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

Recurrent DNMT3A R882 Mutations in Chinese Patients with Acute Myeloid Leukemia and Myelodysplastic Syndrome

Somatic mutations of DNMT3A gene have recently been reported in acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). We examined the entire coding sequences of DNMT3A gene by high-resolution melting analysis and sequencing in Chinese patients with myeloid malignancies. R882 mutations were found in 12/182 AML and in 4/51 MDS, but not in either 79 chronic myeloid leukemia (CML), or 57 myeloproliferative neoplasms (MPNs), or 4 chronic monomyelocytic leukemia. No other DNMT3A mutations were detected in all patients. R882 mutations were associated with old age and more frequently present in monoblastic leukemia (M4 and M5, 7/52) compared to other subtypes (5/130). Furthermore, 14/16 (86.6%) R882 mutations were observed in patients with normal karyotypes. The overall survival of mutated MDS patients was shorter than those without mutation (median 9 and 25 months, respectively). We conclude that DNMT3A R882 mutations are recurrent molecular aberrations in AML and MDS, and may be an adverse prognostic event in MDS

Observation of ηc→ωω\eta_c\to\omega\omega in J/ψ→γωωJ/\psi\to\gamma\omega\omega

Using a sample of $(1310.6\pm7.0)\times10^6$ $J/\psi$ events recorded with the BESIII detector at the symmetric electron positron collider BEPCII, we report the observation of the decay of the $(1^1 S_0)$ charmonium state $\eta_c$ into a pair of $\omega$ mesons in the process $J/\psi\to\gamma\omega\omega$. The branching fraction is measured for the first time to be $\mathcal{B}(\eta_c\to\omega\omega)= (2.88\pm0.10\pm0.46\pm0.68)\times10^{-3}$, where the first uncertainty is statistical, the second systematic and the third is from the uncertainty of $\mathcal{B}(J/\psi\to\gamma\eta_c)$. The mass and width of the $\eta_c$ are determined as $M=(2985.9\pm0.7\pm2.1)\,$MeV/$c^2$ and $\Gamma=(33.8\pm1.6\pm4.1)\,$MeV.Comment: 13 pages, 6 figure

Observation and study of the decay J/ψ→ϕηη′J/\psi\rightarrow\phi\eta\eta'

We report the observation and study of the decay $J/\psi\rightarrow\phi\eta\eta'$ using $1.3\times{10^9}$ $J/\psi$ events collected with the BESIII detector. Its branching fraction, including all possible intermediate states, is measured to be $(2.32\pm0.06\pm0.16)\times{10^{-4}}$. We also report evidence for a structure, denoted as $X$, in the $\phi\eta'$ mass spectrum in the $2.0-2.1$ GeV/$c^2$ region. Using two decay modes of the $\eta'$ meson ($\gamma\pi^+\pi^-$ and $\eta\pi^+\pi^-$), a simultaneous fit to the $\phi\eta'$ mass spectra is performed. Assuming the quantum numbers of the $X$ to be $J^P = 1^-$, its significance is found to be 4.4$\sigma$, with a mass and width of $(2002.1 \pm 27.5 \pm 21.4)$ MeV/$c^2$ and $(129 \pm 17 \pm 9)$ MeV, respectively, and a product branching fraction $\mathcal{B}(J/\psi\rightarrow\eta{}X)\times{}\mathcal{B}(X\rightarrow\phi\eta')=(9.8 \pm 1.2 \pm 1.7)\times10^{-5}$. Alternatively, assuming $J^P = 1^+$, the significance is 3.8$\sigma$, with a mass and width of $(2062.8 \pm 13.1 \pm 7.2)$ MeV/$c^2$ and $(177 \pm 36 \pm 35)$ MeV, respectively, and a product branching fraction $\mathcal{B}(J/\psi\rightarrow\eta{}X)\times{}\mathcal{B}(X\rightarrow\phi\eta')=(9.6 \pm 1.4 \pm 2.0)\times10^{-5}$. The angular distribution of $J/\psi\rightarrow\eta{}X$ is studied and the two $J^P$ assumptions of the $X$ cannot be clearly distinguished due to the limited statistics. In all measurements the first uncertainties are statistical and the second systematic.Comment: 10 pages, 6 figures and 4 table

Evidence of a resonant structure in the e+e−→π+D0D∗−e^+e^-\to \pi^+D^0D^{*-} cross section between 4.05 and 4.60 GeV

The cross section of the process $e^+e^-\to \pi^+D^0D^{*-}$ for center-of-mass energies from 4.05 to 4.60~GeV is measured precisely using data samples collected with the BESIII detector operating at the BEPCII storage ring. Two enhancements are clearly visible in the cross section around 4.23 and 4.40~GeV. Using several models to describe the dressed cross section yields stable parameters for the first enhancement, which has a mass of 4228.6 \pm 4.1 \pm 6.3 \un{MeV}/c^2 and a width of 77.0 \pm 6.8 \pm 6.3 \un{MeV}, where the first uncertainties are statistical and the second ones are systematic. Our resonant mass is consistent with previous observations of the $Y(4220)$ state and the theoretical prediction of a $D\bar{D}_1(2420)$ molecule. This result is the first observation of $Y(4220)$ associated with an open-charm final state. Fits with three resonance functions with additional $Y(4260)$, $Y(4320)$, $Y(4360)$, $\psi(4415)$, or a new resonance, do not show significant contributions from either of these resonances. The second enhancement is not from a single known resonance. It could contain contributions from $\psi(4415)$ and other resonances, and a detailed amplitude analysis is required to better understand this enhancement

Observation of Ds+→pnˉD^+_s\rightarrow p\bar{n} and confirmation of its large branching fraction

The baryonic decay $D^+_s\rightarrow p\bar{n}$ is observed, and the corresponding branching fraction is measured to be $(1.21\pm0.10\pm0.05)\times10^{-3}$, where the first uncertainty is statistical and second systematic. The data sample used in this analysis was collected with the BESIII detector operating at the BEPCII $e^+e^-$ double-ring collider with a center-of-mass energy of 4.178~GeV and an integrated luminosity of 3.19~fb$^{-1}$. The result confirms the previous measurement by the CLEO Collaboration and is of greatly improved precision, which may deepen our understanding of the dynamical enhancement of the W-annihilation topology in the charmed meson decays

First observations of hc→h_c \to hadrons

Based on $(4.48 \pm 0.03) \times 10^{8}$ $\psi(3686)$ events collected with the BESIII detector, five $h_c$ hadronic decays are searched for via process $\psi(3686) \to \pi^0 h_c$. Three of them, $h_c \to p \bar{p} \pi^+ \pi^-$, $\pi^+ \pi^- \pi^0$, and $2(\pi^+ \pi^-) \pi^0$ are observed for the first time, with statistical significances of 7.4$\sigma$, $4.9\sigma$, and 9.1$\sigma$, and branching fractions of $(2.89\pm0.32\pm0.55)\times10^{-3}$, $(1.60\pm0.40\pm0.32)\times10^{-3}$, and $(7.44\pm0.94\pm1.56)\times10^{-3}$, respectively, where the first uncertainties are statistical and the second systematic. No significant signal is observed for the other two decay modes, and the corresponding upper limits of the branching fractions are determined to be $B(h_c \to 3(\pi^+ \pi^-) \pi^0)<8.7\times10^{-3}$ and $B(h_c \to K^+ K^- \pi^+ \pi^-)<5.8\times10^{-4}$ at 90% confidence level.Comment: 17 pages, 16 figure

Measurements of Weak Decay Asymmetries of Λc+→pKS0\Lambda_c^+\to pK_S^0, Λπ+\Lambda\pi^+, Σ+π0\Sigma^+\pi^0, and Σ0π+\Sigma^0\pi^+

Using $e^+e^-\to\Lambda_c^+\bar\Lambda_c^-$ production from a 567 pb$^{-1}$ data sample collected by BESIII at 4.6 GeV, a full angular analysis is carried out simultaneously on the four decay modes of $\Lambda_c^+\to pK_S^0$, $\Lambda \pi^+$, $\Sigma^+\pi^0$, and $\Sigma^0\pi^+$. For the first time, the $\Lambda_c^+$ transverse polarization is studied in unpolarized $e^+e^-$ collisions, where a non-zero effect is observed with a statistical significance of 2.1$\sigma$. The decay asymmetry parameters of the $\Lambda_c^+$ weak hadronic decays into $pK_S^0$, $\Lambda\pi^+$, $\Sigma^+\pi^0$ and $\Sigma^0\pi^+$ are measured to be $0.18\pm0.43(\rm{stat})\pm0.14(\rm{syst})$, $-0.80\pm0.11(\rm{stat})\pm0.02(\rm{syst})$, $-0.57\pm0.10(\rm{stat})\pm0.07(\rm{syst})$, and $-0.73\pm0.17(\rm{stat})\pm0.07(\rm{syst})$, respectively. In comparison with previous results, the measurements for the $\Lambda\pi^+$ and $\Sigma^+\pi^0$ modes are consistent but with improved precision, while the parameters for the $pK_S^0$ and $\Sigma^0\pi^+$ modes are measured for the first time

Observation of D+→f0(500)e+νeD^+ \to f_0(500) e^+\nu_e and Improved Measurements of D→ρe+νeD \to\rho e^+\nu_e

Using a data sample corresponding to an integrated luminosity of 2.93~fb$^{-1}$ recorded by the BESIII detector at a center-of-mass energy of $3.773$ GeV, we present an analysis of the decays $\bar{D}^0\to\pi^+\pi^0 e^-\bar{\nu}_e$ and $D^+\to\pi^-\pi^+ e^+\nu_e$. By performing a partial wave analysis, the $\pi^+\pi^-$ $S$-wave contribution to $D^+\to\pi^-\pi^+ e^+\nu_e$ is observed to be $(25.7\pm1.6\pm1.1)$% with a statistical significance greater than 10$\sigma$, besides the dominant $P$-wave contribution. This is the first observation of the $S$-wave contribution. We measure the branching fractions $\mathcal{B}(D^{0} \to \rho^- e^+ \nu_e) = (1.445\pm 0.058 \pm 0.039) \times10^{-3}$, $\mathcal{B}(D^{+} \to \rho^0 e^+ \nu_e) = (1.860\pm 0.070 \pm 0.061) \times10^{-3}$, and $\mathcal{B}(D^{+} \to f_0(500) e^+ \nu_e, f_0(500)\to\pi^+\pi^-) = (6.30\pm 0.43 \pm 0.32) \times10^{-4}$. An upper limit of $\mathcal{B}(D^{+} \to f_0(980) e^+ \nu_e, f_0(980)\to\pi^+\pi^-) < 2.8 \times10^{-5}$ is set at the 90% confidence level. We also obtain the hadronic form factor ratios of $D\to \rho e^+\nu_e$ at $q^{2}=0$ assuming the single-pole dominance parameterization: $r_{V}=\frac{V(0)}{A_{1}(0)}=1.695\pm0.083\pm0.051$, $r_{2}=\frac{A_{2}(0)}{A_{1}(0)}=0.845\pm0.056\pm0.039$