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Little is known about long-term employment outcomes for patients with first-episode schizophrenia-spectrum (FES) disorders who received early intervention services.
We compared the 10-year employment trajectory of patients with FES who received early intervention services with those who received standard care. Factors differentiating the employment trajectories were explored.
Patients with FES (N = 145) who received early intervention services in Hong Kong between 1 July 2001 and 30 June 2002 were matched with those who entered standard care 1 year previously. We used hierarchical clustering analysis to explore the 10-year employment clusters for both groups. We used the mixed model test to compare cluster memberships and piecewise regression analysis to compare the employment trajectories of the two groups.
There were significantly more patients who received the early intervention service in the good employment cluster (early intervention: N = 98 [67.6%]; standard care: N = 76 [52.4%]; P = 0.009). In the poor employment cluster, there was a significant difference in the longitudinal pattern between early intervention and standard care for years 1–5 (P < 0.0001). The number of relapses during the first 3 years, months of full-time employment during the first year and years of education were significant in differentiating the clusters of the early intervention group.
Results suggest there was an overall long-term benefit of early intervention services on employment. However, the benefit was not sustained for all patients. Personalisation of the duration of the early intervention service with a focus on relapse prevention and early vocational reintegration should be considered for service enhancement.
Declaration of interests
No relevant conflicts of interests reported by C.L.M.H., Y.N.S., P.S., H.H.P. and K.K.Y. S.K.W.C., W.C.C. and E.H.M.L. report that they are members of the working group of the Early Assessment Service for Young People with Psychosis (EASY) programme of the Hospital Authority in Hong Kong. E.Y.H.C. is the convener of the working group of the EASY programme of the Hospital Authority in Hong Kong.
Novel NiMoO4-integrated electrode materials were successfully prepared by solvothermal method using Na2MoO4·2H2O and NiSO4·6H2O as main raw materials, water, and ethanol as solvents. The morphology, phase, and structure of the as-prepared materials were characterized by SEM, XRD, Raman, and FT-IR. The electrochemical properties of the materials in supercapacitors were investigated by cyclic voltammetry, constant current charge–discharge, and electrochemical impedance spectroscopy techniques. The effects of volume ratio of water to ethanol (W/E) in solvent on the properties of the product were studied. The results show that the pure phase monoclinic crystal NiMoO4 product can be obtained when the W/E is 2:1. The diameter and length are 0.1–0.3 µm and approximately 3 µm, respectively. As an active material for supercapacitor, the NiMoO4 nanorods material delivered a discharge specific capacitance of 672, 498, and 396 F/g at a current density of 4, 7, and 10 A/g, respectively. The discharge specific capacitance slightly decreased from 815 to 588 F/g with a retention of 72% after 1000 cycles at a current density of 1 A/g. With these superior capacitance properties, the novel NiMoO4 integrated electrode materials could be considered as promising material for supercapacitors.
Direct determination of barrier height (ΦBH) value between Ir and single crystal (001) hydrogen-terminated diamond with lightly boron doped has been performed using x-ray photoelectron spectroscopy technique. 70 nm Ir islands were formed on hydrogen-terminated diamond surface using anodic aluminum oxide. The ΦBH value for Ir/hydrogen-terminated diamond was −0.43 ± 0.14 eV, indicating that Ir was a suitable metal for ohmic contact with hydrogen-terminated diamond. The band diagram of Ir/hydrogen-terminated diamond was obtained. The experimental ΦBH was compared with the theoretical ΦBH in this work.
The conflict between the Thai state and the Malay-Muslim insurgency in the country's Deep South is one of Southeast Asia's most persistent internal security challenges. The start of the current period of violence dates back to the early 2000s, and since then, a significant number of studies exploring the renewed escalation have been published. In this study, we argue that existing scholarship has not adequately accounted for the external environment in which political decisions were taken on how to deal with the southern insurgency. We seek to show how the internationally dominant, hegemonic security agenda of so-called non-traditional security (NTS) influenced the Thai government's approach to the conflict. Building upon the Copenhagen School's securitisation theory, we show how the insurgency became securitised under the dominant NTS narrative, leading to the adoption of harsh measures and alienating discourses that triggered the escalation of violence that continues today. The specific NTS frameworks that ‘distorted’ the Thai state's approach of one that had been informed solely by local facts and conditions were those of anti-narcotics and Islamist terrorism, albeit in different ways. Based on the findings from the case study, the article concludes with a reflection on the role of the hegemonic NTS agenda and its implications for Southeast Asian politics and scholarship.
We previously reported four heterozygous missense mutations of MYH7, KCNQ1, MYLK2, and TMEM70 in a single three-generation Chinese family with dual Long QT and hypertrophic cardiomyopathy phenotypes for the first time. However, the clinical course among the family members was various, and the potential myocardial dysfunction has not been investigated.
The objective of this study was to investigate the echocardiographic and electrocardiographic characteristics in a genetic positive Chinese family with hypertrophic cardiomyopathy and further to explore the association between myocardial dysfunction and electric activity, and the identified mutations.
A comprehensive echocardiogram – standard two-dimensional Doppler echocardiography and three-dimensional speckle tracking echocardiography – and electrocardiogram were obtained for members in this family.
As previously reported, four missense mutations – MYH7-H1717Q, KCNQ1-R190W, MYLK2-K324E, and TMEM70-I147T – were identified in this family. The MYH7-H1717Q mutation carriers had significantly increased left ventricular mass indices, elevated E/e’ ratio, deteriorated global longitudinal stain, but enhanced global circumferential and radial strain compared with those in non-mutation patients (all p<0.05). The KCNQ1-R190W carriers showed significantly prolonged QTc intervals, and the MYLK2-K324E mutation carriers showed inverted T-waves (both p<0.05). However, the TMEM70-I147T mutation carriers had similar echocardiography and electrocardiographic data as non-mutation patients.
Three of the identified four mutations had potential pathogenic effects in this family: MYH7-H1717Q was associated with increased left ventricular thickness, elevated left ventricular filling pressure, and altered myocardial deformation; KCNQ1-R190W and MYLK2-K324E mutations were correlated with electrocardiographic abnormalities reflected in long QT phenotype and inverted T-waves, respectively.
Existing studies have not investigated the effectiveness of one long-acting injectable antipsychotic (LAI) versus another in preventing hospitalizations among patients with bipolar disorder (BD). This study was conducted to compare all-cause inpatient healthcare utilization and associated costs among BD patients who initiated LAIs.
This retrospective cohort analysis used the Truven Health Analytics MarketScan® Commercial and Medicaid claims database. Bipolar patients >18 years with at least one claim for one of the following LAIs were identified between 1 January 2013 and 30 June 2014 (identification period): aripiprazole, haloperidol, paliperidone, and risperidone. The first day of initiating an LAI was considered the index date. Logistic regression and generalized linear regression models were conducted to estimate risk of inpatient hospitalization and associated costs during the 1-year follow up.
A total of 1,540 BD patients initiated an LAI: 14.5 percent aripiprazole, 16.3 percent risperidone, 21.0 percent haloperidol, and 48.1 percent paliperidone. With the aripiprazole cohort as the reference group, the odds of having any inpatient hospitalizations were significantly higher in haloperidol [Odds Ratio, OR (95 percent Confidence Interval, CI): 1.49 (1.01 - 2.19)] and risperidone [1.78 (1.19 - 2.66)] cohorts. The paliperidone cohort also had a higher risk of having a hospitalization than aripiprazole, but the difference was not statistically significant (p>.05). Among LAI initiators having any inpatient hospitalizations, the adjusted mean all-cause inpatient costs were lowest in the aripiprazole cohort (USD26,002), followed by risperidone (USD27,937), haloperidol (USD30,411), and paliperidone (USD33,240). However, the cost difference was not statistically significant.
Our study findings highlight the value of aripiprazole in reducing all-cause inpatient hospitalizations and associated costs among patients with BD during the 1-year follow-up. It is worthwhile to note that bipolar diagnoses were identified from healthcare claims coded for reimbursement purposes, thus misclassification was possible. Future studies are warranted to understand the impact of LAI use in a longer period of time.
Existing evidence on clinical and economic effectiveness of one long-acting injectable antipsychotic (LAI) versus another in successful management of schizophrenia is scarce. The study was conducted to compare all-cause inpatient healthcare utilization and associated costs among Medicaid patients with schizophrenia who initiated LAIs.
This retrospective cohort analysis used the Truven Health Analytics MarketScan® Medicaid claims database. Schizophrenia patients >18 years with at least one claim for one of the following LAI were identified between 1 January 2013 and 30 June 2014 (identification period): aripiprazole, fluphenazine, haloperidol, paliperidone palmitate, and risperidone. The first day of initiating an LAI was considered the index date. Patients were followed for 1 year from index date. Logistic and general linear regression models were used to estimate risk of inpatient hospitalization and associated costs during follow up.
Of the identified Medicaid patients with schizophrenia, 1,672 (36.7 percent) initiated an LAI: 44.0 percent received paliperidone, 26.4 percent haloperidol, 13.8 percent risperidone, 9.2 percent aripiprazole, and 6.6 percent fluphenazine. With the aripiprazole cohort as the reference group, the odds of having any inpatient hospitalizations were significantly higher in haloperidol [Odds Ratio, OR (95 percent Confidence Interval, CI): 1.51 (1.05 - 2.16)] and risperidone [OR (95 percent CI): 1.58 (1.07 - 2.33)] cohorts. Fluphenazine and paliperidone palmitate cohorts also had higher risk of having any inpatient hospitalizations compared with aripiprazole, but the differences were not statistically significant (p>.05). Among LAI initiators with any inpatient hospitalizations, the adjusted mean inpatient costs were lowest in the aripiprazole cohort (USD25,616), followed by haloperidol (USD30,811), paliperidone (USD30,833), risperidone (USD31,584), and fluphenazine (USD37,338), although differences were not statistically significant.
Our study findings highlight the value of aripiprazole in reducing inpatient hospitalizations and associated costs among patients with schizophrenia. However, our study is limited as our results are reflective of a multi-state Medicaid population. Future studies are warranted to confirm the results in non-Medicaid patient populations.
OBJECTIVES/SPECIFIC AIMS: Psoriasis is one of the most common inflammatory diseases of the skin, affecting about 2%–3% of the US population. Despite its high prevalence, its pathogenesis remains poorly understood. The ability of the microbiome to modify host immunity and metabolism suggests that it may contribute to the development of psoriasis and its cardiometabolic comorbidities. This study aims to characterize the psoriatic skin microbiome and understand the functional role that these bacteria may play. METHODS/STUDY POPULATION: 16s rRNA sequencing of site-matched skin swabs from 8 psoriasis patients and 8 healthy controls was used to identify bacteria and determine their relative abundance and microbial community diversity in the sample. PICRUSt was used to infer the functional roles of the bacteria from 16s rRNA amplicon data. RESULTS/ANTICIPATED RESULTS: Lesional psoriasis skin had lower α diversity (p=0.04), less Actinobacteria (p=0.0001), but higher Firmicutes (p=0.009) compared with controls. At the genus level, lesional skin had more Alloiococcus (p=0.01) and Aerococcus (p=0.01) and demonstrated a trend towards lower Propionibacterium (p=0.08) and higher Gallicola (p=0.09) compared to controls. Interestingly, Alloiococcus (p=0.003) and Gallicola (p=0.04) were also higher in nonlesional skin compared with controls. Furthermore, lesional and nonlesional skin shared an increased abundance of Acinetobacter sp., Staphylococcus pettenkoferi, and Streptococcus sp., relative to controls. Lesional and nonlesional psoriasis skin did not differ significantly in microbiome composition. Predictive functional analysis revealed that both the healthy and psoriatic skin microbiome were enriched with bacteria capable of amino acid and carbohydrate metabolism suggest these functions might have a general role in host-microbe interaction. DISCUSSION/SIGNIFICANCE OF IMPACT: These data reveal intriguing differences in the cutaneous microbiome of psoriatic individuals and healthy controls and suggest that bacterial metabolism may play an important role in host-microbe interaction.
Evidence indicates that the positive effects of 2-year early intervention services for psychosis are not maintained after service withdrawal. Optimal duration of early intervention in sustaining initial improved outcomes remains to be determined.
To examine the sustainability of the positive effects of an extended, 3-year, early intervention programme for patients with first-episode psychosis (FEP) after transition to standard care.
A total of 160 patients, who had received a 2-year early intervention programme for FEP, were enrolled to a 12-month randomised-controlled trial (ClinicalTrials.gov: NCT01202357) comparing a 1-year extension of the early intervention (3-year specialised treatment) with step-down care (2-year specialised treatment). Participants were followed up and reassessed 2 and 3 years after inclusion to the trial.
There were no significant differences between the treatment groups in outcomes on functioning, symptom severity and service use during the post-trial follow-up period.
The therapeutic benefits achieved by the extended, 3-year early intervention were not sustainable after termination of the specialised service.
We are interested in the rate of convergence of a subordinate Markov process to its invariant measure. Given a subordinator and the corresponding Bernstein function (Laplace exponent), we characterize the convergence rate of the subordinate Markov process; the key ingredients are the rate of convergence of the original process and the (inverse of the) Bernstein function. At a technical level, the crucial point is to bound three types of moment (subexponential, algebraic, and logarithmic) for subordinators as time t tends to ∞. We also discuss some concrete models and we show that subordination can dramatically change the speed of convergence to equilibrium.
A magnesium–lithium (Mg–Li) hybrid battery consists of an Mg metal anode, a Li+ intercalation cathode, and a dual-salt electrolyte with both Mg2+ and Li+ ions. The demonstration of this technology has appeared in literature for few years and great advances have been achieved in terms of electrolytes, various Li cathodes, and cell architectures. Despite excellent battery performances including long cycle life, fast charge/discharge rate, and high Coulombic efficiency, the overall research of Mg–Li hybrid battery technology is still in its early stage, and also raised some debates on its practical applications. In this regard, we focus on a comprehensive overview of Mg–Li hybrid battery technologies developed in recent years. Detailed discussion of Mg–Li hybrid operating mechanism based on experimental results from literature helps to identify the current status and technical challenges for further improving the performance of Mg–Li hybrid batteries. Finally, a perspective for Mg–Li hybrid battery technologies is presented to address strategic approaches for existing technical barriers that need to be overcome in future research direction.
Rapid solidification of Al30Si70 alloy was studied via electromagnetic levitation technique. The solidification kinetics and the morphology of the solidification front of the Si phase were analyzed in situ by using a high-speed video camera and subsequent microstructural analysis of as-solidified samples. It shows that solidification of the sample always starts from one point. After that, nucleation continues to proceed at the interface front during growth. The morphology of primary Si transforms from faceted wafer to nonfaceted equiaxed grain and the grain size decreases with increase of undercooling. At small undercooling, the growth velocity of primary Si decreases with time and the floated Si wafers have a trend to agglomerate, while at large undercooling, the nucleation rate decreases with time, which are explained by the fact that silicon content, undercooling and density at the solid–liquid interface change with time in solidification. Finally, the nucleation rate and growth velocity were discussed in combination of classical theory.
A three-dimensional (3D) lattice Boltzmann flux solver (LBFS) is presented in this paper for the simulation of both isothermal and thermal flows. The present solver combines the advantages of conventional Navier-Stokes (N-S) solvers and lattice Boltzmann equation (LBE) solvers. It applies the finite volume method (FVM) to solve the N-S equations. Different from the conventional N-S solvers, its viscous and inviscid fluxes at the cell interface are evaluated simultaneously by local reconstruction of LBE solution. As compared to the conventional LBE solvers, which apply the lattice Boltzmann method (LBM) globally in the whole computational domain, it only applies LBM locally at each cell interface, and flow variables at cell centers are given from the solution of N-S equations. Since LBM is only applied locally in the 3D LBFS, the drawbacks of the conventional LBM, such as limitation to uniform mesh, tie-up of mesh spacing and time step, tedious implementation of boundary conditions, are completely removed. The accuracy, efficiency and stability of the proposed solver are examined in detail by simulating plane Poiseuille flow, lid-driven cavity flow and natural convection. Numerical results show that the LBFS has a second order of accuracy in space. The efficiency of the LBFS is lower than LBM on the same grids. However, the LBFS needs very less non-uniform grids to get grid-independence results and its efficiency can be greatly improved and even much higher than LBM. In addition, the LBFS is more stable and robust.
We investigated the effect of human induced pluripotent stem cell (hiPS) medium on porcine somatic cell nuclear transfer and bovine in vitro fertilized early blastocysts, in comparison with North Carolina State University (NCSU)-37 medium and in vitro culture (IVC)-II medium. After 2 days of culture, the diameter of the portion of the blastocyst that was extruded from the zona pellucid dramatically differed between porcine blastocysts cultured in hiPS medium and those cultured in NCSU-37 medium (221.47 ± 38.94 μm versus 481.87 ± 40.61 μm, P < 0.01). Moreover, the diameter of the portion of the blastocyst significantly differed between bovine blastocysts cultured in hiPS medium and those cultured in IVC-II medium (150.30 ± 29.49 μm versus 195.58 ± 41.59 μm, P < 0.01). Furthermore, the total number of cells per porcine and bovine blastocyst was more than two-fold higher in blastocysts cultured in hiPS medium than in those cultured in NCSU-37 medium (44.33 ± 5.28 and 143.33 ± 16.05, P < 0.01) or IVC-II medium (172.12 ± 45.08 and 604.83 ± 242.64, P < 0.01), respectively. These results indicate that hiPS medium markedly improves the quality of porcine and bovine blastocysts.
The influence of substitution of Fe by Ni or Co on the glass forming ability (GFA) and soft magnetic properties of the Fe71−xNb6B23Nix (x = 1–5) and (Fe1−x−yNixCoy)71Nb6B23 (x = 0.1–0.2, y = 0.1–0.2) amorphous ribbons was systematically studied. The Ni or Co substitution for Fe enhances the GFA and decreases the thermal stability for Fe–Nb–B–Ni and (Fe, Ni, Co)–Nb–B alloy systems. The alloys with Ni and Co substitution have lower glass transition temperature and wider supercooled liquid region than that with Ni substitution. The (Fe0.7Ni0.1Co0.2)71Nb6B23 alloys achieved the maximum supercooled liquid region of 78 K. The saturation magnetization decreased and the coercivity increased with increasing Ni or Co content. The (Fe0.8Ni0.1Co0.1)71Nb6B23 amorphous ribbons exhibited the best soft magnetic properties with high saturation and low coercivity. The findings of Fe-based multicomponent alloys with large GFA, low cost, and good magnetic properties are encouraging to develop new soft magnetic materials.
This paper investigates a 6-degree-of-freedom foldable parallel mechanism for the ship-based stabilized platform, which is driven by closed chain linkages. The velocity and acceleration mappings between the moving platform and inputs of the closed chain linkages are deduced in the form of the first- and second-order influence coefficient matrices. The continuous stiffness matrix is deduced; furthermore, the translation and rotational stiffness along any direction are also deduced. With directional stiffness, the singularity of the mechanism is analyzed, and the explanation of the singularity is given from the viewpoint of stiffness. The directions the platform cannot move or lose its constraints are got from directional stiffness.
Seed protein content is one of the most important traits controlled by quantitative trait loci (QTLs) in soybean. In this study, a Glycine soja accession (ZYD2738) was crossed with two elite cultivars Jidou 12 and Jidou 9 separately and subsequently the resulting F2:3 populations were used to identify QTLs associated with seed protein content. Protein contents in either population appeared to have a normal distribution with transgressive segregation. A total of five QTLs associated with high protein content were identified and mapped to chromosomes 2, 6, 13, 18 and 20, respectively. Of these QTLs, three (qPRO_2_1, qPRO_13_1 and qPRO_20_1) were identified in the same region in both the populations, whereas the other two (qPRO_6_1 and qPRO_18_1) were mapped in two different regions. qPRO_2_1 appears to be a novel protein QTL. qPRO_6_1, qPRO_18_1 and qPRO_20_1 had additive effects on seed protein content, while qPRO_13_1 had an over-dominant effect on seed protein content. These QTLs and their linked markers could serve as effective tools for marker-assisted selection to increase seed protein content.
Multiagent systems have been considered as a potential solution for developing adaptive systems. In this research, a cellular self-organizing (CSO) approach is proposed for developing such multiagent adaptive systems. The design of CSO systems however is difficult because the global effect emerges from local actions and interactions that are often hard to specify and control. In order to achieve high-level flexible and robustness of CSO systems and retain the capability of specifying desired global effects, we propose a field-based regulative control mechanism, called field-based behavior regulation (FBR). FBR is a real-time, dynamical, distributed mechanism that regulates the emergence process for CSO systems to self-organize and self-reconfigure in complex operation environments. FBR characterizes the task environment in terms of “fields” and extends the system flexibility and robustness without imposing global control over local cells or agents. This paper describes the model of CSO systems and FBR, and demonstrates their effectiveness through simulation-based case studies.