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Depression often coexists with other chronic conditions in older people. The COACH study is an ongoing random controlled trial (RCT) to test the effectiveness of a primary-care-based collaborative care approach to treat co-morbid hypertension and depression in Chinese rural elders. In the COACH model, a team—village doctor (VD), aging worker (AW), and psychiatrist consultant—provides collaborative care to enrolled subjects in each intervention village for 12 months. This study examines how COACH was implemented and identifies facilitators and barriers for its more widespread implementation.
Five focus groups were conducted, two with VDs, two with AWs, and one with psychiatrists, for a total of 38 participants. Transcripts were analyzed using qualitative content analysis.
COACH care-team members showed shared understanding and appreciation of the team approach and integrated management of hypertension and depression. Team collaboration was smooth. All members regarded COACH to be effective in reducing depressive symptoms and improving patient health. Facilitators to implementation include training, leaders’ support, geographic proximity between VD and AW pairs, preexisting relationships among care-team members, comparability of COACH activities and existing practices of VDs and AWs, and care team members’ caring about older members of their villages. Barriers to sustainability include frustration of some VDs related to their low wages and feelings of overload of some AWs.
COACH was positively perceived and successfully implemented. The findings offer guidance for planning primary-care-based collaborative depression care in low- and middle-income countries.
Building from the base of knowledge presented in the preceding chapters, this chapter explores how the cycling of carbon in subduction zones and orogenic belts varies with supercontinent cycles and mountain building. It discusses the processes that link short-term and long-term carbon cycling and the timescales of these processes, such as the response times of weathering and atmospheric drawdown at periods of enhanced volcanism. This chapter covers topics of potential fluctuations in the long-term CO2 content of Earth’s atmosphere because of mantle–climate feedback, again taking advantage of the modeling platforms available for further exploration of these topics.
Positive symptoms are a useful predictor of aggression in schizophrenia. Although a similar pattern of abnormal brain structures related to both positive symptoms and aggression has been reported, this observation has not yet been confirmed in a single sample.
To study the association between positive symptoms and aggression in schizophrenia on a neurobiological level, a prospective meta-analytic approach was employed to analyze harmonized structural neuroimaging data from 10 research centers worldwide. We analyzed brain MRI scans from 902 individuals with a primary diagnosis of schizophrenia and 952 healthy controls.
The result identified a widespread cortical thickness reduction in schizophrenia compared to their controls. Two separate meta-regression analyses revealed that a common pattern of reduced cortical gray matter thickness within the left lateral temporal lobe and right midcingulate cortex was significantly associated with both positive symptoms and aggression.
These findings suggested that positive symptoms such as formal thought disorder and auditory misperception, combined with cognitive impairments reflecting difficulties in deploying an adaptive control toward perceived threats, could escalate the likelihood of aggression in schizophrenia.
Polyhedral YVO4: Ln3+ (Ln = Eu, Sm, Yb/Er, Yb/Tm) microcrystals were fabricated via a facile sol–gel auto-combustion method using NH4VO3 as vanadium source in the presence of glycine. The X-ray diffraction patterns were well matched with pure YVO4, and the doped lanthanide ions did not change the host structure. The YVO4 microcrystals annealed from 500 to 1000 °C for 3 h were polyhedral and ranged in particle size from 0.1 to 2 μm. The luminescence properties of YVO4: Ln3+ (Ln = Eu, Sm, Yb/Er, Yb/Tm) samples indicated that all of the YVO4: Ln3+ samples exhibited typical emission spectra of Ln3+ cations, suggesting that the Ln3+ cations were well doped in YVO4 and could be excited efficiently through matrix absorption. In addition, the corresponding mechanisms of emission and energy transfer in the YVO4: Ln3+ are proposed.
The effect of hot streaks from a gas turbine combustor on the thermodynamic load of internally air-cooled nozzle guide vanes (NGVs) and shrouds has been numerically investigated under flight conditions. The study follows two steps: one for the high-fidelity 60° combustor sector with simplified ten NGVs and three thermocouples attached; and the other for the NGV sectors where each sector consists of one high-fidelity NGV (probe NGV) and nine dummy NGVs. The first step identifies which NGV has the highest thermal load and provides the inlet flow boundary conditions for the second step. In the second step, the flow fields and thermal loads of the probe NGVs are resolved in detail.
With the systematically validated physical models, the two-phase flowfield of the combustor-NGVs sector has been successfully simulated. The predicted mean and maximum temperature at the combustor sector exit are in excellent agreement with the experimental data, which provides a solid basis for the hot-streak effect investigation. The results indicate that the second NGV, looking upstream from left, has the highest thermal load. Its maximum surface temperature is 8.4% higher than that for the same NGV but with the mean inlet boundary conditions, and 14.1% higher than the ninth NGV. The finding is consistent with the field-observed NGV damage pattern. To extend the service life of these vulnerable NGVs, some protection methods should be considered.
Severe trauma can lead to amputation of limbs. There is no golden standard or comprehensive evaluation indicator for amputation. It is difficult for the primary rescue organization to focus on the most essential indicators and to determine whether to perform amputation or take proper operation.
For medical staff in first-line medical teams for disaster relief or in a common primary hospital, what indicators should they focus on to keep the patient’s limbs when they receive wounded patients with severe trauma?
A retrospective case-control study was performed based on the patients with severe trauma from January 2013 through December 2018 in the emergency department of Southwest Hospital (Shapingba District, Chongqing, China), a Level I trauma center. A total of 165 cases were divided into amputation group (n = 79) and non-amputation control group (n = 86), which had severe skin and muscle injury but without amputation. The causes of trauma and the special cases were analyzed. Binary logistic regression models were used to find the essential indicators for amputation.
Neurovascular injury with delayed treatment was the most decisive indicator leading to amputation, and time phase was also important for limb salvage. Preliminary treatment of disaster victims and patients with severe trauma should focus on neurovascular status and timely delivery.
Like any therapy, acupuncture is effective for some patients, while not helpful for others. Understanding from a patients' perspective what makes one respond or not to acupuncture can help guide further intervention development. This study aimed to identify factors that influence the perception of acupuncture's therapeutic effect among cancer survivors with insomnia.
We conducted post-treatment semi-structured interviews with cancer survivors who were randomized to the acupuncture group in a clinical trial for the treatment of insomnia. Survivors were categorized into Responders and Non-Responders to acupuncture treatment based on the change in the Insomnia Severity Index with a reduction of eight points or greater as the cut-off for the response. An integrated approach to data analysis was utilized by merging an a priori set of codes derived from the key ideas and a set of codes that emerged from the data through a grounded theory approach. Codes were examined for themes and patterns.
Among 28 cancer survivors interviewed, 18 (64%) were classified as Responders. Participants perceived the ability to respond to acupuncture as dependent on treatment that effectively: (1) alleviated co-morbidities contributing to insomnia, (2) supported sleep hygiene practices, and (3) provided a durable therapeutic effect. Acupuncture treatment that did not address one of these themes often detracted from positive treatment outcomes and diminished perceived benefit from acupuncture.
Significance of results
We identified patient-perceived contributors to response to acupuncture, such as co-morbid medical conditions, adequate support for sleep hygiene practices, and temporary therapeutic relief. Addressing these factors may improve the overall effectiveness of acupuncture for insomnia.
The cao vit gibbon Nomascus nasutus, also known as eastern black crested gibbon, is categorized as Critically Endangered on the IUCN Red List and was considered one of the world's 25 most threatened primates. The only known population occurs along the border between China and Viet Nam. Accurate information on population size and dynamics is critical for the species’ conservation, but population surveys conducted in only one country may over- or underestimate total population size because the home ranges of cao vit gibbon groups often cross the international border. In 2007 and 2016 we conducted two collaborative transboundary censuses of the cao vit gibbon populations in the Trung Khanh Cao Vit Gibbon Species and Habitat Conservation Area in Viet Nam and the Bangliang Gibbon National Nature Reserve in China. The results showed a population size of 102–110 in 2007, which increased to 107–136 in 2016. Our results indicate that previous surveys conducted separately in Viet Nam and China underestimated the global population size of this species. According to our more comprehensive surveys, the gibbon population is increasing slowly. The gibbons and their habitat are legally protected in both countries. Hunting and charcoal making have not been reported in this area since 2007. As habitat carrying capacity is a limiting factor, habitat restoration is required. However, lack of funding to protect the cao vit gibbon remains a challenge.
We present a detailed study of the turbulent wake behind a quarter-ring curved cylinder at Reynolds number
(based on cylinder diameter and incoming flow velocity), by means of direct numerical simulation. The configuration is referred to as a concave curved cylinder with incoming flow aligned with the plane of curvature and towards the inner face of the cylinder. Wake flows behind this configuration are known to be complex, but have so far only been studied at low
. This is the first direct numerical simulation investigation of the turbulent wake behind the concave configuration, from which we reveal new and interesting wake dynamics, and present in-depth physical interpretations. Similar to the low-
cases, the turbulent wake behind a concave curved cylinder is a multi-regime and multi-frequency flow. However, in addition to the coexisting flow regimes reported at lower
, we observe a new transitional flow regime at
. The flow field in this transitional regime is dominated not by von Kármán-type vortex shedding, but by periodic asymmetric helical vortices. Such vortex pairs exist also in some other wake flows, but are then non-periodic. Inspections reveal that the periodic motion of the asymmetric helical vortices is induced by vortex shedding in its neighbouring oblique shedding regime. The oblique shedding regime is in turn influenced by the transitional regime, resulting in a unified and remarkably low dominating frequency in both flow regimes. Owing to this synchronized frequency, the new wake dynamics in the transitional regime might easily be overlooked. In the near wake, two distinct peaks are observed in the time-averaged axial velocity distribution along the curved cylinder span, while only one peak was observed at lower
. The presence of the additional peak is ascribed to a strong favourable base pressure gradient along the cylinder span. It is noteworthy that the axially directed base flow exceeded the incoming velocity behind a substantial part of the quarter-ring and even persisted upwards along the straight vertical extension. As a by-product of our study, we find that a straight vertical extension of 16 cylinder diameters is required in order to avoid any adverse effects from the upper boundary of the flow domain.
Findings of epidemiological studies regarding the association between carrot consumption and lung cancer risk remain inconsistent. The present study aimed to summarise the current epidemiological evidence concerning carrot intake and lung cancer risk with a meta-analysis. We conducted a meta-analysis of case–control and prospective cohort studies, and searched PubMed and Embase databases from their inception to April 2018 without restriction by language. We also reviewed reference lists from included articles. Prospective cohort or case–control studies reporting OR or relative risk with the corresponding 95 % CI of the risk lung cancer for the highest compared with the lowest category of carrot intake. A total of eighteen eligible studies (seventeen case–control studies and one prospective cohort study) were included, involving 202 969 individuals and 5517 patients with lung cancer. The pooled OR of eighteen studies for lung cancer was 0·58 (95 % CI 0·45, 0·74) by comparing the highest category with the lowest category of carrot consumption. Based on subgroup analyses for the types of lung cancer, we pooled that squamous cell carcinoma (OR 0·52, 95 % CI 0·19, 1·45), small-cell carcinoma (OR 0·43, 95 % CI 0·12, 1·59), adenocarcinoma (OR 0·34, 95 % CI 0·15, 0·79), large-cell carcinoma (OR 0·40, 95 % CI 0·10, 1·57), squamous and small-cell carcinoma (OR 0·85, 95 % CI 0·45, 1·62), adenocarcinoma and large-cell carcinoma (OR 0·20, 95 % CI 0·02, 1·70) and mixed types (OR 0·61, 95 % CI 0·46, 0·81). Exclusion of any single study did not materially alter the pooled OR. Integrated epidemiological evidence from observational studies supported the hypothesis that carrot consumption may decrease the risk of lung cancer, especially for adenocarcinoma.
Single-crystalline gallium arsenide (GaAs) grown by various techniques can exhibit hillock defects on the surface when sub-optimal growth conditions are employed. The defects act as nonradiative recombination centers and limit solar cell performance. In this paper, we applied near-field transport imaging to study hillock defects in a GaAs thin film. On the same defects, we also performed near-field cathodoluminescence, standard cathodoluminescence, electron-backscattered diffraction, transmission electron microscopy, and energy-dispersive X-ray spectrometry. We found that the luminescence intensity around the hillock area is two orders of magnitude lower than on the area without hillock defects in the millimeter region, and the excess carrier diffusion length is degraded by at least a factor of five with significant local variation. The optical and transport properties are affected over a significantly larger region than the observed topography and crystallographic and chemical compositions associated with the defect.
The co-occurrence of hepatic cystic echinococcosis (CE) and alveolar echinococcosis (AE) is extremely rare. Here, we present the clinical manifestations and treatment outcomes of three cases with co-occurring CE and AE in the liver. Computed tomography (CT), magnetic resonance imaging and 18FFluorodeoxyglucose Positron Emission Tomography-CT were used for preoperative diagnosis. Specimens were taken intraoperatively and sent for pathological studies to confirm the coexistence of CE and AE by laminated membrane, daughter cysts or germinal layer and infiltration structure. Albendazole was prescribed after operation for 12 months. All patients were completely recovered and showed no recurrence at last follow-up. Therefore, surgical intervention and postoperative application of albendazole are recommended for patients with concurrence of hepatic AE and CE.
The Beijing Twin Study (BeTwiSt), which was established in 2006, is an ongoing study aiming to investigate the genetic and environmental etiology of adolescent psychopathology. Resting-state brain imaging datasets have been examined for same-sex twins, and other psychological traits and emotional and behavioral variables have been examined for all twins. Based on the registry, the main findings regarding the etiological mechanism underlying adolescent development, magnetic resonance imaging results, and genetic and environmental influences on other psychological traits have been published. This article summarizes the key findings in these three areas and discusses future plans for the BeTwiSt.
Needles of Juniperus rigida are used in Chinese traditional medicine for the treatment of brucellosis, dropsy, skin disease, and rheumatoid arthritis. This is the first study that reports anatomical structures of the J. rigida needles collected at different altitudes. The most common anatomical, phytochemical, and histochemical techniques and methods are used. The results show that anatomical structures and chemical composition change significantly at different altitudes. The main anatomical characters are significant xeromorphic structures (thick epidermis, hypodermis, and cuticle), a stomatal band, a developed vascular bundle, and a marginal resin duct. The xeromorphic structures become more pronounced with increasing altitude. The phytochemical and histochemical results demonstrate that the content of the main chemical compounds (phenols and terpenoids) basically increases at a higher elevation. Histochemical analysis localizes the phenols in epidermal cells, sponge tissue, endothelial layer cells, and stomatal bands, and the terpenoids in palisade tissue, sponge tissue, and the edge of the resin duct. This work reveals the relation between anatomy and chemistry in J. rigida needles, contributes to the quality control of its ethno-medicine, and provides the evidence to develop the commercial cultivation.
Endometrial injury is an important cause of intrauterine adhesion (IUA), amenorrhea and infertility in women, with limited effective therapies. Recently, stem cells have been used in animal experiments to repair and improve injured endometrium. To date, our understanding of adipose-derived stem cells (ADSCs) in endometrial injury repair and their further therapeutic mechanisms is incomplete. Here, we examined the benefit of ADSCs in restoration of injured endometrium by applying a rat endometrial injury model. The results revealed by immunofluorescence showed that green fluorescent protein (GFP)-labelled ADSCs can differentiate into endometrial epithelial cells in vivo. At 30 days after ADSCs transplantation, injured endometrium was significantly improved, with increased microvessel density, endometrial thickness and glands when compared with the model group. Furthermore, the fertility of rats with injured endometrium in ADSCs group was improved and had a higher conception rate (60% vs 20%, P = 0.014) compared with the control phosphate-buffered saline (PBS) group. However, there was no difference in the control group compared with the sham group. In addition, expression levels of the oestrogen receptor Eα/β (ERα, ERβ) and progesterone receptor (PR) detected by western blot and enzyme-linked immunosorbent assay (ELISA) were higher in the ADSCs group than in the PBS group. Taken together, these results suggested that ADSC transplantation could improve endometrial injury as a novel therapy for IUA.
Multidimensional instabilities always develop with time during the process of radiation pressure acceleration, and are detrimental to the generation of monoenergetic proton beams. In this paper, a sharp-front laser is proposed to irradiate a triple-layer target (the proton layer is set between two carbon ion layers) and studied in theory and simulations. It is found that the thin proton layer can be accelerated once to hundreds of MeV with monoenergetic spectra only during the hole-boring (HB) stage. The carbon ions move behind the proton layer in the light-sail (LS) stage, which can shield any further interaction between the rear part of the laser and the proton layer. In this way, proton beam instabilities can be reduced to a certain extent during the entire acceleration process. It is hoped such a mechanism can provide a feasible way to improve the beam quality for proton therapy and other applications.
Goosegrass is considered one of the worst agricultural weeds worldwide. Understanding its life cycle will provide useful management information. Field experiments with six emergence times (April, May, June, July, August, and September) were conducted at Anyang, China in 2015 and 2017 to clarify the growth and reproduction of goosegrass emerging at different times within a season. The result showed that plant height, dry weight, average weight per inflorescence, total inflorescence weight, average seed number per inflorescence, and total number of seeds per plant were relatively low in the April cohort, peaked with the May or June emergence cohort, and decreased thereafter. However, the earliest emergence of goosegrass in April had the highest total number of inflorescences. The plants of the May cohort produced the greatest number of seeds: 225,954 and 322,501 seeds per plant in 2015 and 2017, respectively. Delayed emergence resulted in less seed production; most plants that emerged in September did not flower or set seed. The 1,000-seed weight did not vary among the emergence cohorts. The reproductive investment was lowest for plants of the May cohort and then increased as emergence time was delayed to June, July, and August. Fresh mature seed of all emergence cohorts was extremely dormant and had low germination only up to 6% from August to November, and high germination (44% to 93%) in December. The information gained from this study indicates that weed management strategies should focus on the early-emerged seedlings such as the April and May cohorts, so as to effectively prevent goosegrass seed production, minimize the weed seed replenishment into the soil seed bank, and reduce the infestation in subsequent seasons.