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Depression often coexists with other chronic conditions in older people. The COACH study is an ongoing random controlled trial (RCT) to test the effectiveness of a primary-care-based collaborative care approach to treat co-morbid hypertension and depression in Chinese rural elders. In the COACH model, a team—village doctor (VD), aging worker (AW), and psychiatrist consultant—provides collaborative care to enrolled subjects in each intervention village for 12 months. This study examines how COACH was implemented and identifies facilitators and barriers for its more widespread implementation.
Five focus groups were conducted, two with VDs, two with AWs, and one with psychiatrists, for a total of 38 participants. Transcripts were analyzed using qualitative content analysis.
COACH care-team members showed shared understanding and appreciation of the team approach and integrated management of hypertension and depression. Team collaboration was smooth. All members regarded COACH to be effective in reducing depressive symptoms and improving patient health. Facilitators to implementation include training, leaders’ support, geographic proximity between VD and AW pairs, preexisting relationships among care-team members, comparability of COACH activities and existing practices of VDs and AWs, and care team members’ caring about older members of their villages. Barriers to sustainability include frustration of some VDs related to their low wages and feelings of overload of some AWs.
COACH was positively perceived and successfully implemented. The findings offer guidance for planning primary-care-based collaborative depression care in low- and middle-income countries.
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.
l-Carnitine is essential for mitochondrial β-oxidation and has been used as a lipid-lowering feed additive in humans and farmed animals. d-Carnitine is an optical isomer of l-carnitine and dl-carnitine has been widely used in animal feeds. However, the functional differences between l- and d-carnitine are difficult to study because of the endogenous l-carnitine background. In the present study, we developed a low-carnitine Nile tilapia model by treating fish with a carnitine synthesis inhibitor, and used this model to investigate the functional differences between l- and d-carnitine in nutrient metabolism in fish. l- or d-carnitine (0·4 g/kg diet) was fed to the low-carnitine tilapia for 6 weeks. l-Carnitine feeding increased the acyl-carnitine concentration from 3522 to 10 822 ng/g and alleviated the lipid deposition from 15·89 to 11·97 % in the liver of low-carnitine tilapia. However, as compared with l-carnitine group, d-carnitine feeding reduced the acyl-carnitine concentration from 10 822 to 5482 ng/g, and increased lipid deposition from 11·97 to 20·21 % and the mRNA expression of the genes involved in β-oxidation and detoxification in the liver. d-Carnitine feeding also induced hepatic inflammation, oxidative stress and apoptosis. A metabolomic investigation further showed that d-carnitine feeding increased glycolysis, protein metabolism and activity of the tricarboxylic acid cycle and oxidative phosphorylation. Thus, l-carnitine can be physiologically utilised in fish, whereas d-carnitine is metabolised as a xenobiotic and induces lipotoxicity. d-Carnitine-fed fish demonstrates increases in peroxisomal β-oxidation, glycolysis and amino acid degradation to maintain energy homeostasis. Therefore, d-carnitine is not recommended for use in farmed animals.
Dalian, China, is a city free of rabies in recent 20 years, but the annual cost for rabies vaccination still brings an economic burden on society and individuals. We did a retrospective descriptive analysis to analyse the reason for this and try to find some ways to resolve it. A total of 10 028 post-exposure prophylaxis (PEP) cases were recorded from January 2016 to December 2017. According to the exposure grades, 32 cases were grade I; 7712 cases were grade II; 2284 cases were grade III. All the patients in the cases were injured by pet dogs without abnormal clinical signs, and 80% of them were home pet dogs. Fifty-two per cent of the pet dogs were vaccinated. All the dogs survived during the PEP vaccination period. The data showed that a considerable proportion of people who did not have exposure risk for rabies had received vaccination. The underlying reasons included social, medical and personal factors. So here we proposed to replace the current ‘five-course’ intramuscular injection with intradermal injection method in the cities free of rabies in China, this can not only achieve effective vaccination but also save resources and eliminate the fear of rabies from victims. Meanwhile we should strengthen communication on rabies knowledge and make a routine evaluation of rabies surveillance system to improve understanding of the risk for rabies from biting animals.
Hepatitis B constitutes a severe public health challenge in China. The Community-based Collaborative Innovation hepatitis B (CCI-HBV) project is a national epidemiological study of hepatitis B and has been conducting a comprehensive intervention in southern Zhejiang since 2009.
The comprehensive intervention in CCI-HBV areas includes the dynamic hepatitis B screening in local residents, the normalised treatment for hepatitis B infections and the upcoming full-aged hepatitis B vaccination. After two rounds of screening (each round taking for 4 years), the initial epidemiological baseline of hepatitis B in Qinggang was obtained, a coastal community in east China. By combining key data and system dynamics modelling, the regional hepatitis B epidemic in 20 years was predicted.
There were 1041 HBsAg positive cases out of 12 228 people in Round 1 indicating HBV prevalence of 8.5%. Of the 13 146 people tested in Round 2, 1171 people were HBsAg positive, with a prevalence of 8.9%. By comparing the two rounds of screening, the HBV incidence rate of 0.192 per 100 person-years was observed. By consulting electronic medical records, the HBV onset rate of 0.533 per 100 person-years was obtained. We generated a simulated model to replicate the real-world situation for the next two decades. To evaluate the effect of interventions on regional HBV prevalence, three comparative experiments were conducted.
In this study, the regional hepatitis B epidemic in 20 years was predicted and compared with HBV prevalence under different interventions. Owing to the existing challenges in research methodology, this study combined HBV field research and simulation to provide a system dynamics model with close-to-real key data to improve prediction accuracy. The simulation also provided a prompt guidance for the field implementation.
The effect of zirconium alloying on the crystal structures and mechanical properties of binary tungsten–zirconium alloys is investigated in this study using the first-principles method. Firstly, we investigate the cell volumes, lattice constants, and formation energies of binary W1−xZrx (x = 0, 0.0625, 0.125, 0.1875, 0.25, and 0.5) alloys. It is shown that binary tungsten–zirconium alloys maintain BCC structures. When the concentration of zirconium atoms is lower than 12.5%, the structures of binary tungsten–zirconium alloys can be thermodynamically stable. The elastic constants of binary tungsten–zirconium alloys are calculated based on the optimized atomic lattice. Then, the elastic modulus and other mechanical parameters are deduced according to the relevant formulas. It is shown that the mechanical strength of binary tungsten–zirconium alloy decreases with an increasing concentration of zirconium atoms, which is lower than the mechanical strength of pure tungsten metal. However, the mechanical strength of binary tungsten–zirconium alloys is higher than that of pure zirconium metal. In addition, zirconium alloying can be effective in improving the ductility of pure tungsten metal.
Northeastern China is a region of high tick abundance, multiple tick-borne pathogens and likely human infections. The spectrum of diseases caused by tick-borne pathogens has not been objectively evaluated in this region for clinical management and for comparison with other regions globally where tick-transmitted diseases are common. Based on clinical symptoms, PCR, indirect immunofluorescent assay and (or) blood smear, we identified and described tick-borne diseases from patients with recent tick bite seen at Mudanjiang Forestry Central Hospital. From May 2010 to September 2011, 42% (75/180) of patients were diagnosed with a specific tick-borne disease, including Lyme borreliosis, tick-borne encephalitis, human granulocytic anaplasmosis, human babesiosis and spotted fever group rickettsiosis. When we compared clinical and laboratory features to identify factors that might discriminate tick-transmitted infections from those lacking that evidence, we revealed that erythema migrans and neurological manifestations were statistically significantly differently presented between those with and without documented aetiologies (P < 0.001, P = 0.003). Twelve patients (6.7%, 12/180) were co-infected with two tick-borne pathogens. We demonstrated the poor ability of clinicians to identify the specific tick-borne disease. In addition, it is necessary to develop specific laboratory assays for optimal diagnosis of tick-borne diseases.
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.
Consider the scattering of a time-harmonic acoustic incident wave by a bounded, penetrable, and isotropic elastic solid, which is immersed in a homogeneous compressible air or fluid. The paper concerns the numerical solution for such an acoustic-elastic interaction problem in three dimensions. An exact transparent boundary condition (TBC) is developed to reduce the problem equivalently into a boundary value problem in a bounded domain. The perfectly matched layer (PML) technique is adopted to truncate the unbounded physical domain into a bounded computational domain. The well-posedness and exponential convergence of the solution are established for the truncated PML problem by using a PML equivalent TBC. An a posteriori error estimate based adaptive finite element method is developed to solve the scattering problem. Numerical experiments are included to demonstrate the competitive behavior of the proposed method.
More than 200 molecular clouds were newly found distributed beyond the Outer arm in the extreme outer Galaxy (EOG) region by MWISP. Those MCs roughly following the HI′s distribution well delineate the outermost spiral structure (the Outer Scutum-Centaurus arm) and warp of our Galaxy. Besides, those MCs show different σv-Radius relation and exhibit higher value of αvir than MCs in the inner Galaxy.
Using the data from APOGEE, WISE, and GLIMPSE, we explored the variation of the near-infrared (NIR) and mid-infrared (MIR) interstellar extinction laws of the Milky Way. We derived the IR extinction laws towards a number of different sightlines, including 24 bins along Galactic latitude (b) and 592 plates observed by APOGEE. Our results indicate that E(J-H)/E(J-K) show only subtle variation along b, Galactic longitude (l), or the depth of E(J-K). This suggests that the NIR extinction law can be considered as universal. Similarly, E(K-W1, W2, W3, [3.6], [4.5], [5.8], [8.0])/E(J-K) also show only small variation along b, l, or the extinction depth. The MIR extinction curve is flat, indicating that the MIR extinction law is likely universal.
The temporal dynamics of ciliate community structure in a southern Chinese shrimp aquaculture facility were investigated during the period June–September 2012. A total of 53 species belonging to 37 genera and 17 orders were recorded based on analyses of eight samples. Ciliate abundance peaked between 16 August and 14 September 2012, while the maximum number of species occurred on 26 June 2012. Clear temporal patterns were observed in the ciliate community structure. The patterns of succession of the 10 most abundant species were consistent with the results of a Canonical Analysis of Principal coordinates (CAP) analysis. Correlation analyses showed that these patterns of succession were related to temporal changes in environmental variables. In summary, the results demonstrate that the ciliate community responds predictably to environmental variations and recovers from shrimp cultivation.
A diode-pumped alkali vapor laser (DPAL) is one of the most promising candidates of the next-generation high-powered laser source. As the saturated number density of alkali vapor is highly dependent on the temperature inside a vapor cell, the temperature distribution in the cross-section of a cell will greatly affect the homogeneity of a laser medium and the output characteristics of a DPAL. In this paper, we developed an algorithm based on the regime concluding quasi-Hilbert transform to evaluate the phase aberration of a wavefront when the probe beam passes through the vapor cell placed in one arm of a Mach–Zehnder interference setup. According to the theoretical algorithm, we deduced the temperature distribution of a cesium vapor cell for different heating conditions. The study is thought to be useful for development of a high-powered laser.
A diode-pumped alkali laser (DPAL) provides the significant promise for high-powered performances. In this paper, a mathematical model is introduced for examination of the kinetic processes of a diode-pumped cesium vapor hollow-core photonic-crystal fiber (HC-PCF) laser, in which the cesium vapor is filled in the center hole of a photonic-bandgap fiber instead of a glass cell. The influence of deleterious processes including energy pooling, photo-ionization, and Penning ionization on the physical features of a fiber DPAL is studied in this report. It has been theoretically demonstrated that the deleterious processes cannot be ignored in a high-powered fiber-DPAL system.
Picoeukaryotes (<2–3 μm) perform key roles for the functioning of marine ecosystems, but little is known regarding the composition and diversity of picoeukaryotes in aquaculture areas. In this study, the Illumina MiSeq platform was used for sequencing the V4 variable region within the 18S rDNA gene to analyse genetic diversity and relative abundance of picoeukaryotic communities in the Qinhuangdao scallop cultivation area of the Bohai Sea. The community was dominated by three super groups, the alveolates (54%), stramenopiles (41%) and chlorophytes (3%), and three groups, dinoflagellates (54%), pelagomonadales (40%) and prasinophytes (3%). Furthermore, a contrasting station with open water away from the eutrophic aquaculture area was chosen. The communities collected from the two stations exhibited significant differences, with higher diversity in the aquaculture area. These results provide the first snapshot of the picoeukaryotic diversity in surface waters of the Qinhuangdao scallop cultivation area, and basic data for future studies on picoeukaryote community in an aquaculture region.
In order to better understand the chemical conditions and evolutionary properties of massive star-forming regions, and to explore the physical and chemical behavior of simple hydrocarbon molecules, we have used telescopes such as CSO, JCMT, CARMA and SMA, to map the multi-transitions of C2H and HC3N. The column densities and abundances are compared with chemical models to gain some diagnostic of the environment of the regions.
The existence of black holes with masses of about one billion solar masses in quasars at redshifts z > 6 presents significant challenges to theories of the formation and growth of black holes and the black hole/galaxy co-evolution in the early Universe. Here we report a recent discovery of an ultra-luminous quasar at redshift z = 6.30, which has an observed optical and near-infrared luminosity a few times greater than those of previously known z > 6 quasars. With near-infrared spectroscopy, we obtain a black hole mass of about 12 billion solar masses, which is well consistent with the mass derived by assuming an Eddington-limited accretion. This ultra-luminous quasar with at z > 6 provides a unique laboratory to the study of the mass assembly and galaxy formation around the most massive black holes at cosmic dawn. It raises further challenges to the black hole/galaxy co-evolution in the epoch of cosmic reionization because the black hole needs to grow much faster than the host galaxy.
Dietary patterns represent the combined effects of foods, and illustrate efficaciously the impact of diet on health outcomes. Some findings of previous studies have limited applicability to Chinese children due to cultural factors. The presnt study was designed to identify dietary patterns and determine their relationships with obesity among Chinese children and adolescents. Data collected from 1282 children and adolescents aged 7–17 years from the 2011 China Health and Nutrition Survey (CHNS) were used. Dietary patterns were identified using factor analysis of data from three consecutive 24-h dietary recalls. Weight and height were measured following standard methods, and BMI was calculated. Three dietary patterns were identified: modern (high intakes of milk, fast foods and eggs), traditional north (high intakes of wheat, tubers and other cereals) and traditional south (high intakes of vegetables, rice and pork). After adjusting for some confounders and total energy intake, subjects in the highest quartiles of the modern and traditional north patterns were found to have significantly greater risk of obesity (OR 3·10, 95 % CI 1·52, 6·32, and OR 2·42, 95 % CI 1·34, 4·39, respectively). In conclusion, the modern dietary pattern and the traditional north dietary pattern were associated with higher risk of obesity. Promoting healthier eating patterns could help prevent obesity in Chinese children.
The family of interferon-inducible transmembrane proteins (IFITMs) plays a crucial role in inhibiting proliferation, promoting homotypic cell adhesion and mediating germ cell development. In the present study, the full-length cDNAs of zebrafish ifitm1 (744 bp) and ifitm3 (702 bp) were obtained by rapid amplification of cDNA ends (RACE). Reverse transcription polymerase chain reaction (RT-PCR) analysis showed that ifitm1 mRNA was expressed in the ovary, testis, brain, muscle, liver and kidney, while ifitm3 mRNA was only detected in the ovary. Based on in situ hybridization, ifitm1 mRNA was found to be strongly expressed in the ooplasm from stage I to stage II and ifitm3 mRNA was also strongly expressed in the ooplasm from stage I to stage II, furthermore ifitm3 expression ultimately localized to the cortex region beneath the plasma membrane of stage IV oocytes. During development, ifitm1 expression was initially detected in the enveloping layer cells and deep layer cells of shield stage embryos. Then, throughout the segmentation phase (10.25–24 hours post-fertilization (hpf)), ifitm1 expression was mainly detected in the head, trunk and tail regions. Unlike ifitm1, ifitm3 expression was initially detected in sphere stage embryos and was then broadly expressed throughout the embryo from the 70% epiboly stage to 24 hpf. Interestingly, ifitm3 was also expressed in primordial germ cells (PGCs) from the bud stage to 24 hpf. This expression analysis indicates that zebrafish ifitm1 may play a critical role in early organogenesis and may perform immune or hematopoietic functions and ifitm3 might be necessary for PGC migration and the formation of female germ cells.