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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.
In this paper we present an experimental and theoretical study of weak bubble plumes in unstratified and stationary water. We define a weak bubble plume as one that spreads slower than the linear rate of a classic plume. This work focuses on the characteristics of the mean flow in the plume, including centreline velocity, plume spreading and entrainment of ambient water. A new theory based on diffusive spreading instead of an entrainment hypothesis is used to describe the lateral spreading of the bubbles and the associated plume. The new theory is supported by the experimental data. With the measured data of liquid volume fluxes and the new theory, we conclude that the weak bubble plume is a decreasing entrainment process, with the entrainment coefficient
in the weak bubble plume decreasing with height
, and taking on values much smaller than those in a classic bubble plume. An additional non-dimensional diffusion coefficient,
, is also needed to describe the evolution of the volume and kinematic momentum fluxes for the mean flow in the weak bubble plume. Here,
is the effective turbulent diffusion coefficient,
is the terminal rise velocity of the bubbles, and
is the kinematic buoyancy flux of the source. Finally, we provide a unified framework for the mean flow characteristics, including volume flux, momentum flux and plume spreading for the classic and weak bubble plumes, which also provides insight on the transition from classic to weak bubble plume behaviour.
We present the turbulent kinetic energy (t.k.e.) budget of a dilute bubble plume in its asymptotic state. The budget is derived from an experimental dataset of bubble plumes formed inside an unstratified water tank. The experiments cover both the adjustment phase and asymptotic state of the plume. The diameters
of air bubbles are in the range 1–4 mm and the air void fraction
is between 0.7 % and 1.8 %. We measured the three components of the instantaneous liquid velocity vector with a profiling acoustic Doppler velocimeter. From the experiments, we found the following inside the heterogeneous bubble core of the plume: (i) the probability density functions of the standardized liquid fluctuations are very similar to those of homogeneous bubble swarms rising with and without background liquid turbulence; (ii) the characteristic temporal frequency
at which bubbles inject t.k.e. into the liquid agrees with the prediction
observed and theoretically derived for homogeneous bubble swarms (
is the bubble slip velocity); (iii) the liquid turbulence is anisotropic with the ratio of turbulence intensities between the vertical and horizontal components in the range 1.9–2.1; (iv) the t.k.e. production by air bubbles is much larger than that by liquid mean shear; and (v) an increasing fraction of the available work done by bubbles is deposited into liquid turbulence as one moves away from the plume centreline. Together with the existing knowledge of homogeneous bubble swarms, our results of the heterogeneous bubble plume support the view that millimetre-sized bubbles create specific patterns of liquid fluctuations that are insensitive to flow conditions and can therefore be possibly modelled by a universal form.
We experimentally investigate the informational theory of legislative
committees (Gilligan and Krehbiel 1989). Two committee members provide policy-relevant
information to a legislature under alternative legislative rules.
Under the open rule, the legislature is free to make any decision;
under the closed rule, the legislature chooses between a member’s
proposal and a status quo. We find that even in the
presence of biases, the committee members improve the legislature’s
decision by providing useful information. We obtain evidence for two
additional predictions: the outlier principle,
according to which more extreme biases reduce the extent of
information transmission; and the distributional
principle, according to which the open rule is more
distributionally efficient than the closed rule. When biases are
less extreme, we find that the distributional principle dominates
the restrictive-rule principle, according to
which the closed rule is more informationally efficient. Overall,
our findings provide experimental support for Gilligan and
Krehbiel’s informational theory.
The increasing tropospheric ozone concentration [O3] strongly affects plant growth. However, the response of belowground processes in rice (Oryza sativa L.) systems to higher O3 is not well understood. The grain production, belowground biomass partitioning, root morphology and activity of rice (cv. Shanyou 63) were investigated in a free-air O3 enrichment platform at four key growth stages. Elevated O3 (EO3, 50% above the ambient O3) significantly decreased the grain yield and total biomass at the grain milky mature stage, root biomass at the tillering stage and root to shoot ratios (RRS) at the flowering and grain filling stages. The effects of EO3 on root morphology and activity varied among rice growth stage. EO3 significantly decreased root length, density, area, diameter and volume at the flowering stage, but EO3 significantly decreased various root morphological indices at the tillering, grain filling and milky mature stages. EO3 significantly increased the specific root respiration rate (root activity) and root respiration rate (autotrophic respiration) at grain filling and milky mature stages. Higher root autotrophic respiration and lower RRS in response to EO3 would reduce allocation of assimilated carbon to root growth, adversely affecting rice productivity. Our findings are critical for understanding the O3-induced impairment of belowground processes and carbon cycling in rice cropping systems and breeding of O3-tolerant cultivars under higher [O3] scenarios.
We present a generalisation of the Kármán–Howarth–Monin (K–H–M) equation to include variable-density (VD) effects. The derived equation (i) reduces to the original K–H–M equation when density is a constant and (ii) leads to a VD analogue of the
-law with the same value of constant (
) appearing as the prefactor of the dissipation rate. The equation is employed to understand negative turbulent kinetic energy production in a
turbulent round jet with an initial density ratio of 4.2. From a Reynolds-averaged Navier–Stokes (RANS) perspective, negative production means that the mean flow is strengthened at the expense of the energy of turbulent fluctuations. We show that the associated energy transfer is accomplished by the deformation of smaller turbulent eddies into large ones in the development region of the jet and is captured by the linear scale-by-scale energy transfer term in the VD K–H–M equation. The nonlinear transfer term of the VD K–H–M equation depicts a conventional forward cascade for all eddies having a size less than the Eulerian integral length scale, regardless of their orientation. The net effect is a retarded energy cascade in the non-Boussinesq jet that has not been accounted for by existing turbulence theories. Implications of this observation for turbulence modelling are discussed.
Diarrhea is a common cause of morbidity and mortality and the incidence of diarrhea in the world has changed little over the past four decades. To assess the prevalence of and healthcare practices for diarrhea, a cross-sectional study was conducted in Pudong, Shanghai, China. In October 2014, a total of 5324 community residents were interviewed. Respondents were asked if they had experienced diarrhea (defined as ⩾3 passages of watery, loose, bloody, or mucoid stools within a 24-h period) in the previous month prior to the interview. The monthly prevalence of diarrhea was 4·1% (95% CI: 3·3–4·8), corresponding to an incidence rate of 0·54 episodes per person-year. The proportion of individuals with diarrhea who sought healthcare was 21·2% (95% CI: 13·4–29·0). Diarrhea continues to impose a considerable burden on the community and healthcare system in Pudong. Young age and travel were identified as predictors of increased diarrhea occurrence.
Introduction: Medication discrepancies are unintended differences between a patient’s outpatient and inpatient medication regimens, and occur in up to 60% of hospital admissions. Canadian emergency departments (EDs) have implemented medication reconciliation forms that are pre-populated with outpatient medication dispensing data in order to reduce medication discrepancies and resultant adverse drug events. However, these forms may introduce errors of commission by prompting prescribers to reorder discontinued or potentially harmful medications. Our objective was to evaluate the incidence of medication discrepancies and errors of commission after the implementation of pre-populated medication reconciliation forms. Methods: This chart review included admitted patients who were enrolled in a parent study in which a research pharmacist prospectively collected best-possible medication histories (BPMHs) in the ED using all available information sources. Following discharge, research assistants uninvolved with the parent study compared medication orders documented within 48 h of admission with the BPMH to identify medication discrepancies and errors of commission. Errors of commission were defined as inappropriate continuations of medications and reordering discontinued medications. An independent panel adjudicated the clinical significance of the errors. We used regression methods to identify factors associated with errors. The sample size was limited by enrolment into the parent study. Results: Of 151 patients, 71 (47%; 95%CI 39.2-54.9) were exposed to 112 medication errors. Of these errors, 75.9% (85/112; 95%CI 67.1-82.9) were discrepancies, of which 18.8% (16/85; 95%CI 12.0-28.4) were clinically significant. Errors of commission made up 24.1% (27/112; 95%CI 17.3-32.8) of all errors, of which 37.0% (10/27; 95%CI 18.8-55.2) were clinically significant. Taking 8 or more medications was associated with a 5-fold greater odds of experiencing a medication error after controlling for confounders (OR 5.00; 95%CI 2.45-10.17; p<0.001). Conclusion: Clinically significant medication discrepancies and errors of commission remain common despite the implementation of electronically pre-populated medication reconciliation forms. Prospective studies are needed to evaluate whether using pre-populated medication reconciliation forms increases the risk of introducing errors of commission.
The collision between aqueous drops in air typically leads to coalescence after impact. Rebounding of the droplets with similar sizes at atmospheric conditions is not generated, unless with significantly large pressure or high impact parameters exhibiting near-grazing collision. Here we demonstrate experimentally the creation of a non-coalescent regime through addition of a small amount of water-soluble surfactant. We perform a direct simulation to account for the continuum and short-range flow dynamics of the approaching interfaces, as affected by the soluble surfactant. Based on the immersed-boundary formulation, a conservative scheme is developed for solving the coupled surface-bulk convection–diffusion concentration equations, which presents excellent mass preservation in the solvent as well as conservation of total surfactant mass. We show that the Marangoni effect, caused by non-uniform distributions of surfactant on the droplet surface and surface tension, induces stresses that oppose the draining of gas in the interstitial gap, and hence prohibits merging of the interfaces. In such gas–liquid systems, the repulsion caused by the addition of surfactant, as frequently observed in liquid–liquid systems such as emulsions in the form of an electric double-layer force, was found to be too weak to dominate in the attainable range of interfacial separation distances. These results thus identify the key mechanisms governing the impact dynamics of surfactant-coated droplets in air and imply the potential of using a small amount of surfactant to manipulate impact outcomes, for example, to prevent coalescence between droplets or interfaces in gases.
There is considerable confusion concerning the species of Sarcocystis in South American camelids (SAC). Several species names have been used; however, proper descriptions are lacking. In the present paper, we redescribe the macroscopic sarcocyst forming Sarcocystis aucheniae and describe and propose a new name, Sarcocystis masoni for the microscopic sarcocyst forming species. Muscles samples were obtained from llamas (Lama glama) and guanacos (Lama guanicoe) from Argentina and from alpacas (Vicugna pacos) and llamas from Peru. Individual sarcocysts were processed by optical and electron microscopy, and molecular studies. Microscopic sarcocysts of S. masoni were up to 800 µm long and 35–95 µm wide, the sarcocyst wall was 2·5–3·5 µm thick, and had conical to cylindrical villar protrusions (vp) with several microtubules. Each vp had 11 or more rows of knob-like projections. Seven 18S rRNA gene sequences obtained from sarcocysts revealed 95–96% identity with other Sarcocystis spp. sequences reported in the GenBank. Sarcocysts of S. aucheniae were macroscopic, up to 1·2 cm long and surrounded by a dense and laminar 50 µm thick secondary cyst wall. The sarcocyst wall was up to 10 µm thick, and had branched vp, appearing like cauliflower. Comparison of the 11 sequences obtained from individual macroscopic cysts evidenced a 98–99% of sequence homology with other S. aucheniae sequences. In conclusion, 2 morphologically and molecularly different Sarcocystis species, S. masoni (microscopic cysts) and S. aucheniae (macroscopic cysts), were identified affecting different SAC from Argentina and Peru.
IC5146 is one of the filamentary clouds observed in Herschel Gould Belt Survey. Here we present our polarization observations toward IC5146 taken with AIMPOL, TRIPOL and Mimir. Our results reveal that the large scale structure of magnetic field is well perpendicular to the main filament, but is likely parallel to the sub-filaments, which are structure extended out from the main filaments. We have also conducted CO observations to reveal the gas kinematics along the filaments or magnetic field; this result suggests the gas is possibly confined by magnetic field in most of the region until reaching supercritical. Based on our results, we suggests that at least four types of filaments can be found in IC5146, behaving different physical properties and consistent with different formation mechanisms. Our conclusions reveal that filaments are a combination of a variety types of objects.
Sterol regulatory element-binding protein-2 (SREBP-2) is a pivotal transcriptional factor in cholesterol metabolism. Factors interfering with the proper functioning of SREBP-2 potentially alter plasma lipid concentrations. Consuming fruits and vegetables is associated with beneficial plasma lipid profile. The mechanism by which plant foods induce desirable lipid changes remains unclear. Apigenin, a common plant food flavonoid, was shown to modulate the nuclear translocation of SREBP-2 in the hepatic cells WRL-68 in the present study. The processing of SREBP-2 protein occurred after translation, and apigenin blocked this activation route. Further examination indicated that AMP-activated protein kinase (AMPK) was activated by the flavone, and co-administrating the AMPK-specific inhibitor compound C could release the blockage. Reporter gene assay revealed that the transactivation of sterol responsive element (SRE)-containing 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) promoter was suppressed by the flavone. Similarly, electromobility shift assay result also demonstrated a reduced DNA-binding activity on the SRE domain under the same treatment. The reduced transactivity and DNA-binding activity could be attributed to a decreased amount of SREBP-2 translocating from cytosol to nucleus as depicted by confocal microscopy. Quantitative RT-PCR assay demonstrated that the transcription of HMGCR followed the same pattern of SREBP-2 translocation. In summary, the present study showed that apigenin prevented SREBP-2 translocation and reduced the downstream gene HMGCR transcription. The minimum effective dosage should be achievable in the form of functional food consumption or dietary supplementation.
Few countries routinely collect comprehensive encephalitis data, yet understanding the epidemiology of this condition has value for clinical management, detecting novel and emerging pathogens, and guiding timely public health interventions. When this study was conducted there was no standardized diagnostic algorithm to aid identification of encephalitis or systematic surveillance for adult encephalitis. In July 2012 we tested three pragmatic surveillance options aimed at identifying possible adult encephalitis cases admitted to a major Australian hospital: hospital admissions searches, clinician notifications and laboratory test alerts (CSF herpes simplex virus requests). Eligible cases underwent structured laboratory investigation and a specialist panel arbitrated on the final diagnosis. One hundred and thirteen patients were initially recruited into the 10-month study; 20/113 (18%) met the study case definition, seven were diagnosed with infectious or immune-mediated encephalitis and the remainder were assigned alternative diagnoses. The laboratory alert identified 90% (102/113) of recruited cases including six of the seven cases of confirmed encephalitis suggesting that this may be a practical data source for case ascertainment. The application of a standardized diagnostic algorithm and specialist review by an expert clinical panel aided diagnosis of patients with encephalitis.
Anorexia nervosa (AN) and body dysmorphic disorder (BDD) are characterized by distorted body image and are frequently co-morbid with each other, although their relationship remains little studied. While there is evidence of abnormalities in visual and visuospatial processing in both disorders, no study has directly compared the two. We used two complementary modalities – event-related potentials (ERPs) and functional magnetic resonance imaging (fMRI) – to test for abnormal activity associated with early visual signaling.
We acquired fMRI and ERP data in separate sessions from 15 unmedicated individuals in each of three groups (weight-restored AN, BDD, and healthy controls) while they viewed images of faces and houses of different spatial frequencies. We used joint independent component analyses to compare activity in visual systems.
AN and BDD groups demonstrated similar hypoactivity in early secondary visual processing regions and the dorsal visual stream when viewing low spatial frequency faces, linked to the N170 component, as well as in early secondary visual processing regions when viewing low spatial frequency houses, linked to the P100 component. Additionally, the BDD group exhibited hyperactivity in fusiform cortex when viewing high spatial frequency houses, linked to the N170 component. Greater activity in this component was associated with lower attractiveness ratings of faces.
Results provide preliminary evidence of similar abnormal spatiotemporal activation in AN and BDD for configural/holistic information for appearance- and non-appearance-related stimuli. This suggests a common phenotype of abnormal early visual system functioning, which may contribute to perceptual distortions.
Fe2SiS4 and Fe2GeS4 crystalline materials posses direct bandgaps of ∼1.55 and ∼1.4 eV respectively and an absorption coefficient larger than 105 cm–1; their theoretical potential as solar photovoltaic absorbers has been demonstrated. However, no solar devices that employ either Fe2SiS4 or Fe2GeS4 have been reported to date. In the presented work, nanoprecursors to Fe2SiS4 and Fe2GeS4 have been fabricated and employed to build ultra-thin-film layers via spray coating and rod coating methods. Temperature-dependent X-Ray diffraction analyses of nanoprecursors coatings show an unprecedented low temperature for forming crystalline Fe2SiS4 and Fe2GeS4. Fabricating of ultra-thin-film photovoltaic devices utilizing Fe2SiS4 and Fe2GeS4 as solar absorber material is presented.