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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.
To evaluate the Orange County Clostridium difficile infection (CDI) prevention collaborative’s effect on rates of CDI in acute-care hospitals (ACHs) in Orange County, California.
Controlled interrupted time series.
We convened a CDI prevention collaborative with healthcare facilities in Orange County to reduce CDI incidence in the region. Collaborative participants received onsite infection control and antimicrobial stewardship assessments, interactive learning and discussion sessions, and an interfacility transfer communication improvement initiative during June 2015–June 2016. We used segmented regression to evaluate changes in monthly hospital-onset (HO) and community-onset (CO) CDI rates for ACHs. The baseline period comprised 17 months (January 2014–June 2015) and the follow-up period comprised 28 months (September 2015–December 2017). All 25 Orange County ACHs were included in the CO-CDI model to account for direct and indirect effects of the collaborative. For comparison, we assessed HO-CDI and CO-CDI rates among 27 ACHs in 3 San Francisco Bay Area counties.
HO-CDI rates in the 15 participating Orange County ACHs decreased 4% per month (incidence rate ratio [IRR], 0.96; 95% CI, 0.95–0.97; P < .0001) during the follow-up period compared with the baseline period and 3% (IRR, 0.97; 95% CI, 0.95–0.99; P = .002) per month compared to the San Francisco Bay Area nonparticipant ACHs. Orange County CO-CDI rates declined 2% per month (IRR, 0.98; 95% CI, 0.96–1.00; P = .03) between the baseline and follow-up periods. This decline was not statistically different from the San Francisco Bay Area ACHs (IRR, 0.97; 95% CI, 0.95–1.00; P = .09).
Our analysis of ACHs in Orange County provides evidence that coordinated, regional multifacility initiatives can reduce CDI incidence.
To compare risk of surgical site infection (SSI) following cesarean delivery between women covered by Medicaid and private health insurance.
Cesarean deliveries covered by Medicaid or private insurance and reported to the National Healthcare Safety Network (NHSN) and state inpatient discharge databases by hospitals in California (2011–2013).
Deliveries reported to NHSN and state inpatient discharge databases were linked to identify SSIs in the 30 days following cesarean delivery, primary payer, and patient and procedure characteristics. Additional hospital-level characteristics were obtained from public databases. Relative risk of SSI by primary payer primary payer was assessed using multivariable logistic regression adjusting for patient, procedure, and hospital characteristics, accounting for facility-level clustering.
Of 291,757 cesarean deliveries included, 48% were covered by Medicaid. SSIs were detected following 1,055 deliveries covered by Medicaid (0.75%) and 955 deliveries covered by private insurance (0.63%) (unadjusted odds ratio, 1.2; 95% confidence interval [CI], 1.1–1.3; P < .0001). The adjusted odds of SSI following cesarean deliveries covered by Medicaid was 1.4 (95% CI, 1.2–1.6; P < .0001) times the odds of those covered by private insurance.
In this, the largest and only multicenter study to investigate SSI risk following cesarean delivery by primary payer, Medicaid-insured women had a higher risk of infection than privately insured women. These findings suggest the need to evaluate and better characterize the quality of maternal healthcare for and needs of women covered by Medicaid to inform targeted infection prevention and policy.
An experiment was conducted to determine the effects of supplementing different amounts of daidzein in a diet on the growth performance, blood biochemical parameters and meat quality of finishing beef cattle. Thirty finishing Xianan steers were distributed in three groups equilibrated by weight and fed three different dietary treatments (concentrate ratio = 80%): (1) control; (2) 500 mg/kg daidzein and (3) 1000 mg/kg daidzein, respectively. Steers were slaughtered after an 80-day feeding trial. Results showed that daidzein supplementation had no effect on the final body weight, average daily gain and feed conversion rate of steers. Steers fed with 1000 mg/kg daidzein had greater dry matter intake than those fed with control diets. Compared with the control group, the 1000 mg/kg daidzein group had a higher fat thickness, lower shear force and lightness. The pH, drip loss, cooking loss, redness (a*), yellowness (b*), moisture, ash, crude protein and intramuscular fat of the Longissimus dorsi muscle were unaffected by daidzein supplementation. Compared with the control group, the 1000 mg/kg daidzein group significantly increased the serum concentrations of insulin, free fatty acid and Glutamic-pyruvic transaminase. The 500 mg/kg daidzein group significantly increased the serum concentration of tetraiodothyronine compared with the control group. Supplemental daidzein did not affect the blood antioxidant ability and blood immune parameters in serum. In conclusion, daidzein supplementation above 500 mg/day modifies feed intake and metabolic and hormonal profile, with positive and negative effects on meat quality.
where Ω is a bounded smooth domain in ℝN (N ≥ 1), α ≥ 2 and θ is a parameter. Under the assumption that g(x, u) is sublinear near the origin with respect to u, we study the effect of the perturbation term h(x, u), which may break the symmetry of the associated energy functional. With the aid of critical point theory and the truncation method, we show that this system possesses multiple small negative energy solutions.
An electromechanical coupling model is established for the space-tethered combination (STC) under microgravity environment after target capture by the tethered robot system (TRS). A linearized dynamic model of the STC is put forward with its controllability and observability as a control system analyzed. A double closed-loop tension control strategy is proposed to mitigate the impact and suing longitudinal vibration caused by the velocity difference between the platform and target. Experiment setup is built on a ground-based flotation platform to investigate the impact of the STC. Results of simulation and experimental validation show that the proposed tension control strategy is responsive and rapid in tension tracking and effectively prevent impact.
As the US population ages, the number of hip and knee arthroplasties is expected to increase. Because surgical site infections (SSIs) following these procedures contribute substantial morbidity, mortality, and costs, we projected SSIs expected to occur from 2020 through 2030.
We used a stochastic Poisson process to project the number of primary and revision arthroplasties and SSIs. Primary arthroplasty rates were calculated using annual estimates of hip and knee arthroplasty stratified by age and gender from the 2012–2014 Nationwide Inpatient Sample and standardized by census population data. Revision rates, dependent on time from primary procedure, were obtained from published literature and were uniformly applied for all ages and genders. Stratified complex SSI rates for arthroplasties were obtained from 2012–2015 National Healthcare Safety Network data. To evaluate the possible impact of prevention measures, we recalculated the projections with an SSI rate reduced by 30%, the national target established by the US Department of Health and Human Services (HHS).
Without a reduction in SSI rates, we projected an increase in complex SSIs following hip and knee arthroplasty of 14% between 2020 and 2030. We projected a total burden of 77,653 SSIs; however, meeting the 30% rate reduction could prevent 23,297 of these SSIs.
Given current SSI rates, we project that complex SSI burden for primary and revision arthroplasty may increase due to an aging population. Reducing the SSI rate to the national HHS target could prevent 23,000 SSIs and reduce subsequent morbidity, mortality, and Medicare costs.
We studied the radiolysis of a wide variety of N-heterocycles, including many of biological importance, and find that the majority are remarkably stable in the solid-state when subjected to large doses of ionizing gamma radiation from a 60Co source. Degradation of N-heterocycles as a function of dose rate and total dose was measured using high-performance liquid chromatography with UV detection. Many N-heterocycles show little degradation when γ-irradiated up to a total dose of ~1 MGy, which approximates hundreds of millions of years’ worth of radiation emitted in meteorite parent bodies due to slow radionuclide decay. Extrapolation of these results suggests that these N-heterocyclic compounds would be stable in dry parent bodies over solar system timescales. We suggest that the abundance of these N-heterocycles as measured presently in carbonaceous meteorites is largely reflective of their abundance at the time aqueous alteration stopped in their parent bodies and the absence of certain compounds in present-day samples is either due to the formation mechanisms or degradation which occurred during periods of aqueous alteration or thermal metamorphism.
A new planar multiple-input–multiple-output (MIMO) antenna for ultra wideband (UWB) applications is presented. The proposed antenna operates over the frequency band from 3.1 to 10.6 GHz and it consists of two identical circular monopoles on an FR4 substrate. The wide isolation is achieved through a novel planar decoupling structure that is being inserted between the dual antennas. Moreover, a center slot is etched on the common ground to further increase isolation. The effectiveness of the decoupling structure is analyzed, and performance study has been performed to investigate the mutual coupling reduction. A good isolation of more than 31 dB has been achieved through the entire UWB band (more than 12 dB improvement over the reference antenna). The proposed UWB antenna with and without the wideband decoupling structure has been investigated and verified both numerically and experimentally. The measurement results of the proposed UWB–MIMO antenna are in good agreement with the simulation results. The proposed UWB antenna has been compared with previous works regarding antenna size, geometric complexity, bandwidth, and isolation level. The proposed antenna has some outstanding characteristics such as a geometric simplicity, compact size, broad bandwidth, and low correlation which give the antenna an excellent diversity performance and a good candidate for UWB applications.
While studies suggest that nutritional supplementation may reduce aggressive behavior in children, few have examined their effects on specific forms of aggression. This study tests the primary hypothesis that omega-3 (ω-3), both alone and in conjunction with social skills training, will have particular post-treatment efficacy for reducing childhood reactive aggression relative to baseline.
In this randomized, double-blind, stratified, placebo-controlled, factorial trial, a clinical sample of 282 children with externalizing behavior aged 7–16 years was randomized into ω-3 only, social skills only, ω-3 + social skills, and placebo control groups. Treatment duration was 6 months. The primary outcome measure was reactive aggression collected at 0, 3, 6, 9, and 12 months, with antisocial behavior as a secondary outcome.
Children in the ω-3-only group showed a short-term reduction (at 3 and 6 months) in self-report reactive aggression, and also a short-term reduction in overall antisocial behavior. Sensitivity analyses and a robustness check replicated significant interaction effects. Effect sizes (d) were small, ranging from 0.17 to 0.31.
Findings provide some initial support for the efficacy of ω-3 in reducing reactive aggression over and above standard care (medication and parent training), but yield only preliminary and limited support for the efficacy of ω-3 in reducing overall externalizing behavior in children. Future studies could test further whether ω-3 shows promise in reducing more reactive, impulsive forms of aggression.
We present possible conceptual designs of a laser system for driving table-top free-electron lasers based on terahertz acceleration. After discussing the achievable performances of laser amplifiers with Yb:YAG at cryogenic and room temperature and Yb:YLF at cryogenic temperature, we present amplification modules with available results and concepts of amplifier chains based on these laser media. Their performances are discussed in light of the specifications for the tasks within the table-top light source. Technical and engineering challenges, such as cooling, control, synchronization and diagnostics, are outlined. Three concepts for the laser layout feeding the accelerator are eventually derived and presented.
Contact-line mobility characterizes how fast a liquid can wet or unwet a solid support by relating the contact angle
to the contact-line speed
. The contact angle changes dynamically with contact-line speeds during rapid movement of liquid across a solid. Speeds beyond the region of stick–slip are the focus of this experimental paper. For these speeds, liquid inertia and surface tension compete while damping is weak. The mobility parameter
is defined empirically as the proportionality, when it exists, between
. We discover that
exists and measure it. The experimental approach is to drive the contact line of a sessile drop by a plane-normal oscillation of the drop’s support. Contact angles, displacements and speeds of the contact line are measured. To unmask the mobility away from stick–slip, the diagram of
, the traditional diagram, is remapped to a new diagram by rescaling with displacement. This new diagram reveals a regime where
is proportional to
and the slope yields the mobility
. The experimental approach reported introduces the cyclically dynamic contact angle goniometer. The concept and method of the goniometer are illustrated with data mappings for water on a low-hysteresis non-wetting substrate.
Background: Among patients with schizophrenia, there is evidence of a negative association between self-stigma and subjective quality of life (SQoL), and self-esteem was an important mediator in the association. We attempted to use a longitudinal study to investigate the aforementioned mediation on a sample with schizophrenia. Methods: We used longitudinal data retrieved from medical records of a psychiatric centre between June 2014 and December 2015. In the data, we retrieved information of self-stigma using the Self-Stigma Scale — Short; SQoL, using the WHO questionnaire on the Quality of Life — Short Form; and self-esteem, using the Rosenberg Self-Esteem Scale. All the measures were evaluated five times. Linear mixed-effect models accompanied by Sobel tests were used to tackle the mediating effects. Results: Data from 74 patients (57 males) with schizophrenia were eligible for analysis; their mean (SD) age was 39.53 (10.67); mean age of onset was 22.95 (8.38). Self-esteem was a mediator for patients in physical (p = .039), psychological (p = .003), and social SQoL (p = .004), but not in environment SQoL (p = .051). Conclusion: Based on our findings, mental health professionals could tailor different programs to patients with schizophrenia, such as self-stigma reduction and self-esteem improvement programs. However, treatment as a whole should be sensitive to both self-stigma and self-esteem. Also, we should consider individuals’ health and wellbeing from social perspectives of disability rather than the medical model of disability emphasising symptoms and medications.
It is difficult to control Holotrichia parallela Motschulsky with chemical insecticides due to the larvae's soil-living habit, thus the pest has caused great economic losses in agriculture. In addition, uridine diphosphate-glycosyltransferases (UGTs) catalyze the glycosylation process of a variety of small lipophilic molecules with sugars to produce water-soluble glycosides, and play multiple roles in detoxification, endobiotic modulation, and sequestration in an insect. Some UGTs were found specifically expressed in antennae of Drosophila melanogaster and Spodoptera littoralis, and glucurono-conjugated odorants could not elicit any olfactory signals, suggesting that the UGTs may play roles in odorant inactivation by biotransformation. In the current study, we performed a genome-wide analysis of the candidate UGT family in the dark black chafer, H. parallela. Based on a UGT gene signature and the similarity of these genes to UGT homologs from other organisms, 20 putative H. parallela UGT genes were identified. Bioinformatics analysis was used to predict sequence and structural features of H. parallela UGT proteins, and revealed important domains and residues involved in sugar donor binding and catalysis by comparison with human UGT2B7. Phylogenetic analysis of these 20 UGT protein sequences revealed eight major groups, including both order-specific and conserved groups, which are common to more than one order. Of these 20 UGT genes, HparUGT1265-1, HparUGT3119, and HparUGT8312 were highly (>100-fold change) expressed in antennae, suggesting a possible role in olfactory tissue, and most likely in odorant inactivation and olfactory processing. The remaining UGT genes were expressed in all tissues (head, thorax, abdomen, leg, and wing), indicating that these UGTs likely have different biological functions. This study provides the fundamental basis for determining the function of UGTs in a highly specialized olfactory organ, the H. parallela antenna.
Sea-ice freeboard heights for 17 ICESat campaign periods from 2003 to 2009 are derived from ICESat data. Freeboard is combined with snow depth from Advanced Microwave Scanning Radiometer for Earth Observing System (AMSR-E) data and nominal densities of snow, water and sea ice, to estimate sea-ice thickness. Sea-ice freeboard and thickness distributions show clear seasonal variations that reflect the yearly cycle of growth and decay of the Weddell Sea (Antarctica) pack ice. During October–November, sea ice grows to its seasonal maximum both in area and thickness; the mean freeboards are 0.33–0.41m and the mean thicknesses are 2.10–2.59 m. During February–March, thinner sea ice melts away and the sea-ice pack is mainly distributed in the west Weddell Sea; the mean freeboards are 0.35–0.46m and the mean thicknesses are 1.48–1.94 m. During May–June, the mean freeboards and thicknesses are 0.26–0.29m and 1.32–1.37 m, respectively. the 6 year trends in sea-ice extent and volume are (0.023±0.051)×106 km2 a–1 (0.45% a–1) and (0.007±0.092)×103 km3 a–1 (0.08% a–1); however, the large standard deviations indicate that these positive trends are not statistically significant.
The Ice, Cloud and land Elevation Satellite (ICESat) in its 8 day repeat orbit mode provided data not only on the along-track surface slope, but also on the cross-track surface slope from adjacent repeat ground tracks. During the first 36 days of operation, four to five such repeat orbits occurred within 1 km in the cross-track direction. This provided an opportunity to use ICESat data to measure surface slope in the cross-track direction at 1 km scale. An algorithm was developed to calculate the cross-track surface slope. Combining the slopes in the cross-track and along-track directions gives a three-dimensional surface slope at 1 km scale. The along-track surface slope and surface roughness at 10km scale are also calculated. A comparison between ICESat surface elevation and a European Remote-sensing Satellite (ERS-1) 5 km digital elevation model shows a difference of 1–2 m in central Greenland where the surface slope is small, and >20m at the edge of Greenland where the surface slope is large. The large elevation difference at the edge is most likely due to the slope-induced error in radar altimeter measurement. Accurate surface slope data from ICESat will help to correct the slope-induced error of radar altimeter missions such as Geosat, ERS-1 and ERS-2.
Comparison of the distribution of seasonal variations in surface elevation derived from a firn-densification–elevation model with observed variations derived from ERS-1/-2 satellite radar altimetry shows close similarity in the patterns of the amplitude of the variations over the North Greenland ice sheet. The amplitudes of the seasonal variations decrease from west to east and from south to north, determined by the accumulation rate and the surface-temperature distribution pattern. Several methods of estimating the amplitude of the seasonal variation in the observations are compared, including the use of a three-frequency sinusoidal function derived from the modeled seasonal variation that is asymmetric. The resulting correlation coefficient between the observed amplitude, estimated with the three-frequency function, and the modeled amplitude is 0.66 and the slope is 0.7. Residual differences may be caused by interannual variability in accumulation and temperature and other approximations in the model.
We derive mass changes of the Greenland ice sheet (GIS) for 2003–07 from ICESat laser altimetry and compare them with results for 1992–2002 from ERS radar and airborne laser altimetry. The GIS continued to grow inland and thin at the margins during 2003–07, but surface melting and accelerated flow significantly increased the marginal thinning compared with the 1990s. The net balance changed from a small loss of 7 ± 3 Gt a−1 in the 1990s to 171 ± 4 Gt a−1 for 2003–07, contributing 0.5 mm a−1 to recent global sea-level rise. We divide the derived mass changes into two components: (1) from changes in melting and ice dynamics and (2) from changes in precipitation and accumulation rate. We use our firn compaction model to calculate the elevation changes driven by changes in both temperature and accumulation rate and to calculate the appropriate density to convert the accumulation-driven changes to mass changes. Increased losses from melting and ice dynamics (17–206 Gt a−1) are over seven times larger than increased gains from precipitation (10–35 Gt a−1) during a warming period of ∼2 K (10 a)−1 over the GIS. Above 2000 m elevation, the rate of gain decreased from 44 to 28 Gt a−1, while below 2000 m the rate of loss increased from 51 to 198 Gt a−1. Enhanced thinning below the equilibrium line on outlet glaciers indicates that increased melting has a significant impact on outlet glaciers, as well as accelerating ice flow. Increased thinning at higher elevations appears to be induced by dynamic coupling to thinning at the margins on decadal timescales.
Changes in ice mass are estimated from elevation changes derived from 10.5 years (Greenland) and 9 years (Antarctica) of satellite radar altimetry data from the European Remote-sensing Satellites ERS-1 and -2. For the first time, the dH/dt values are adjusted for changes in surface elevation resulting from temperature-driven variations in the rate of firn compaction. The Greenland ice sheet is thinning at the margins (–42 ± 2Gta¯1 below the equilibrium-line altitude (ELA)) and growing inland (+53 ± 2Gta-1 above the ELA) with a small overall mass gain (+11 ± 3Gta–1; –0.03 mma–1 SLE (sea-level equivalent)). The ice sheet in West Antarctica (WA) is losing mass (–47 ± 4Gta–1) and the ice sheet in East Antarctica (EA) shows a small mass gain (+16 ± 11 Gta–1) for a combined net change of –31 ± 12 Gta–1 (+0.08mma–1 SLE). The contribution of the three ice sheets to sea level is +0.05±0.03mma–1. The Antarctic ice shelves show corresponding mass changes of –95 ± 11 Gta–1 in WA and +142 ± 10Gta–1 in EA. Thinning at the margins of the Greenland ice sheet and growth at higher elevations is an expected response to increasing temperatures and precipitation in a warming climate. The marked thinnings in the Pine Island and Thwaites Glacier basins of WA and the Totten Glacier basin in EA are probably ice- dynamic responses to long-term climate change and perhaps past removal of their adjacent ice shelves. The ice growth in the southern Antarctic Peninsula and parts of EA may be due to increasing precipitation during the last century.
Mass changes of the Antarctic ice sheet impact sea-level rise as climate changes, but recent rates have been uncertain. Ice, Cloud and land Elevation Satellite (ICESat) data (2003–08) show mass gains from snow accumulation exceeded discharge losses by 82 ± 25 Gt a−1, reducing global sea-level rise by 0.23 mm a−1. European Remote-sensing Satellite (ERS) data (1992–2001) give a similar gain of 112 61 Gt a−1. Gains of 136 Gt a−1 in East Antarctica (EA) and 72 Gt a−1 in four drainage systems (WA2) in West Antarctic (WA) exceed losses of 97 Gt a−1 from three coastal drainage systems (WA1) and 29 Gt a−1 from the Antarctic Peninsula (AP). EA dynamic thickening of 147 Gt a−1 is a continuing response to increased accumulation (>50%) since the early Holocene. Recent accumulation loss of 11 Gt a−1 in EA indicates thickening is not from contemporaneous snowfall increases. Similarly, the WA2 gain is mainly (60 Gt a−1) dynamic thickening. In WA1 and the AP, increased losses of 66 ± 16 Gt a−1 from increased dynamic thinning from accelerating glaciers are 50% offset by greater WA snowfall. The decadal increase in dynamic thinning in WA1 and the AP is approximately one-third of the long-term dynamic thickening in EA and WA2, which should buffer additional dynamic thinning for decades.