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To explore whether and how group cognitive-behavioural therapy (GCBT) plus medication differs from medication alone for the treatment of generalised anxiety disorder (GAD).
Hundred and seventy patients were randomly assigned to the GCBT plus duloxetine (n=89) or duloxetine group (n=81). The primary outcomes were Hamilton Anxiety Scale (HAMA) response and remission rates. The explorative secondary measures included score reductions from baseline in the HAMA total, psychic, and somatic anxiety subscales (HAMA-PA, HAMA-SA), the Hamilton Depression Scale, the Severity Subscale of Clinical Global Impression Scale, Global Assessment of Functioning, and the 12-item Short-Form Health Survey. Assessments were conducted at baseline, 4-week, 8-week, and 3-month follow-up.
At 4 weeks, HAMA response (GCBT group 57.0% vs. control group 24.4%, p=0.000, Cohen’s d=0.90) and remission rates (GCBT group 21.5% vs. control group 6.2%, p=0.004; d=0.51), and most secondary outcomes (all p<0.05, d=0.36−0.77) showed that the combined therapy was superior. At 8 weeks, all the primary and secondary significant differences found at 4 weeks were maintained with smaller effect sizes (p<0.05, d=0.32−0.48). At 3-month follow-up, the combined therapy was only significantly superior in the HAMA total (p<0.045, d=0.43) and HAMA-PA score reductions (p<0.001, d=0.77). Logistic regression showed superiority of the combined therapy for HAMA response rates [odds ratio (OR)=2.12, 95% confidence interval (CI) 1.02−4.42, p=0.04] and remission rates (OR=2.80, 95% CI 1.27−6.16, p=0.01).
Compared with duloxetine alone, GCBT plus duloxetine showed significant treatment response for GAD over a shorter period of time, particularly for psychic anxiety symptoms, which may suggest that GCBT was effective in changing cognitive style.
This article overviews the ultrasonic welding process, a solid-state joining method, using the example of welding of a magnesium alloy as well as the joining of magnesium alloys in general. In situ high-speed imaging and infrared thermography were utilized to study interfacial relative motion and heat generation during ultrasonic spot welding of AZ31B magnesium (Mg) alloys. A postweld ultrasonic nondestructive evaluation was performed to study the evolution of local bond formation at the faying interface (contact surface of the joint between the top and bottom Mg sheets) at different stages of the welding process. Two distinct stages were observed as the welding process progresses. In the early stage, localized reciprocating sliding occurred at the contact faying interface between the two Mg sheets, resulting in localized rapid temperature rise from the localized frictional heating. Microscale (submillimeter) bonded regions at the Mg–Mg faying surface started to form, but the overall joint strength was low. The early-stage localized bonds were broken during the subsequent vibrations. In the later stage, no relative motion occurred at any points of the faying interface. Localized bonded regions coalesced into a macroscale joint that was strong enough to prevent the Mg–Mg interface from further breakage and sliding. With increasing welding time, the bonded area continued to increase.
Altered heart rate variability (HRV), an index of autonomic nervous system function, has been reported in generalized anxiety disorder (GAD), but the results have been mixed. Thus, the present study, using a large sample size and better methodology, aims to examine whether GAD is associated with impaired HRV, both at rest and in response to posture challenges.
In total, 1832 participants were recruited in this study, consisting of 682 patients with GAD (including 326 drug- and comorbidity-free GAD patients) and 1150 healthy controls. Short-term HRV was measured during the supine-standing-supine test (5-min per position). Propensity score matching (PSM), a relatively novel method, was used to control for potential confounders.
After PSM algorithm, drug- and comorbidity-free GAD patients had reductions in resting (baseline) high-frequency power (HF), an index for parasympathetic modulation, and increases in the low-frequency/HF ratio (LF/HF), an index for sympathovagal balance as compared to matched controls. Furthermore, the responses of HF and LF/HF to posture changes were all attenuated when compared with matched controls. Effect sizes, given by Cohen's d, for resting HF and HF reactivity were 0.42 and 0.36–0.42, respectively.
GAD is associated with altered sympathovagal balance, characterized by attenuation in both resting vagal modulation and vagal reactivity, with an almost medium effect size (Cohen's d ≈ 0.4), regardless of medication use or comorbidity status.
In 2007, Taiwan began conducting health technology assessments (HTA) to support the National Health Insurance Administration (NHIA) in its reimbursement decisions for drugs, medical devices, and medical services.
In this study, the development, missions, and procedures of the implementation of HTA in Taiwan are briefly introduced. Moreover, the value of HTA is examined by reviewing the outcomes and impacts of recent HTA-related research projects, which are classified into five categories: (i) pharmaceutical products, (ii) medical procedures, (iii) medical devices, (iv) health policy, and (v) social care.
Overall, the 10-year implementation of HTA has not only supported the government's decision making but also enhanced patient care. Furthermore, patient evidence has been highlighted, and patient care pathways have been transformed through patient involvement in HTA.
In conclusion, HTA's value has been determined by both government and social aspects in Taiwan.
A high-power, Joule-class, nanosecond temporally shaped multi-pass ring laser amplifier system with two neodymium-doped phosphate glass (Nd:glass) laser heads is demonstrated. The laser amplifier system consists of three parts: an all-fiber structure seeder, a diode-pumped Nd:glass regenerative amplifier and a multi-pass ring amplifier, where the thermally induced depolarization of two laser heads is studied experimentally and theoretically. Following the injection of a square pulse with the pulse energy of 0.9 mJ and pulse width of 6 ns, a 0.969-J high-energy laser pulse at 1 Hz was generated, which had the ability to change the waveform arbitrarily, based on the all-fiber structure front end. The experimental results show that the proposed laser system is promising to be adopted in the preamplifier of high-power laser facilities.
This manuscript describes low-voltage epoxy-carbon nanotube composites with highly nonlinear resistances. Carbon nanotube paste was deposited on interdigitated electrodes and I-V characteristics were obtained over different voltage ranges and at different sweep speeds. In most cases, the injection process into the electrode-composite interface region was dominant, with exponential voltage dependence of the current.
This study investigated the effect of pre-exercise α-lactalbumin ingestion on subsequent endurance exercise performance, muscle pain and mood states. In a two-stage cross-over counterbalance design, eleven male endurance runners (age: 31 (se 2) years, height: 169·5 (se 4·4) cm, weight: 63·6 (se 5·1) kg, V̇O2max: 58·8 (se 6·3) ml/kg per min) consumed two solutions (carbohydrate+α-lactalbumin, CA; carbohydrate+whey protein isolate, CW) 2 h before a self-paced 21-km run. Creatine kinase, IL-6, muscle pain, pressure pain threshold (PPT) and mood states were assessed 2 h before exercise, immediately before exercise (Pre-ex0) and immediately after exercise (Post-ex0). No difference was found in 21-km running performance between two trials (CA v. CW: 115·85 (se 5·20) v. 118·85 (se 5·51) min, P=0·48). Compared with CW, CA led to higher PPT at Pre-ex0 (41·77 (se 2·27) v. 35·56 (se 2·10) N/cm2, P<0·01) and Post-ex0 (38·76 (se 3·23) v. 35·30 (se 3·55) N/cm2, P=0·047). Compared with CW, CA reduced the feeling of fatigue at Post-ex0 (P<0·01); CA also reduced salivary cortisol levels at Post-ex0 (0·72 (se 0·07) v. 0·83 (se 0·13) ng/ml, P<0·01). In conclusion, the ingestion of α-lactalbumin did not improve the 21-km time-trial performance. However, compared with the pre-exercise ingestion of whey protein, that of α-lactalbumin led to superior results during similar levels of endurance exercise: it elevated PPT and reduced the feeling of fatigue and the cortisol levels.
The properties of a mixed metallic and semiconducting carbon nanotube (CNT) sample dispersed in nonconjugated poly(methyl methacrylate) (PMMA) and conjugated poly(bisdodecylquaterthiophene) (PQT12) were compared, with and without p-doping by NOBF4. The CNTs were distributed much more evenly, and percolated at much lower concentrations (ca. 2%), in the PMMA as compared to PQT12, as judged by optical microscopy and electronic conductivity measurements. Seebeck coefficients (S) obtained on the PMMA samples indicated dominance by the metallic fraction, with values <10 µV/K. Composites made with PQT12 alone showed slightly higher values of S, but with the addition of 3 wt % dopant, S increased markedly to about 100 µV/K at 5-10% CNT fractions, while conductivity was unexpectedly low. As the CNT fraction in the doped sample was increased to 25-30%, conductivity approached that of the comparable concentration of CNTs in PMMA, while S, ca. 15 µV/K, was still higher than that measured in PMMA. The observations inform interpretations of CNT-polymer composite thermoelectric data, pointing out the roles of conjugated main chains and added dopants in modulating contributions of CNTs to thermoelectric composite performance.
The purpose of the study was to determine the incidence of cardiovascular disease (CVD) among people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (PLWHA) in Taiwan. PLWHA were identified from the Taiwan Centers for Disease Control HIV Surveillance System between 2000 and 2014. To examine the effect of active antiretroviral therapy (HAART) on CVD incidence, incidence densities and standardised incidence rates (SIRs) of CVD were calculated after stratifying PLWHA by HAART. Of 26 272 PLWHA (mean age, 32.3 years) identified, 73.4% received HAART. Compared with general population, SIRs (95% confidence interval) were higher for incident coronary artery disease (1.11 (1.04–1.19)), percutaneous coronary intervention (1.32 (1.18–1.47)), coronary artery bypass surgery (1.47 (1.29–1.66)), sudden cardiac death (3.01 (2.39–3.73)), heart failure (1.50 (1.31–1.70)) and chronic kidney disease (1.95 (1.81–2.10)), but was lower for incident atrial fibrillation (0.53 (0.37–0.73)). Considering the effect of HAART on incident CVD, the SIRs for all-cause, ischaemic and haemorrhagic stroke were higher in PLWHA who did not receive HAART, but were lower in PLWHA who received HAART. PLWHA had higher risks of incident coronary artery disease, percutaneous coronary intervention, coronary artery bypass surgery, sudden cardiac death, heart failure and chronic kidney disease. HAART reduces risks of incident CVD in PLWHA.
The following paper investigates the prevalence and characteristics of asymptomatic norovirus infection in the population living around oyster farm sites. Two consecutive surveys were conducted from January 2014 to December 2014 and 4549 stool samples were screened during the same time period. The total asymptomatic infection rate was 4.04% (184/4549). Norovirus infection rate was 5.20% in oyster farming population which was significantly higher compared with non-farming population where the infection rate was 3.65% (χ2 = 5.49, P < 0.05). A total of 184 NoV positive samples were identified by real time-quantitative polymerase chain reaction (RT-qPCR) and semi-nested RT-PCR and 136 sequences were obtained. The sequences were clustered into 14 genotypes. GI strains were clustered into six genotypes, including GI.2, GI.3, GI.5, GI.6, GI.8 and GI.9; while GII strains were clustered into GII.2, GII.3, GII.4, GII.5, GII.6, GII.8 and GII.13. GI.9 and GII.17 were the predominant and most prevalent genotypes, respectively. The GII.17 genotype replaced GII.4 becoming the dominant genotype in the oyster farming area in 2014. To sum up, long-term monitoring of asymptomatic infection is crucial for the detection of new variant strains and for identifying outbreaks during the early stage.
Propofol is a intravenous anaesthetic most commonly used in ultrasound oocyte retrieval. We studied if the use of propofol had an effect on mouse oocyte maturation, pregnancy, childbirth and progeny and investigated the correlation between propofol side effects and reproductive performance in mice. There was no statistical difference in mating, pregnancy, childbirth, litter size, the number of stillbirths and survival between each group (P>0.05). Propofol also had no effect on polar body extrusion in oocyte maturation as well as on pronucleus formation and, subsequently, early embryo development (P>0.05). An increased concentration of propofol had no effect on this result, although propofol at more than 0.01 mg/ml reduced polar body extrusion. Different concentrations of propofol had no effect on oocyte culture in vitro, pronucleus formation and early embryo development.
A high power laser system was used to drive the ignition of inertial confinement fusion (ICF), of which the high energy, the uniform focal spot, the accurate laser waveform, and the synchronization between the laser beams are key parameters. To accomplish this, global laser characteristics control should be assured, which was the main purpose of the injection laser system. In this paper, the key technological progress involved in the improvement of the performance of the injection laser of SG-II is reported, including frequency domain control, time domain control, near-field spatial shaping, pre-amplifier technology, and the optical parametric chirped pulse amplification pump source.
Ga2−xFexO3 (GFO) bulks with x from 0.7 to 1.3 have been fabricated using the classic solid-state route. The structural, optical, and magnetic properties have been investigated systematically. X-ray diffraction spectra and FULLPROF profile fitting indicate that GFO bulks belong to the orthorhombic structure with the space group Pc21n. Phase separation appears at the Fe content of x = 1.3. The optical bandgap decreases almost linearly with the increase of iron content, which means that the bandgap of GFO bulks can be controlled by adjusting the Fe content in the samples. The magnetic property measurements suggest that GFO is ferromagnetic, and the magnetic properties are enhanced compared with other reported works, exhibiting the application in ferromagnetic semiconductors devices.
In this paper, zircon U–Pb geochronology, major and trace elements, and Sr–Nd isotope geochemistry of the Baiyanghe dolerites in northern West Junggar of NW China are presented. The U–Pb dating of zircons from the dolerites yielded ages of 272.2±4 Ma and 276.7±6.2 Ma, which indicate the emplacement times. The dolerites are characterized by minor variations in SiO2 (46.89 to 49.07 wt%), high contents of Al2O3 (13.60 to 13.92 wt%) and total Fe2O3 (11.14 to 11.70 wt%), and low contents of MgO (2.67 to 3.64 wt%) and total alkalis (Na2O+K2O, 5.1 to 5.97 wt%, K2O/Na2O = 0.37–0.94), which indicate affinities to metaluminous tholeiite basalt. The REE pattern ((La/Sm)N = 2.25–2.34, (La/Yb)N = 7.42–8.36), V–Ti/1000 and 50*Zr–Ti/50–Sm discrimination diagrams show that these rocks are OIB-type. The high contents of Zr and Ti indicate a within-plate tectonic setting, and samples plot in the ‘plume source’ field shown on the Dy/Yb(N) versus Ce/Yb(N) diagram. The positive εNd(t) values (+7.09 to +7.48), high initial 87Sr/86Sr ratios (0.70442 to 0.70682) and depletions of Nb and Ta elements in the samples can be explained by the involvement of subducted sediments. In summary, it is possible that the Baiyanghe dolerites were derived from an OIB-like mantle source and associated with a mantle plume tectonic setting. Therefore, our samples provide the youngest evidence for the existence of a mantle plume, which may provide new insights into the Late Palaeozoic tectonic setting of West Junggar.
General life stress has been associated with altered DNA methylation in individuals of African Ancestry, although the relationship between parenting stress and DNA methylation has not been described. The purpose of this study was to examine the relationship between maternal parenting stress and DNA methylation among African Ancestry mother-child dyads.
We evaluated epigenome-wide DNA methylation relative to parenting stress in 74 mother-child dyads using linear mixed models.
Significant variation in maternal DNA methylation at 95 CpG sites was associated with level of parenting stress. Notably, we identified a change in DNA methylation associated with poly (ADP-ribose) polymerase-1, which plays a key role in stress signaling. We did not identify any significant variation in child DNA methylation related to maternal parenting stress.
However, DNA methylation patterns observed in children mirrored patterns observed in their mothers. The results suggest that differential maternal DNA methylation is associated with higher levels of parenting stress.