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With the development of evidence-based interventions for treatment of priority mental health conditions in humanitarian settings, it is important to establish the cost-effectiveness of such interventions to enable their scale-up.
To evaluate the cost-effectiveness of the Problem Management Plus (PM+) intervention compared with enhanced usual care (EUC) for common mental disorders in primary healthcare in Peshawar, Pakistan. Trial registration ACTRN12614001235695 (anzctr.org.au).
We randomly allocated 346 participants to either PM+ (n = 172) or EUC (n = 174). Effectiveness was measured using the Hospital Anxiety and Depression Scale (HADS) at 3 months post-intervention. Cost-effectiveness analysis was performed as incremental costs (measured in Pakistani rupees, PKR) per unit change in anxiety, depression and functioning scores.
The total cost of delivering PM+ per participant was estimated at PKR 16 967 (US$163.14) using an international trainer and supervisor, and PKR 3645 (US$35.04) employing a local trainer. The mean cost per unit score improvement in anxiety and depression symptoms on the HADS was PKR 2957 (95% CI 2262–4029) (US$28) with an international trainer/supervisor and PKR 588 (95% CI 434–820) (US$6) with a local trainer/supervisor. The mean incremental cost-effectiveness ratio (ICER) to successfully treat a case of depression (PHQ-9 ≥ 10) using an international supervisor was PKR 53 770 (95% CI 39 394–77 399) (US$517), compared with PKR 10 705 (95% CI 7731–15 627) (US$102.93) using a local supervisor.
The PM+ intervention was more effective but also more costly than EUC in reducing symptoms of anxiety, depression and improving functioning in adults impaired by psychological distress in a post-conflict setting of Pakistan.
This study investigated the influence of berberine (BBR) supplementation in normal and high lipid diets on lipid metabolism and accumulation in black sea bream (Acanthopagrus schlegelii). Berberine was supplemented at 50 mg/kg to control (Con, 11.1% crude lipid) and high lipid (HL, 20.2% crude lipid) diets and named as ConB and HLB, respectively. After the 8-week feeding trial, fish body length and specific growth rate were significantly reduced by high lipid diets (P < 0.05). Muscle and whole-body crude lipid contents were significantly influenced by both BBR supplementation and dietary lipid level. Fish fed HLB diet had significantly lower serum triglyceride, low-density lipoprotein cholesterol contents, and alanine aminotransferase activity compared with the HL group. The HL group presented vast lipid accumulation in the liver, and hypertrophied hepatocytes along with large lipid droplets, and translocation of nuclear to the cell periphery. These abnormalities in black sea bream were alleviated in the HLB group. Berberine supplementation in high lipid diet significantly downregulated the hepatic expression levels of accα, srebp-1, 6pgd, g6pd and pparγ, whereas the lpl, hsl, and cpt1a expression levels were significantly upregulated. However, the expression levels of these genes showed opposite trends in muscle (except for pparγ). In conclusion, dietary BBR supplementation in high lipid diet reduced hepatic lipid accumulation by downregulating lipogenesis gene expression and upregulating lipolysis gene expression, and it increased muscle lipid contents with opposite trends of the mechanism observed in the liver.
Flavonoid-rich foods have shown a beneficial effect against non-alcoholic fatty liver disease (NAFLD) in short-term randomized trials and animal experiments. It is uncertain whether the usual dietary intake of flavonoids may benefit patients with NAFLD. This study evaluated the association between the usual intake of total flavonoids and their subclasses and the risk of progression in NAFLD. The prospective study included 2694 adults from the Guangzhou Nutrition & Health Study. Face-to-face interviews using a 79-item food frequency questionnaire were administered to assess habitual dietary flavonoid intake, while abdominal ultrasonography was conducted to evaluate the presence and degree of NAFLD, with measurements conducted three years apart. After adjustment for potential confounders, higher flavonoid intakes were gradely associated with reduced risks of worsen NAFLD status. The relative risks (95% CI) of worsening (vs. non-worsening) NAFLD in the highest (vs. lowest) quintile were 0.71 (0.54, 0.93) for total flavonoids, 0.74 (0.57, 0.95) for flavanones, 0.74 (0.56, 0.96) for flavan-3-ols, 0.90 (0.68, 1.18) for flavonols, 0.73 (0.56, 0.93) for flavones, 0.79 (0.61, 1.02) for isoflavones and 0.74 (0.57, 0.96) for anthocyanins. Sub-group analysis found that the beneficial associations were evident only in overweight/obese participants (P-interactions=0.015). An L-shaped (non-linear) relationship was observed between total flavonoid intake and the risk of NAFLD progression. Path analyses showed that the association between flavonoids and NAFLD progression was mediated by decreases in serum cholesterol and HOMA-IR. This prospective study showed that higher flavonoids intake was associated with a lower risk of NAFLD progression in the elderly overweight/obese Chinese population.
This paper proposes a set of novel indices for evaluating the kinematic performance of a 3-RRS (R and S denote revolute and spherical joint respectively, R denotes active joint.), parallel mechanism whose translational and rotational movements are strongly coupled. First, the indices are formulated using the decoupled overall Jacobian matrix, which is developed using coordinate transformation. Then, the influences of the homogeneous dimensionless parameters on these indices are investigated. In addition, the dimension synthesis of the 3-RRS parallel mechanism is carried out by minimizing the mean value of the kinematic performance indices and their standard deviation. The results demonstrate that the established approach facilitates good global kinematic performance of the parallel mechanism.
Bituminous limestone of the Ediacaran Shibantan Member of the Dengying Formation (551–539 Ma) in the Yangtze Gorges area contains a rare carbonate-hosted Ediacara-type macrofossil assemblage. This assemblage is dominated by the tubular fossil Wutubus Chen et al., 2014 and discoidal fossils, e.g., Hiemalora Fedonkin, 1982 and Aspidella Billings, 1872, but frondose organisms such as Charnia Ford, 1958, Rangea Gürich, 1929, and Arborea Glaessner and Wade, 1966 are also present. Herein, we report four species of Arborea from the Shibantan assemblage, including the type species Arborea arborea (Glaessner in Glaessner and Daily, 1959) Glaessner and Wade, 1966, Arborea denticulata new species, and two unnamed species, Arborea sp. A and Arborea sp. B. Arborea arborea is the most abundant frond in the Shibantan assemblage. Arborea denticulata n. sp. resembles Arborea arborea in general morphology but differs in its fewer primary branches and lower length/width ratio of primary branches. Arborea sp. A and Arborea sp. B are fronds with a Hiemalora-type basal attachment. Sealing by microbial mats and authigenic cementation may have played an important role in the preservation of Arborea in the Shibantan assemblage. The Shibantan material of Arborea extends the stratigraphic, ecological, and taphonomic ranges of this genus.
During the detection of industrial hazardous gases, like formaldehyde (HCHO), the selectivity is still a challenging issue. Herein, an alternative HCHO chemosensor that based on the tin oxide nanoparticles is proposed, which was obtained through a facile hydrothermal method. Gas sensing performances showed that the optimal working temperature located at only 180 °C, the response value of 79 via 50 ppm HCHO was much higher than that of 35 at 230 °C. However, the compromised test temperature was selected as 230 °C, taking into account the faster response/recovery speeds than 180 °C, named 20/23versus 53/60 s, respectively. The response (35) of the SnO2 nanoparticles-based sensor to 50 ppm of HCHO is about 400% higher than that of bulk SnO2 sensor (9), especially when the gas concentration is 1 ppm, SnO2 nanoparticles also has a higher sensitivity which may possibly result from more exposed active sites and small size effect for nanoparticles than for bulk ones. The gas sensor based on SnO2 nanoparticles can be utilized as a promising candidate for practical low-temperature detectors of HCHO due to its higher gas response, excellent response–recovery properties, and perfect selectivity.
Integrating LiMn2O4(LMO) and different carbon materials to build a mixed cathode system can provide fast transport channels to improve the conduction of both electrons and ions. In this paper, our work studied in situ low-temperature hydrothermal synthesis of LMO nanocomposites based on graphene oxide (GO)/carbon nanotubes (CNTs) hydrogel. Compared with the pure LMO nanoparticles, GO/CNTs/LMO (GCLMO) composites greatly improved electrochemical performance in specific capacity, cycle performance and rate ability. The electrochemical test results showed that the specific capacitance of GCLMO nanocomposites reached 396 F/g at the current density of 0.5 A/g, which was much higher than 221 F/g of pure LMO. Even at the current density of 10 A/g, the specific capacitance was still as high as 309 F/g. Besides, after 2000 cycles, the specific capacitance retention of the composite was 93%. Electrochemical data showed that GCLMO composite is an ideal cathode material for supercapacitors.
Soft robots can perform effectively inspecting than rigid robots in some special environments such as nuclear pipelines and high-voltage cables. This article presents a versatile quadruped soft rod-climbing robot (SR-CR) that consists of four bending actuators and a telescopic actuator. The bending actuator is composed of flexible bellows with multiple folding air chambers, elastic telescopic layer (ETL), and strain-limiting layer (SLL). The telescopic actuator provides the energy for the robot to climb forward. The SR-CR is activated by a control strategy that alternates the body deformation and feet pneumatic clenched for stable climbing. The robot can climb rods at 90°, with the maximum speed of up to 2.33 mm/s (0.018 body length/s). At 0.83 HZ, the maximum moving speed of the robot in climbing horizontally parallel rods can reach 18.43 mm/s. In addition, the SR-CR can also achieve multiple impressive functions, including turning around a corner at a rate of 7 mm/s (0.054 body length/s), carrying a payload of 3.7 times its self-weight on horizontal rods at a speed of 9 mm/s (0.069 body length/s).
The novel coronavirus (COVID-19) pandemic has spread over 213 countries and territories. We sought to describe the clinical features of fatalities in patients with severe COVID-19 in an internet-based retrospective cohort study through retrieving the clinical information of 100 COVID-19 deaths from non-duplicating incidental reports in Chinese provincial and other governmental websites between January 23 and March 10, 2020. About 6 of 10 COVID-19 deaths were males (64.0%). The average age was 70.7±13.5 years, and 84% of patients were elderly (over age 60 y). The mean duration from admission to diagnosis was 2.2±3.8 days (median: 1). The mean duration from diagnosis to death was 9.9±7.0 days (median: 9). About 3 of 4 cases (76.0%) were complicated by 1 or more chronic diseases, including hypertension (41.0%), diabetes (29.0%) and coronary heart disease (27.0%), respiratory disorders (23.0%) and cerebrovascular disease (12.0%). Fever (46.0%), cough (33.0%), shortness of breath (9.0%) were the most common first symptoms. Multiple organ failure (67.9%), circulatory failure (20.2%) and respiratory failure (11.9%) are the top three direct causes of death. COVID-19 deaths are mainly elderly and patients with chronic diseases especially cardiovascular disorders and diabetes. Multiple organ failure is the most common direct cause of death.
Accumulating studies have found structural and functional abnormalities of the striatum in bipolar disorder (BD) and major depressive disorder (MDD). However, changes in intrinsic brain functional connectivity dynamics of striato-cortical circuitry have not been investigated in BD and MDD. This study aimed to investigate the shared and specific patterns of dynamic functional connectivity (dFC) variability of striato-cortical circuitry in BD and MDD.
Brain resting-state functional magnetic resonance imaging data were acquired from 128 patients with unmedicated BD II (current episode depressed), 140 patients with unmedicated MDD, and 132 healthy controls (HCs). Six pairs of striatum seed regions were selected: the ventral striatum inferior (VSi) and the ventral striatum superior (VSs), the dorsal-caudal putamen (DCP), the dorsal-rostral putamen (DRP), and the dorsal caudate and the ventral-rostral putamen (VRP). The sliding-window analysis was used to evaluate dFC for each seed.
Both BD II and MDD exhibited increased dFC variability between the left DRP and the left supplementary motor area, and between the right VRP and the right inferior parietal lobule. The BD II had specific increased dFC variability between the right DCP and the left precentral gyrus compared with MDD and HCs. The MDD had increased dFC variability between the left VSi and the left medial prefrontal cortex compared with BD II and HCs.
The patients with BD and MDD shared common dFC alteration in the dorsal striatal-sensorimotor and ventral striatal-cognitive circuitries. The patients with MDD had specific dFC alteration in the ventral striatal-affective circuitry.
In this paper, we use finite element analysis (FEA) to study the linear viscoelastic response of polyurea, a type of hard–soft block copolymer. A Niblack's algorithm-based technique employed on atomic force microscopy images provides geometry inputs for the FEA model, while the viscoelastic master curves of the soft matrix are obtained via a combination of dynamic mechanical analysis data and molecular dynamic (MD) estimations. In this microstructural image-based FEA framework, we introduce an interphase area of altered properties between the hard and soft domains. Both spatial and property distributions of this interphase area affect the viscoelastic response of the copolymer system. To quantitatively investigate the impact of structural and property features of the interphase on the energy storage and dissipation of a system during linear perturbation, we develop a statistical descriptor representation of the interphase region related to physical parameters. Utilizing decision-tree and random forest concepts from machine learning, we apply a ranking algorithm to identify the most significant features for four different mechanical response descriptors. Results show that the total interphase volume fraction and shifting factor distributions in the interphase area dominate the magnitude of the tan δ peak, whereas the magnitudes of the shifting factors primarily affect the tan δ peak location in frequency space. This method allows us to readily identify the dominant features impacting individual properties and paves the way for material design of hard–soft block copolymer systems.