The Differential Impact of COVID-19 on Labour Market Outcomes of Immigrants in Canada.

Based on Canadian Labour Force Survey data, we estimate the differential effect of the COVID-19 pandemic on seven labour market outcomes, and separate between recent and established immigrants relative to domestic-born Canadians. We also use Recentered Influence Function (RIF) unconditional quantile regressions to estimate the differential effects across the distribution of outcomes. We find that the pandemic had an adverse effect on the labour market outcomes for all workers, and that the adverse effects were generally larger for immigrants and especially recent immigrants as well as for immigrants at the bottom of the outcome distributions. The adverse effects were generally larger at the earliest waves of the pandemic, and for recent immigrants who were female, less educated, and those with child responsibilities, and for jobs at greater risk of contact with the pandemic.

Sur la base des données de l'Enquête sur la population active du Canada, nous estimons l'effet différentiel de la pandémie de COVID-19 sur sept résultats sur le marché du travail, séparément pour les immigrants récents et établis par rapport aux Canadiens nés au pays. Nous utilisons également des régressions quantiles inconditionnelles de la fonction d'influence recentrée (RIF) pour estimer les effets différentiels sur la distribution des résultats. Nous constatons que la pandémie a eu un effet négatif sur les résultats du marché du travail pour tous les travailleurs, les effets négatifs étaient généralement plus importants pour les immigrants et en particulier les immigrants récents ainsi que pour les immigrants au bas de la distribution des résultats. Les effets néfastes étaient généralement plus importants pour les premières vagues de la pandémie et pour les immigrants récents qui étaient des femmes, moins instruits, ceux qui avaient des responsabilités envers les enfants et pour les emplois les plus à risque d'être en contact avec la pandémie.

Exploring lemology teaching with "internet plus" flipped classroom pedagogy.

BACKGROUND: To investigate the use of flipped classroom pedagogy based on "Internet plus" in teaching viral hepatitis in the lemology course during the COVID-19 epidemic. METHODS: This study included students from the clinical medicine general practitioner class at Nanjing Medical University's Kangda College, with the observation group consisting of 67 students from the 2020-2021 school year and the control group consisting of 70 students from the 2019-2020 school year. The observation group used "Internet plus" flipped classroom pedagogy, while the control group used conventional offline instruction. The theory course and case analysis ability scores from the two groups were compared and analyzed, and questionnaire surveys were administered to the observation group. RESULT: After the flipped classroom, the observation group had significantly higher theoretical test scores (38.62 ± 4.52) and case analysis ability scores (21.08 ± 3.58) than the control group (37.37 ± 2.43) (t = 2.024, P = 0.045) and (19.16 ± 1.15) (t = 4.254, P < 0.001), respectively. The questionnaire survey in the observation group revealed that the "Internet plus" flipped classroom pedagogy approach can help enhance students' enthusiasm to learn, clinical thinking ability, practical application ability, and learning efficiency, with satisfaction rates of 81.7%, 85.0%, 83.3%, and 78.8%, respectively; 89.4% of students expressed hope that whenever physical classes resumed, the offline courses could be combined with this pedagogy approach. CONCLUSION: The use of the "Internet plus" flipped classroom pedagogy technique for teaching viral hepatitis in a lemology course boosted students' theory learning ability as well as their case analysis ability. The majority of students were pleased with this type of instruction and hoped that whenever physical classes resumed, the offline courses may be integrated with the "Internet plus" flipped classroom pedagogical approach.

Behavioral symptoms, depression symptoms, and medication use in Michigan nursing home residents with dementia during COVID-19.

BACKGROUND: The COVID-19 pandemic significantly disrupted nursing home (NH) care, including visitation restrictions, reduced staffing levels, and changes in routine care. These challenges may have led to increased behavioral symptoms, depression symptoms, and central nervous system (CNS)-active medication use among long-stay NH residents with dementia. METHODS: We conducted a retrospective, cross-sectional study including Michigan long-stay (≥100 days) NH residents aged ≥65 with dementia based on Minimum Data Set (MDS) assessments from January 1, 2018 to June 30, 2021. Residents with schizophrenia, Tourette syndrome, or Huntington's disease were excluded. Outcomes were the monthly prevalence of behavioral symptoms (i.e., Agitated Reactive Behavior Scale ≥ 1), depression symptoms (i.e., Patient Health Questionnaire [PHQ]-9 ≥ 10, reflecting at least moderate depression), and CNS-active medication use (e.g., antipsychotics). Demographic, clinical, and facility characteristics were included. Using an interrupted time series design, we compared outcomes over two periods: Period 1: January 1, 2018-February 28, 2020 (pre-COVID-19) and Period 2: March 1, 2020-June 30, 2021 (during COVID-19). RESULTS: We included 37,427 Michigan long-stay NH residents with dementia. The majority were female, 80 years or older, White, and resided in a for-profit NH facility. The percent of NH residents with moderate depression symptoms increased during COVID-19 compared to pre-COVID-19 (4.0% vs 2.9%, slope change [SC] = 0.03, p < 0.05). Antidepressant, antianxiety, antipsychotic and opioid use increased during COVID-19 compared to pre-COVID-19 (SC = 0.41, p < 0.001, SC = 0.17, p < 0.001, SC = 0.07, p < 0.05, and SC = 0.24, p < 0.001, respectively). No significant changes in hypnotic use or behavioral symptoms were observed. CONCLUSIONS: Michigan long-stay NH residents with dementia had a higher prevalence of depression symptoms and CNS active-medication use during the COVID-19 pandemic than before. During periods of increased isolation, facility-level policies to regularly assess depression symptoms and appropriate CNS-active medication use are warranted.

Prediction of container port congestion status and its impact on ship's time in port based on AIS data

The growth of container throughput and the impact of COVID-19 have made container ports increasingly congested, leading to uncertain cargo transit times and high freight rates. Shipping parties want to know in advance the congestion of each port in the next phase to adjust their plans, but there are few studies involving congestion prediction, and this study hopes to make some additions. Three indicators are extracted from Automatic Identification System (AIS) data to represent the port congestion status for the sake of generalizability. And those indicators are used to predict port congestion status and further to predict container ships' time in port using the eXtreme Gradient Boosting (XGBoost) and SHapley Additive exPlanation (SHAP) algorithms. The established models show that those indicators can improve prediction accuracy of port time compared to not considering port status. The findings also show that port congestion status contributes significantly to determining port time and makes it fluctuate by up to nearly 50 hours. The prediction results could help shipping companies to change their transportation schedules early to bypass ports with long waiting times or to arrange ships to enter the port earlier for delivering cargos on schedule. [ FROM AUTHOR]

Association of Systemic Family Dynamics and Well-Being During the COVID-19 Outbreak: A Cross-Sectional Survey

This cross-sectional survey evaluated well-being and family dynamics before and during the COVID-19 pandemic in 1287 (16 + years of age, 68.3% female) Chinese participants. Structural equation modeling was used to test the association of well-being and systemic family dynamics, and related moderating factors. Results indicated some subscales of well-being and systemic family dynamics significantly worsened during the pandemic. A modified model fits well for both data before and during the pandemic in which well-being was significantly associated with systemic family dynamic and by family income. Age also positively related systemic family dynamics. The relationship between family income and well-being and the relationship between systemic family dynamics and well-being were moderated by the pandemic. The results suggest that well-being and systemic family dynamics and their associations are impacted by the COVID-19 pandemic. Systemic family dynamics could be a potential resource for enhancing well-being during the COVID-19 pandemic by some interventions. [ FROM AUTHOR]

Does Canada's Express Entry System Meet the Challenges of the Labor Market?

While most immigrant-receiving countries have restricted immigration during the COVID-19 pandemic, Canada has taken a very different approach, increasing its immigration targets over the next three years. With this move, Canada has made it clear that immigrants are expected to play a lead role in the post-pandemic economic recovery. Most of these immigrants will be admitted through Express Entry, a hybrid system introduced in 2015 that combines elements of both supply- and demand-driven selection. In this article, we examine whether Canada's hybrid selection system meets its current and future labor market needs in a post-pandemic world. Using a mixed methods approach, we combine analysis of an administrative dataset with data from qualitative interviews with employers and experts in the immigration sector. We find that while Express Entry is a flexible and responsive tool for selecting immigrants, it narrows the occupational profiles of newcomers. The system also does not fully address the labor shortages and skills gaps described by Canadian employers. We argue that Canada's post-pandemic labor market will require a wider range of skills, and that Express Entry's adaptability should be carefully monitored and adjusted to broaden the skill mix of immigrants and facilitate skills match between immigrants and employers.

Damage Averted: Estimating the Effects of COVID-19 Vaccines on Hospitalizations, Mortality and Costs in Canada

[...]vaccination allowed for a reduction in many preventative public health measures that disrupted the social and economic lives of Canadians. [...]vaccine procurement and administration costs were some $3.7 billion, while the direct savings associated with averted cases and hospitalizations were an estimated $3.3 billion to $5.8 billion, resulting in a net cost-benefit estimate of-$0.4 billion to $2.1 billion, without considering the benefits of saved lives. While comprehensive analysis of the indirect effects of vaccination is beyond the scope of this study, we model the macroeconomic effect of delayed access to vaccines with different lockdown strategies (uniform or differentiated by age group). While this study does not include these indirect effects in the cost-benefit analysis of the public health impact of vaccinations on the broader economy, they represent large and significant positive impacts.

Association between acute stress response and peer bullying behaviors among middle school students

Objective: To explore the association between acute stress response during the outbreak of COVID-19 and peer bullying behaviors during the normalized management of COVID-19 among middle school students, and to provide a basis for developing relevant measures for peer bullying prevention.

Exploring the impact of shielding advice on the wellbeing of individuals identified as clinically extremely vulnerable amid the COVID-19 pandemic: a mixed-methods evaluation.

BACKGROUND: The national shielding programme was introduced by UK Government at the beginning of the COVID-19 pandemic, with individuals identified as clinically extremely vulnerable (CEV) offered advice and support to stay at home and avoid all non-essential contact. This study aimed to explore the impact and responses of "shielding" on the health and wellbeing of CEV individuals in Southwest England during the first COVID-19 lockdown. METHODS: A two-stage mixed methods study, including a structured survey (7 August-23 October 2020) and semi-structured telephone interviews (26 August-30 September 2020) with a sample of individuals who had been identified as CEV and advised to "shield" by Bristol, North Somerset & South Gloucestershire (BNSSG) Clinical Commissioning Group (CCG). RESULTS: The survey was completed by 203 people (57% female, 54% > 69 years, 94% White British, 64% retired) in Southwest England identified as CEV by BNSSG CCG. Thirteen survey respondents participated in follow-up interviews (53% female, 40% > 69 years, 100% White British, 61% retired). Receipt of 'official' communication from NHS England or General Practitioner (GP) was considered by participants as the legitimate start of shielding. 80% of survey responders felt they received all relevant advice needed to shield, yet interviewees criticised the timing of advice and often sought supplementary information. Shielding behaviours were nuanced, adapted to suit personal circumstances, and waned over time. Few interviewees received community support, although food boxes and informal social support were obtained by some. Worrying about COVID-19 was common for survey responders (90%). Since shielding had begun, physical and mental health reportedly worsened for 35% and 42% of survey responders respectively. 21% of survey responders scored ≥ 10 on the PHQ-9 questionnaire indicating possible depression and 15% scored ≥ 10 on the GAD-7 questionnaire indicating possible anxiety. CONCLUSIONS: This research highlights the difficulties in providing generic messaging that is applicable and appropriate given the diversity of individuals identified as CEV and the importance of sharing tailored and timely advice to inform shielding decisions. Providing messages that reinforce self-determined action and assistance from support services could reduce the negative impact of shielding on mental health and feelings of social isolation.

Industries' heterogeneous reactions during the COVID‐19 outbreak: Evidence from Chinese stock markets

This study examines the heterogeneous effects of the COVID-19 outbreak on stock prices in China. We confirm what is already known, that the pandemic has had a significant negative impact on stock market returns. Additionally, we find, this effect is heterogeneous across industries. Second, fear sentiment can directly cause stock prices to fall and panic exacerbates the negative impact of the pandemic on stock returns. Third, and most importantly, we demonstrate the underlying mechanisms of four firm characteristics and find that those with high asset intensity, low labor intensity, high inventory-to-revenue ratio, and small market value are more negatively affected than others. For labor-intensive state-owned firms, in particular, stock performance worsened because of higher idle labor costs. Finally, we created an index to measure the relative position of an industry in the supply chain, which shows that downstream companies were more vulnerable to the effects of the pandemic.

Photocatalytic degradation of COVID-19 related drug arbidol hydrochloride by Ti3C2 MXene/supramolecular g-C3N4 Schottky junction photocatalyst.

Because of the current COVID-19 outbreak all over the world, the problem of antiviral drugs entering water has become increasingly serious. Arbidol hydrochloride (ABLH) is one of the most widely used drugs against COVID-19, which has been detected in sewage treatment plant sediments after the COVID-19 outbreak. However, there has been no report on the degradation of ABLH. In order to remove ABLH we prepared a novel photocatalyst composed of Ti3C2 MXene and supramolecular g-C3N4 (TiC/SCN) via a simple method. The properties of the material were studied by a series of characterizations (SEM, TEM, EDS, XRD, FTIR, UV-vis, DRS, XPS, TPC, PL, EIS and UPS), indicating the successful preparation of TiC/SCN. Results show that 99% of ABLH was removed within 150 min under visible light illumination by the 0.5TiC/SCN (containing 0.5% of TiC). The performance of 0.5TiC/SCN was about 2.66 times that of SCN resulting from the formation of Schottky junction. Furthermore, under real sunlight illumination, 99.2% of ABLH could be removed by 0.5TiC/SCN within 120 min, which was better than that of commercial P25 TiO2. The pH, anions (NO3- and SO42-) and dissolved organic matter (fulvic acid) could significantly affect the ABLH degradation. Moreover, three possible degradation pathways of ABLH were proposed, and the toxicities of the corresponding by-products were less toxic than ABLH. Meanwhile, findings showed that the superoxide radicals played a major role in the photocatalytic degradation of ABLH by 0.5TiC/SCN. This study provides a well understanding of the mechanism of ABLH degradation and provides a valuable reference for the treatment of ABLH in water.

A Complete Information Interaction-Based Bus Passenger Flow Control Model for Epidemic Spread Prevention

Because the strategy of stopping bus lines during an epidemic can negatively impact residents, this study proposes a bus passenger flow control model to optimize the safety of and access to bus transport. The information interaction environment can provide a means for the two-way regulation of buses and passengers. In this model, passengers first request their pick-up and drop-off location, and then the bus feeds back information on whether it accepts the request. Through this method, passenger flow control can be realized through complete information interaction. The study aimed to establish a multi-objective function that minimizes the weighted total cost of the safety cost, the passenger travel cost, and the bus travel cost during an epidemic. The constraints were the full load and riding rates of urban buses in peak periods under the condition of epidemic prevention and control. The results showed that, in the morning peak period, the passenger flow control scheme reduced the passenger infection probability by 17.89%, compared with no passenger flow control scheme. The weighted total cost of the epidemic safety cost, the passenger travel cost, and the bus operation cost was reduced by 8.04%. The optimization effect of the passenger flow control scheme of this model is good, and not only reduces the probability of passengers being infected, but also meets the requirements of epidemic prevention and the travel needs of residents.

Ocular Inflammatory Reactions following an Inactivated SARS-CoV-2 Vaccine: A Four Case Series.

PURPOSE: To report a four-case series of ocular adverse events post an inactivated COVID-19 vaccination in China. METHODS: The four patients exhibited ocular inflammatory reactions on the same day after receiving an inactivated SARS-CoV-2 vaccine. RESULTS: All patients underwent detailed ophthalmic examinations, with the medical diagnosis of Vogt-Koyanagi-Harada, Ponser-Schlossman, secondary post-inflammatory glaucoma, and iridocyclitis, respectively. No patients had any other underlying medical conditions causing the ocular complications. The ocular inflammatory reactions of these four patients were resolved with the administration of oral or topical corticosteroids. CONCLUSION: Our cases remind the ophthalmologist that adverse ocular events may happen after the administration of SARS-CoV-2 vaccine. Since the ocular complications could be resolved with the corticosteroid treatment, the events were considered to be inflammatory reactions caused by the SARS-CoV-2 vaccine.

Customer Engagement With VR-Enabled Tourism Activities at Cultural Heritage Sites

Despite the tremendous amount of academic interest in virtual reality (VR), the existing conceptual models that presented VR attributes as antecedents of users' acceptance and attitudes, failed to examine the power of VR technologies in promoting the alternative attractiveness of virtual tourism compared to traditional onsite visitation. This is of great significance to the solution of over-tourism issues frequently seen in the today's tourism destinations, especially worldfamous cultural heritage sites. Therefore, the present study fills the literature gap and empirically validates a conceptual framework that shows how visitors' engagement with VR-enabled tourism activities could lead to an enhanced alternative attractiveness of virtual tourism, and their pro-cultural behaviors. A total of 571 valid responses from US visitors that have adopted VR-enabled tourism activities were collected to confirm the role of four VR attributes, i.e., immersion, vividness, presence, and enjoyment, in motivating users' engagement behaviors with VR tourism activities. The study findings also testified that visitors who engaged with VR tourism activities are likely to adopt pro-cultural behaviors in the future and assessed the alternative attractiveness of VR tourism against the traditional onsite visitation. The findings will provide valuable implications for policymakers who aspire to preserve the cultural heritage sites while promoting cultural heritage destinations through advanced VR technologies

Waste flow of wet wipes and decision-making mechanism for consumers’ discarding behaviors

Wet wipes have been widely used in consumers' daily lives, especially confronted with the COVID-19 pandemic. Most wet wipes contain plastic components, which cause salient plastic consumption and environmental pollution after their usage. In the current study, the discarding stage of wet wipes in China is investigated systematically. The waste flow of wet wipes are described in detail for the first time, based on the results of domestic waste composition field survey and 2461 consumer questionnaires. The decision-making mechanism for consumers’ wet wipes discarding behavior has been established, and the impacts of various factors have been quantified and analyzed by using structural equation modeling. Results show that waste wet wipes account for 0.2% of all domestic waste in China. Consumer behavior, which is determined by 12 influencing factors, will affect the flow of waste wet wipes substantially. All factors are divided into three categories, including “consumption habit”, “cost” and “incentive”. Among all factors, “time cost” is the most crucial one which indicates matching the convenient solid waste treatment infrastructure is an effective way to ameliorate environmental leakage. Popularizing the knowledge that wet wipes contain plastic through various ways such as printing the composition on packaging bags is a feasible approach. In order to mitigate the environmental impacts, a systematic solution integrating production, consumption and disposal processes of wet wipes is necessary.

How social enterprises gain cognitive legitimacy in the post-pandemic period? Social welfare logic and digital transformation

Purpose>This paper aims to propose a social enterprise legitimation mechanism by combining the established logic and transformational logic to test the validity of the conceptual model.Design/methodology/approach>The authors construct the theoretical framework based on integrating organizational identity theory, attention-based view and collected 128 social enterprises data during the post-pandemic period in China. The authors applied multiple hierarchical regression analysis and mediation analysis to test the research hypothesis.Findings>The results show that strong organizational identity contributes significantly to the cognitive legitimacy of social enterprise. Besides, we found that social welfare logic and digital transformation can positively mediate the correlation between organizational identity and cognitive legitimacy.Practical implications>Social enterprises enhance legitimacy significantly by social welfare logic comparing with commercial logic, which indicates that social enterprises should allocate more internal resources and attention to present the organization's social value through various distributions. More importantly, social enterprises should embrace digital transformation to enhance transparency and efficiency, decrease transaction costs, enlarge organizational social impact to strengthen cognitive legitimacy.Originality/value>The paper first proposed and empirically tested that digital transformation is an important mechanism to enhance the social enterprise's cognitive legitimacy.

Systematic review and meta-analysis of olfactory and gustatory dysfunction in COVID-19.

BACKGROUND: Chemosensory disorders associated with COVID-19 have been widely discussed during the pandemic. We performed a meta-analysis to assess the risk factors for olfactory and gustatory dysfunction in patients with COVID-19. METHODS: Three databases (PubMed, Embase, and Cochrane Library) were searched for studies published between December 1, 2019, and August 31, 2021. We selected random-effects model or fixed-effects model to pool data based on heterogeneity. The results were reported as odds ratios (ORs) or standardized mean differences (SMDs) and the corresponding 95% confidence intervals (CIs). Heterogeneity was reported as I2. RESULTS: Twenty-six studies with a total of 13,813 patients were included. The pooled data indicated that sex (OR 1.47; 95% CI 0.93-2.31), age (SMD -5.80; 95% CI -13.35 to 1.75), smoking (OR 2.04; 95% CI 0.72-5.79), and comorbidity (OR 1.21; 95% CI 0.58-2.53) of patients with COVID-19 had no effect on gustatory dysfunction. Olfactory dysfunction was more likely to occur in older patients with COVID-19 (SMD, -5.22; 95% CI, -8.28 to -2.16). Patients with COVID-19 with nasal congestion (OR 3.41; 95% CI 2.30-5.06) and rhinorrhea (OR 2.35; 95% CI 1.60-3.45) were more prone to olfactory dysfunction. CONCLUSION: These findings emphasize that older patients with COVID-19 are more likely to experience olfactory dysfunction. Symptoms of nasal congestion and rhinorrhea may affect the recognition of olfactory dysfunction.

Perceived Psychological Feelings Make Important Contributions to the Symptoms of Common Mental Disorders of Medical Staff During the COVID-19.

OBJECTIVE: Lack of information about mental health status among medical staff during the epidemic of COVID-19 in China is one of the major barriers to psychological interventions. This paper aims to evaluate the contributions of perceived psychological feelings to the symptoms of common mental disorders among medical staff during the epidemic of COVID-19 in China. METHOD: A large sample of medical staff based on a non-probability sampling design was collected from February 17 to 24, 2020. The symptoms of common mental disorders were screened based on self-reported instruments to evaluate psychological distress, anxious symptoms, and depressive symptoms during the past week. Perceived psychological feelings were based on self-report. Logistic regressions and elastic net regularizations were used to evaluate the independent effect of the psychological feelings controlled by hospitals and participants characteristics. RESULTS: Totally 4,677 medical staff completed the survey. The prevalence of psychological distress, anxious symptoms, and depressive symptoms were 15.9% (95% CI 14.8-16.9), 16.0% (95% CI 15.0-17.1), and 34.6% (95% CI 33.2-35.9). Feelings of having adequate personal protective equipment, receiving enough emotional supports from both family members and colleagues were significantly associated with fewer symptoms of common mental disorders, while the feelings of overloaded work and insufficient rest times contributed to more psychological problems. CONCLUSIONS: Psychological feelings make important contributions to the symptoms of common mental disorders of medical staff during the epidemic of COVID-19. Strategies of psychological aids or interventions could be developed based on these feelings.

Plasmonic LAMP: Improving the Detection Specificity and Sensitivity for SARS-CoV-2 by Plasmonic Sensing of Isothermally Amplified Nucleic Acids.

The ability to detect pathogens specifically and sensitively is critical to combat infectious diseases outbreaks and pandemics. Colorimetric assays involving loop-mediated isothermal amplification (LAMP) provide simple readouts yet suffer from the intrinsic non-template amplification. Herein, a highly specific and sensitive assay relying on plasmonic sensing of LAMP amplicons via DNA hybridization, termed as plasmonic LAMP, is developed for the severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) RNA detection. This work has two important advances. First, gold and silver (Au-Ag) alloy nanoshells are developed as plasmonic sensors that have 4-times stronger extinction in the visible wavelengths and give a 20-times lower detection limit for oligonucleotides over Au counterparts. Second, the integrated method allows cutting the complex LAMP amplicons into short repeats that are amendable for hybridization with oligonucleotide-functionalized Au-Ag nanoshells. In the SARS-CoV-2 RNA detection, plasmonic LAMP takes ≈75 min assay time, achieves a detection limit of 10 copies per reaction, and eliminates the contamination from non-template amplification. It also shows better detection specificity and sensitivity over commercially available LAMP kits due to the additional sequence identification. This work opens a new route for LAMP amplicon detection and provides a method for virus testing at its early representation.

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.