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Benzodiazepine receptor agonists (BZRAs) are commonly used clinically and data on their hazardous use from large populations of psychiatric patients is limited.
To assess the current status of hazardous BZRA use and related factors in Chinese out-patient psychiatric settings.
The study included out-patients with at least one BZRA prescription from five psychiatric settings in east, central and west China in 2018. Demographic and prescription information were extracted from the electronic prescription database. We defined the co-occurrence of overdose and long-term use as hazardous use, and patients whose recorded diagnoses did not meet any indications approved by the Chinese Food and Drug Administration as over-indication users. Additionally, 200 hazardous users were randomly selected for follow-up interview to confirm the actual situation.
Among 720 054 out-patients, 164 450 (22.8%) had at least one BZRA prescription; 55.9% of patients were prescribed over-indication and 3% were defined as hazardous users. Multilevel multivariate regression analysis with hospital as a random effect showed that factors associated with hazardous use were older age (18–64 years: β = 0.018; 95% CI 0.013–0.023; >65 years: β = 0.015; 95% CI 0.010–0.021), male (β = 0.005, 95% CI 0.003–0.007), over-indication (β = 0.013, 95% CI 0.012–0.015), more out-patient visits (β = 0.006, 95% CI 0.006–0.006) and more visits to different doctors (β = 0.007, 95% CI 0.007–0.008); 98.5% of hazardous users (197/200) could not be contacted.
BZRAs are commonly used and there is a relatively large proportion of over-indication users among Chinese psychiatric out-patients. However, only a small proportion of hazardous users were detected. The study highlights how to use prescription data to support improvements in clinical practice.
High-pressure die-casting (HPDC) AZ91 tensile specimens were used to investigate characteristics of gas pores and their effects on mechanical properties of HPDC AZ91 magnesium (Mg) alloy. Combining the stereoscopic morphology of gas pores obtained from a three-dimensional (3D) reconstruction technique with the experimental data from uniaxial tensile testing, we worked on finite element simulation to find the relationship between gas pores and the mechanical properties of HPDC AZ91 Mg alloy. Results indicate that the 2D metallography images have one-sidedness. Moreover, gas pores >100 µm in the center region have a remarkable negative influence on the ultimate tensile strength (UTS) and elongation. With an increase in the size of large gas pores in the center region, the UTS and elongation of the material decreases. In addition, the distribution of gas pores in the specimens and the areal fraction of gas pores >100 µm on cross sections can also affect the UTS and elongation to some extent.
Fundamental relations of surface instability for micro-scale multilayer thin film systems are derived based on the Hill and Hutchinson bifurcation theory and the volume average integral. In the present relations, a size effect is considered through generalizing the plastic hardening modulus to include the strain gradient hardening effects. By using the model, firstly, the parameter-controlled instability region is divided and analyzed, secondly, the surface instability of the multilayer thin films are analyzed. In the surface instability analysis, several kinds of failure band formations are obtained, such as the kink bands and the compressive buckling bands in vertical direction and in inclined direction. Moreover, the failure mechanism of the multilayer thin film system due to surface instability is used to interpret the microstructure features of the surface-nanocrystallization materials.
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