This study aims to assess whether a standard intervention package of cardiovascular disease (CVD) care was being delivered effectively, and if it was associated with improved lifestyle and biomedical indicators. In rural China, we implemented a pragmatic cluster randomized controlled trial for 12 months, randomized at the township hospital level, and compared with usual care. Intervention case management guideline, training and performance monitoring meeting and patient support activities were designed to fit within the job description of family doctors in the township hospitals and comprised: 1) prescription of a standardised package of medicines targeted at those with hypertension or diabetes; 2) advice about specific lifestyle interventions; and 3) advice about medication adherence. Participants were 50–74 years old, had hypertension and CVD risk scores >20% or diabetes, but were excluded if a history of severe CVD events. We also randomly selected 100 participants from six selected clusters per arm as a panel to collect intermediate biomedical indicators over time. A total of 28,130 participants, in 33 intervention and 34 control township hospitals, were recruited. Compared with the control arm, participants in the intervention arm had substantially improved prescribing rates of anti-hypertensives, statins and aspirin (P<0.001), and had higher medication taking rates of aspirin and statins (P0.05). Implementation of the package by family doctors was feasible and improved prescribing and some lifestyle changes. Additional measures such as reducing medication costs and patient education are required. Current Controlled Trials ISRCTN58988083

This paper presents a field study on the axial behavior of four large-diameter drilled shafts embedded in coarse sand. The grouting and loading test procedures were reported. The bearing capacity of shafts (TS1 and TS2) and grouted drilled shafts (TS3 and TS4) were herein determined by the bi-directional static test and top-down load test, respectively. The enhancement mechanism of bearing characteristics of the grouted shafts was discussed in detail. The test results indicate that the bearing characteristics and load transfer mechanisms of the test shafts were significantly affected by the quantity of pressurized cement slurry and the mechanical properties of the soil surrounding the shafts. Furthermore, the tip resistance of shaft can be mobilized more rapidly and fully after grouting, the side and tip resistance are mobilized in a more synchronized and coordinated manner due to the pre-mobilization of the grouted cement. Additionally, the standard penetration test (SPT) prediction model was introduced to calculate and predict the SPT blow counts of soil after grouting. The results show that the post grouting has a more obvious improvement on the strength of cohesionless soil.

The extensive development of urban underground space increases the risk of deformation to adjacent structures during deep excavations. This study investigates the response of three low-strength strip-foundation buildings (#4, #8, and #11 of the Ninggong Apartment) in Nanjing, China, affected by the excavation of an adjacent super-long, narrow subway station. The site is located in a typical soft alluvial area of the Yangtze River, characterized by highly compressible and sensitive soil, which poses substantial challenges. Pre-construction ground improvement was implemented to mitigate the impacts of diaphragm wall trenching; however, monitoring data indicated that buildings’ settlements of this stage still reached 28.2%, 24.8%, and 27.2% of their final values, with extensive influence zones. Subsequent excavation of the eastern and middle sections induced further cumulative and differential settlements, raising safety concerns and necessitating structural strengthening before adjacent western excavation. An integrated underpinning system, combining anchor static pressure steel pipe piles with a raft foundation, was adopted. Although short-term settlement increased during pile and raft installation, post-strengthening settlement rates decreased significantly. The adjacent western excavation caused only 13.3% of the settlement to be observed during the middle section’s excavation. All buildings were ultimately protected from excessive deformation. The protective strategies and lessons learned provide practical guidance for similar projects.

In this paper, we propose a robust controller that achieves natural and stably fast locomotion on a real blind quadruped robot. With only proprioceptive information, the quadruped robot can move at a maximum speed of 10 times its body length, and has the ability to pass through various complex terrains. The controller is trained in the simulation environment by model-free reinforcement learning. In this paper, the proposed loose neighborhood control architecture not only guarantees the learning rate, but also obtains an action network that is easy to transfer to a real quadruped robot. Our research finds that there is a problem of data symmetry loss during training, which leads to unbalanced performance of the learned controller on the left-right symmetric quadruped robot structure, and proposes a mirror-world neural network to solve the performance problem. The learned controller composed of the mirror-world network can make the robot achieve excellent anti-disturbance ability. No specific human knowledge such as a foot trajectory generator are used in the training architecture. The learned controller can coordinate the robot's gait frequency and locomotion speed, and the locomotion pattern is more natural and reasonable than the artificially designed controller. Our controller has excellent anti-disturbance performance, and has good generalization ability to reach locomotion speeds it has never learned and traverse terrains it has never seen before.