Availability, cost, and prescription patterns of antihypertensive medications in primary health care in China: a nationwide cross-sectional survey

Background: Around 200 million adults in China have hypertension, but few are treated or achieve adequate control of their blood pressure. Available and affordable medications are important for successfully controlling hypertension, but little is known about current patterns of access to, and use of, antihypertensive medications in Chinese primary health care. Methods: We used data from a nationwide cross-sectional survey (the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project primary health care survey), which was undertaken between November, 2016 and May, 2017, to assess the availability, cost, and prescription patterns of 62 antihypertensive medications at primary health-care sites across 31 Chinese provinces. We surveyed 203 community health centres, 401 community health stations, 284 township health centres, and 2474 village clinics to assess variation in availability, cost, and prescription by economic region and type of site. We also assessed the use of high-value medications, defined as guideline-recommended and low-cost. We also examined the association of medication cost with availability and prescription patterns. Findings: Our study sample included 3362 primary health-care sites and around 1 million people (613 638 people at 2758 rural sites and 478 393 people at 604 urban sites). Of the 3362 sites, 8·1% (95% CI 7·2–9·1) stocked no antihypertensive medications and 33·8% (32·2–35·4) stocked all four classes that were routinely used. Village clinics and sites in the western region of China had the lowest availability. Only 32·7% (32·2–33·3) of all sites stocked high-value medications, and few high-value medications were prescribed (11·2% [10·9–11·6] of all prescription records). High-cost medications were more likely to be prescribed than low-cost alternatives. Interpretation: China has marked deficiencies in the availability, cost, and prescription of antihypertensive medications. High-value medications are not preferentially used. Future efforts to reduce the burden of hypertension, particularly through the work of primary health-care providers, will need to improve access to, and use of, antihypertensive medications, paying particular attention to those with high value

Spatial variations in soil erodibility induced by rock outcropping on sloping cropland in the karst region of Southwest China

Sloping croplands in karst areas of Southwest China usually contain a multitude of rock outcrops with diameters larger than 25 cm. Rock outcrops and spatial location have substantial effects on soil properties and thus likely affect soil erodibility. Moreover, rock outcropping is a indicator of rocky desertification and has an important impact on soil erosion and soil formation processes. However, the potential effects of spatial location and rock outcrops on the soil erodibility of sloping cropland in karst areas are still unclear. This study was performed to explore the variations in soil erodibility reflected by saturated hydraulic conductivity (KS), mean weight diameter (MWD), soil structural stability (SSI), soil erodibility factor (K) and soil organic carbon content (SOC) at three spatial locations in sloping cropland with rock outcrops on the karst hillside. The results showed that the soil erodibility indicators KS, MWD, SSI and SOC declined with increasing soil depth for all tested sites. SSI and SOC were predominant factors contributing to the variation in soil erodibility, which were 34.9 % and 35.1 % at the upper spatial location, 31.4 % and 30.9 % at the middle spatial location, and 32.1 % and 32.6 % at the lower spatial location, respectively. There were significant variations in the K factor between the sloping cropland with rock outcrops and the control group. The variations in soil erodibility indicators with rock outcrops and spatial locations were attributed to the changes in soil particle distribution, soil bulk density and SOC. There was a significant linear correlation between the K factor and spatial location, slope gradient, coverage and height of rock outcrops. These results indicated that rock outcrops and their characteristics can reduce soil erosion intensity by redistributing precipitation and runoff, thus further affecting infiltration and soil erodibility. These findings are helpful to comprehend the processes and mechanisms of the spatial variation in soil erosion on sloping cropland with rock outcrops

Confront or Comply? Managing Social Risks in China’s Urban Renewal Projects

Social sustainability is a major concern of planners and local officials when urban renewal projects are being conducted. Extreme individualism can potentially cause conflicts of interest, making urban renewal in Western cities fraught with various types of social risks. As a country with a deep-rooted socialist tradition, urban renewal projects in China are influenced by collectivist culture and show different features from those of the West. The objective of this research is to investigate how different stakeholders in urban redevelopment projects, including local residents, social organizations, the local state, and developers, interact with each other and how the associated social risks are hedged against. Using a recent well-known project in the city of Guangzhou, the authors attempt to present the latest progress in social risk management in China. With support from a government-sponsored project, the authors have conducted a questionnaire-based survey with a year-long fieldwork follow-up. Using ATLAS.ti software, we found that that “residents’ demand”, “status of collaboration”, and “degree of trust” are the keys to risk management. The results of an ordered probit model show that residents are worried about overall planning, the relocation timetable, and whether their personal needs are taken into account. It is also indicated that the timely disclosure of project information, high-quality public participation, and a reasonable compensation plan can possibly boost the support rate. The authors suggest that utilizing China’s collectivist culture could be an effective way to mitigate social risks, and residents’ personal interests should also be respected

An Adaptive Switching Control Strategy under Heavy–Light Load for the Bidirectional LLC Considering Parasitic Capacitance

The LLC topology is widely used to link renewable energy and inverters to provide constant voltage in the smart grid. Due to its characteristics, the voltage regulation range under light load conditions is limited, so that the output voltage cannot be maintained constant. The adaptive switching control strategy is proposed in this paper to keep the output constant. Under heavy load conditions, the voltage is kept constant by adjusting the frequency to ensure the accuracy of the control. The phase shift is adjusted to achieve constant voltage, considering the influence of parasitic capacitance on the modeling process for the changing trend of output voltage in light load conditions. The switching point is calculated from the characteristic curve to ensure that the output voltage is stable during mode switching. In addition, there is a new hysteresis control which is robust near the switching point to cope with the instability of the new energy itself and frequent disturbance under light load. Finally, a 400V–36V–1KW prototype is used to verify this control strategy

Eocene Sedimentary–Diagenetic Environment Analysis of the Pingtai Area of the Qaidam Basin

Based on the petrological characteristics and elemental geochemical analysis of core samples from the Pingtai area in the northern structural belt of the Qaidam Basin, this study shows that the clay mineral assemblage of Lulehe Formation sandstone is dominated by high contents of smectite, chlorite and illite, and does not contain illite–smectite mixed layers or kaolinite. The chlorite and illite in the Xiaganchaigou Formation decreased gradually and the smectite disappeared. In addition, illite–smectite mixed layers began to appear and kaolinite was not present. These results indicate that the diagenetic environment of the Pingtai area in the early Eocene was dominated by alkaline media poor in K+ and rich in Mg2+, Na+ and Ca2+. In the late Eocene, K+ content in the diagenetic medium increased significantly, and smectite began to transform into illite. From the early Eocene to the late Eocene, the overall climate and environmental characteristics showed a transition from cold and dry to a cold climate that alternated between dry and wet. The content changes of common oxides, such as CaO, MgO, K2O, Na2O, SiO2, Al2O3, Fe2O3 and TiO2, showed obvious correlation. Based on the content and ratio change tendencies of Sr, Ba, Cu, Zn, U, Th, Ce and other trace elements, combined with the variation characteristics of rare earth element contents, it is suggested that the Lulehe Formation was dominated by a dry and cold freshwater sedimentary environment, and that paleoclimatic conditions were relatively cold and arid during this sedimentary period. However, the climate in the sedimentary period of the Xiaganchaigou Formation was dominated by a cold environment alternating between dry and wet, which also reflected the finding that the global climate was mainly cold and dry in the early Eocene and gradually became warm and humid in the late Eocene

Eocene Sedimentary–Diagenetic Environment Analysis of the Pingtai Area of the Qaidam Basin

Based on the petrological characteristics and elemental geochemical analysis of core samples from the Pingtai area in the northern structural belt of the Qaidam Basin, this study shows that the clay mineral assemblage of Lulehe Formation sandstone is dominated by high contents of smectite, chlorite and illite, and does not contain illite–smectite mixed layers or kaolinite. The chlorite and illite in the Xiaganchaigou Formation decreased gradually and the smectite disappeared. In addition, illite–smectite mixed layers began to appear and kaolinite was not present. These results indicate that the diagenetic environment of the Pingtai area in the early Eocene was dominated by alkaline media poor in K+ and rich in Mg2+, Na+ and Ca2+. In the late Eocene, K+ content in the diagenetic medium increased significantly, and smectite began to transform into illite. From the early Eocene to the late Eocene, the overall climate and environmental characteristics showed a transition from cold and dry to a cold climate that alternated between dry and wet. The content changes of common oxides, such as CaO, MgO, K2O, Na2O, SiO2, Al2O3, Fe2O3 and TiO2, showed obvious correlation. Based on the content and ratio change tendencies of Sr, Ba, Cu, Zn, U, Th, Ce and other trace elements, combined with the variation characteristics of rare earth element contents, it is suggested that the Lulehe Formation was dominated by a dry and cold freshwater sedimentary environment, and that paleoclimatic conditions were relatively cold and arid during this sedimentary period. However, the climate in the sedimentary period of the Xiaganchaigou Formation was dominated by a cold environment alternating between dry and wet, which also reflected the finding that the global climate was mainly cold and dry in the early Eocene and gradually became warm and humid in the late Eocene

Efficient Tandem Addition/Cyclization for Access to 2,4-Diarylquinazolines via Catalytic Carbopalladation of Nitriles

The first example of the palladium-catalyzed tandem addition/cyclization of 2-(benzylidenamino)benzonitriles with arylboronic acids has been developed. This transformation features good functional group tolerance and provides an alternative synthetic pathway to access 2,4-diarylquinazolines in moderate to good yields. A plausible mechanism for the formation of 2,4-diarylquinazolines involving sequential nucleophilic addition followed by an intramolecular cyclization is proposed

Roles of the Siglec family in bone and bone homeostasis

Tremendous progress has been seen in the study of the role of sialic acid binding im-munoglobulin type lectins (Siglecs) in osteoimmunology in the past two decades. Interest in Siglecs as immune checkpoints has grown from the recognition that Siglecs have relevance to human disease. Siglecs play important roles in inflammation and cancer, and play key roles in immune cell signaling. By recognizing common sialic acid containing glycans on glycoproteins and glycolipids as regulatory receptors for immune cell signals, Siglecs are expressed on most immune cells and play important roles in normal homeostasis and self-tolerance. In this review, we describe the role that the siglec family plays in bone and bone homeostasis, including the regulation of osteoclast differentiation as well as recent advances in inflammation, cancer and osteoporosis. Particular emphasis is placed on the relevant functions of Siglecs in self-tolerance and as pattern recognition receptors in immune responses, thereby potentially providing emerging strategies for the treatment of bone related diseases