangerous solid waste, but also a secondary resource. In the present research, the extraction of chromium from the tannery sewage sludge was investigated through the process of blank roasting-sodium carbonate roasting-water leaching and the process of sulfuric acid curing-water leaching, respectively. The process of sulfuric acid curing-water leaching was characterised by high extraction of chromium, a simple process as well as low cost of mineral decomposition, which made it the better option. For the process of sulfuric acid curing-water leaching, the leaching of chromium reached up to 99.5% under the optimum conditions of sulfuric acid curing (raw tannery sewage sludge cured at room temperature for 5 min with 42 wt% sulfuric acid addition), followed by water leached at 100°C for 30 min with a liquid/solid ratio of 2 mL/g

Pharmacodynamic and pharmacokinetic characterization of the aldosterone synthase inhibitor FAD286 in two rodent models of hyperaldosteronism: comparison with the 11{beta}-hydroxylase inhibitor metyrapone

Aldosterone synthase (CYP11B2) inhibitors (ASI) represent an attractive therapeutic approach for mitigating the untoward effects of aldosterone. We characterized the pharmacokinetic/pharmacodynamic relationships of a prototypical ASI FAD286 (FAD) and compared these profiles to the "11beta-hydroxylase inhibitor" metyrapone (MET) in two rodent models of secondary hyperaldosteronism and corticosteronism. In chronically cannulated Sprague-Dawley rats, angiotensin II (ANG II, 300 ng/kg bolus + 100 ng/kg/min infusion) or adrenocorticotropic hormone (ACTH, 100 ng/kg + 30 ng/kg/min) acutely elevated plasma aldosterone concentration (PAC) from ~0.26 nM to a sustained level of ~2.5 nM for 9 h. ACTH but not ANG II elicited a sustained increase in plasma corticosterone concentration (PCC) from ~300 nM to ~1340 nM. After 1 h of Ang II or ACTH infusion, FAD (0.01-100 mg/kg p.o.) or MET (0.1-300 mg/kg p.o.) dose- and drug-plasma-concentration-dependently reduced the elevated PACs over the ensuing 8 h. FAD was ~12 times more dose-potent than MET in reducing PAC but of similar or slightly greater potency on a plasma drug concentration basis. Both agents also decreased PCC in the ACTH model at relatively higher doses and with similar dose potencies whereas FAD was 6-fold weaker based on drug exposures. FAD was ~50-fold selective for reducing PAC vs. PCC whereas MET was only ~3-fold selective. We conclude that FAD is a potent, orally active, and relatively selective ASI in two rat models of hyperaldosteronism. MET is an order of magnitude less selective than FAD but is, nevertheless, more potent as an ASI than as an 11beta-hydroxylase inhibitor

The growth morphologies of GaN layer on Si(111) substrate

International audienceThe growth morphologies of metalorganic chemical vapor deposition (MOCVD) grown GaN layer on Si(1 1 1) substrate were studied using atomic force microscopy and transmission electron microscopy. It was found that the growth process of GaN/Si(1 1 1) consisted of two cycles of island growth and coalescence. These two cycles process differs markedly from that of one cycle process reported. The stress of evolving GaN layers on Si(1 1 1) was characterized by measuring the lattice constant c of GaN using X-ray diffraction (XRD) technique. It was proposed that the large tensile stress within the film during growth initiated this second island growth cycle, and the interaction between the GaN islands with high orientational fluctuation on the buffer layer induced this large tensile growth stress when coalescence occurred