SummaryBackgroundStaphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection.MethodsIn this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants.FindingsBetween Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18–45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference −1·4%, 95% CI −7·0 to 4·3; hazard ratio 0·96, 0·68–1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3–4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005).InterpretationAdjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia.FundingUK National Institute for Health Research Health Technology Assessment.

SummaryBackgroundResults of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects.MethodsFOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762.FindingsBetween Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months.InterpretationFluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function.FundingUK Stroke Association and NIHR Health Technology Assessment Programme.

Egyptian cotton leafworm, Spodoptera littoralis (Boisduval), is the most devastating agricultural lepidopterous pests of cotton and vegetable plants (Hatem et al., 2009). The intensive application of organophosphates, carbamates and pyrethroids insecticides has given rise to S. littoralis populations resistant to all of these groups (Abou-Taleb, 2010). Selective insecticides with modes of action differed from those insecticide groups are highly desirable in integrated pest management (IPM) programs. Among these insecticides are insect growth regulators (IGRs) and ivermectin insecticide group. IGRs were developed to mimic, block or otherwise interact with the hormonal system of insects (Oetken et al., 2004). These include the juvenile hormone analogues, the ecdysone agonists and the chitin synthesis inhibitors (CSIs) (Graf, 1993; Tunaz and Uygun, 2004). The use of insecticides may result in multiple sublethal effects on insect pests (Singh and Marwaha, 2000 and Sabri et al 2017). These sub-lethal effects as well as mortality must be considered when investigating the total effects of insecticides (Yin et al., 2008). Moreover, these sublethal doses may interfere with some biochemical process such as the related enzymes activity. One of the related enzymes to IGR's mode of action are phenoloxidases that related to critical steps of melanization reactions, which are crucial for the sclerotization of a new cuticle after ecdysis (Andersen, 2005). Therefore, the aim of the present work is to clarify toxicity and the role played by the sublethal dose LC50 of three IGRs belonging to CSIs on the 4 th instar larvae of S. littoralis in order to better understand of the action of these compounds on lepidopterous larvae through studying their effect on biochemical parameters. These parameters are attained by estimating activity of some enzyme affecting in cuticle formation. MATERIALS AND METHODS-Rearing technique of S. littoralis: S. littoralis strain used in this study is a laboratory susceptible strain reared in the Plant Protection Research Institute at Dokki, Giza Governorate according to El Defrawi et al., 1964.The culture was maintained under optimum conditions (27 0 C+2 and 70+5 RH) and reared on fresh castor bean leaves, the 2 nd & 4 th larval instar which used in this study.

Ergonomics is a multidisciplinary scientific discipline that studies man-artifact interaction. Ergonomics-tailored teaching and learning materials and activities require to consider jointly the needs of the users (i.e. teachers and students) and the resources within the learning environment. The fundamental question confronting educational ergonomics is how to incorporate ergonomics into interventions targeting designing features in the learning environment to improve the learning performance of EFL students, particularly English language integrated skills. This paper, therefore, sets out to show how ergonomics features that consider users' factors and reduce discomfort can be utilized in teaching the English language. It addresses the following points: the definition of ergonomics based-instruction, the importance of using ergonomics in EFL education, and how teachers can incorporate ergonomics in teaching the English language integrated skills. Finally, the researchers provide conclusions and pedagogical implications as well as suggestions for future research agenda regarding adopting an ergonomics perspective in EFL education and fostering ergonomics literacy.