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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.
Because of its unique mechanical, chemical, and biological properties, 3D-printed polyether ether ketone (PEEK) has great potential as customized bone replacement and other metal alloy implant replacement. PEEK samples were printed using fused deposition modeling (FDM) and evaluated in terms of their dimensional accuracy, crystallinity, and mechanical properties. Crystallinity and mechanical properties increased with elevated chamber temperature and post-printing annealing. Variations of material properties from three printers are evident. Many factors affect the quality of 3D-printed PEEK. Future FDA regulations for 3D-printed products are needed for this highly customizable manufacturing process to ensure safety and effectiveness for biomedical applications.
Cryoconite is a dark-coloured granular sediment that contains biological and mineralogical components, and it plays a pivotal role in geochemistry, carbon cycling and glacier mass balance. In this work, we collected cryoconite samples from Laohugou Glacier No. 12 (LHG) on the north-eastern Tibetan Plateau during the summer of 2015 and measured the spectral albedo. To explore the impacts of this sediment on surface ablation, the ice melting differences between the cryoconite-free (removed) ice and the intact layers were compared. The results showed that the mean concentrations of black carbon (BC), organic carbon (OC) and total iron (Fe) in the LHG cryoconite were 1.28, 11.18 and 39.94 mg g−1, respectively. BC was found to play a stronger role in solar light adsorption than OC and free Fe. In addition, ice covered by cryoconite exhibited the lowest mean reflectance (i.e., <0.1). Compared with the cryoconite-free ice surface, cryoconite effectively absorbed solar energy and enhanced glacial melting at a rate of 2.27–3.28 cm d−1, and free Fe, BC and OC were estimated to contribute 1.01, 0.99 and 0.76 cm d−1, respectively. This study provides important insights for understanding the role of cryoconite in the glacier mass balance of the northern Tibetan Plateau.
The effective charge of an element is a parameter characterizing the electromigration effect, which can determine the reliability of interconnection in electronic technologies. In this work, machine learning approaches were employed to model the effective charge (z*) as a linear function of physically meaningful elemental properties. Average fivefold (leave-out-alloy-group) cross-validation yielded root-mean-square-error divided by whole data set standard deviation (RMSE/σ) values of 0.37 ± 0.01 (0.22 ± 0.18), respectively, and R2 values of 0.86. Extrapolation to z* of totally new alloys showed limited but potentially useful predictive ability. The model was used in predicting z* for technologically relevant host–impurity pairs.
Primary fluid recovery from a porous medium is driven by the volumetric expansion of the in situ fluid. For production from a petroleum reservoir, primary recovery accounts for more than half of the total amount of recovered hydrocarbon. The primary recovery process is studied here at the pore scale and the macroscopic scale. The pore-scale flow is first analysed using the compressible Navier–Stokes equations and the mathematical theory for low-Mach-number flow developed by Klainerman & Majda (Commun. Pure Appl. Maths, vol. 34 (4), 1981, pp. 481–524; vol. 35 (5), 1982, pp. 629–651). An asymptotic analysis shows that the pore-scale flow is governed by the self-diffusion of the fluid and it exhibits a slip-like mass flow rate, even though the velocity satisfies the no-slip condition on the pore wall. The pore-scale density equation is then upscaled to a macroscopic diffusion equation for the density which possesses a diffusion coefficient proportional to the fluid’s kinematic viscosity. Darcy’s law is shown to be inapplicable to primary fluid recovery and it should be replaced by a new mass flux equation which depends on the porosity but not on the permeability. This is in stark contrast to the classical result and it can have important implications for hydrocarbon recovery as well as other applications.
Abnormal thyroid function is prevalent among women and has been linked to increased risk of chronic disease. Posttraumatic stress disorder (PTSD) has been linked to thyroid dysfunction in some studies; however, the results have been inconsistent. Thus, we evaluated trauma exposure and PTSD symptoms in relation to incident thyroid dysfunction in a large longitudinal cohort of civilian women.
We used data from 45 992 women from the ongoing Nurses’ Health Study II, a longitudinal US cohort study that began in 1989. In 2008, history of trauma and PTSD were assessed with the Short Screening Scale for Diagnostic and Statistical Manual of Mental Disorders, fourth edition, PTSD, and incident thyroid dysfunction was determined by participants’ self-report in biennial questionnaires of physician-diagnosed hypothyroidism and Graves’ hyperthyroidism. The study period was from 1989 to 2013. Proportional hazard models were used to estimate multivariable-adjusted hazard ratios and 95% confidence intervals (CIs) for incident hypothyroidism and Graves’ hyperthyroidism.
In multivariable-adjusted models, we found significant associations for PTSD only with hypothyroidism [p-trend <0.001; trauma with no PTSD symptoms, 1.08 (95% CI 1.02–1.15); 1–3 PTSD symptoms, 1.12 (95% CI 1.04–1.21); 4–5 PTSD symptoms, 1.23 (95% CI 1.13–1.34); and 6–7 PTSD symptoms, 1.26 (95% CI 1.14–1.40)]. PTSD was not associated with risk of Graves’ hyperthyroidism (p-trend = 0.34). Associations were similar in sensitivity analyses restricted to outcomes with onset after 2008, when PTSD was assessed.
PTSD was associated with higher risk of hypothyroidism in a dose-dependent fashion. Highlighted awareness for thyroid dysfunction may be especially important in women with PTSD.
The purpose of the present meta-analysis was to evaluate the association between the inflammatory potential of diet, determined by the dietary inflammatory index (DII®) score, and depression.
Systematic review and meta-analysis.
A comprehensive literature search was conducted in PubMed, Web of Science and EMBASE databases up to August 2018. All observational studies that examined the association of the DII score with depression/depressive symptoms were included.
Four prospective cohorts and two cross-sectional studies enrolling a total of 49 584 subjects.
Overall, individuals in the highest DII v. the lowest DII category had a 23 % higher risk of depression (risk ratio (RR)=1·23; 95 % CI 1·12, 1·35). When stratified by study design, the pooled RR was 1·25 (95 % CI 1·12, 1·40) for the prospective cohort studies and 1·16 (95 % CI 0·96, 1·41) for the cross-sectional studies. Gender-specific analysis showed that this association was observed in women (RR=1·25; 95 % CI 1·09, 1·42) but was not statistically significant in men (RR=1·15; 95 % CI 0·83, 1·59).
The meta-analysis suggests that pro-inflammatory diet estimated by a higher DII score is independently associated with an increased risk of depression, particularly in women. However, more well-designed studies are needed to evaluate whether an anti-inflammatory diet can reduce the risk of depression.
Research on the risk of stroke following the use of mood stabilisers specific to patients with bipolar disorder is limited.
In this study, we investigated the risk of stroke following the exposure to mood stabilisers in patients with bipolar disorder.
Data for this nationwide population-based study were derived from the Taiwan National Health Insurance Research Database. Among a retrospective cohort of patients with bipolar disorder (n = 19 433), 609 new-onset cases of stroke were identified from 1999 to 2012. A case–crossover study design utilising 14-day windows was applied to assess the acute exposure effect of individual mood stabilisers on the risk of ischaemic, haemorrhagic and other types of stroke in patients with bipolar disorder.
Mood stabilisers as a group were significantly associated with the increased risk of stroke in patients with bipolar disorder (adjusted risk ratio, 1.26; P = 0.041). Among individual mood stabilisers, acute exposure to carbamazepine had the highest risk of stroke (adjusted risk ratio, 1.68; P = 0.018), particularly the ischaemic type (adjusted risk ratio, 1.81; P = 0.037). In addition, acute exposure to valproic acid elevated the risk of haemorrhagic stroke (adjusted risk ratio, 1.76; P = 0.022). In contrast, acute exposure to lithium and lamotrigine did not significantly increase the risk of any type of stroke.
Use of carbamazepine and valproic acid, but not lithium and lamotrigine, is associated with increased risk of stroke in patients with bipolar disorder.
Volumetric expansion driven drainage flow of a viscous compressible fluid from a small capillary with a sealed end is studied in the low Mach number limit using the linearized compressible Navier–Stokes equations with no-slip condition. Density relaxation, oscillation and decay as well as the velocity field are investigated in detail. It is shown that fluid drainage is controlled by the slow decay of the standing acoustic wave inside the capillary; and the acoustic wave retards the density diffusion by reducing the diffusion coefficient of the density envelope equation by one half. Remarkably the no-slip flow exhibits a slip-like mass flow rate. The period-averaged mass flow rate at the exit (drainage rate) is found proportional to the fluid’s kinematic viscosity via the density diffusion coefficient and the average drainage speed is independent of the capillary radius. These findings are valid for arbitrarily small capillaries as long as the continuum assumption holds and they are in stark contrast to the classical lubrication based theory. Generalization to a capillary with a sound absorbing end is achieved by a simple model. The reported results offer new insights to the nature of slow viscous compressible flows in very small capillaries.
We analyzed a 2-year time series of meteorological data (January 2011–December 2012) from three automatic weather stations on Laohugou glacier No. 12, western Qilian Mountains, China. Air temperature, humidity and incoming radiation were significantly correlated between the three sites, while wind speed and direction were not. In this work, we focus on the effects of clouds on other meteorological parameters and on glacier melt. On an average, ~18% of top-of-atmosphere shortwave radiation was attenuated by the clear-sky atmosphere, and clouds attenuated a further 12%. Most of the time the monthly average increases in net longwave radiation caused by clouds were larger than decreases in net shortwave radiation but there was a tendency to lose energy during the daytime when melting was most intense. Air temperature and wind speed related to turbulent heat flux were found to suppress glacier melt during cloudy periods, while increased water vapor pressure during cloudy days could enhance glacier melt by reducing energy loss by latent heat. From these results, we have increased the physical understanding of the significance of cloud effects on continental glaciers.
A fully discrete A-ϕ finite element scheme for a nonlinear model of type-II superconductors is proposed and analyzed. The nonlinearity is due to a field dependent conductivity with the regularized power-law form. The challenge of this model is the error estimate for the nonlinear term under the time derivative. Applying the backward Euler method in time discretisation, the well-posedness of the approximation problem is given based on the theory of monotone operators. The fully discrete system is derived by standard finite element method. The error estimate is suboptimal in time and space.
This paper optimises two-ship collision-avoidance manoeuvres accounting for both collision risk and fuel use. A collision-avoidance manoeuvring optimisation model is developed to minimise fuel consumption while assuring ships' operational safety. The model can optimally determine when to begin collision-avoidance actions, how to change courses, and what rudder angles are needed. A quantitative scenario simulation is developed to illustrate the model application. The methodology can be further developed to guide practical ship collision-avoidance manoeuvring decisions made under more operational scenarios. In particular, this research can contribute to the development of computer-aided collision-avoidance operations to improve the safety and energy efficiency of maritime transportation.
This work quantifies glacier variations in the Naimona’nyi area of the western Himalaya by integrating glacier spatial data from ASTER and the Landsat series of satellite imagery at four different times: 1976, 1990, 1999 and 2003. Comparison of the results from individual images with those from the integrated method indicates that the integrated approach provides a better result. Glacier variations were mapped and analyzed; discrepancies between images could be detected and removed from the integrated data using remap tables in Arc/Info grid both graphically and numerically. Our results show that glaciers in the region both retreated and advanced during the last 28 years; however, retreat dominates. The variation of glaciers in the western Himalayan region is dramatic compared with other regions in high Asia. From 1976 to 2003, glacier area decreased from 84.41 km2 to 77.29 km2. Sequential images show that glacier areas shrank by 0.17, 0.19 and 0.77 km2 a−1, on average, during the periods 1976–90, 1990–99 and 1999–2003, respectively, suggesting that glacier retreat has accelerated.
Using Geographical Information System (GIS) and remote-sensing technologies, we describe quantitative measurements of glacier variations in the Geladandong mountain region of central Tibet. Data from Landsat images at three different times, 1973–76, 1992 and 2002, are compared with glacier areas digitized from a topographic map based on aerial photographs taken in 1969. We find that while some glaciers have advanced during the past 30 years, others have retreated. The area of retreat is much larger than that of advance. The total glacier area has decreased from 889km2 in 1969 to 847km2 in 2002, a reduction of almost 43 km2 (i.e. 4.8% decrease, or an average of 1.29km2 a–1). The variation of glacier area in the Geladandong mountain region is not as large as in other regions within the Tibetan Plateau. Glacier areas decreased 4.7km2 (i.e. an average of 0.68km2 a–1) during 1969–76, 15.4km2 (0.96km2 a–1) during 1976–92, and 22.4km2 (2.24km2 a–1) during 1992–2002, suggesting accelerated glacier retreat in recent years. The recession rates of glacier termini also increased. It is likely that the increase in summer air temperature is the major reason for glacier shrinkage in the Geladandong mountain region.
Advance directives are important for nursing home residents with dementia; for those with advanced dementia, surrogates determine medical decisions. However, in Taiwan, little is known about what influences the completion of these advance directives. The purpose of this study was to identify factors, which influence the presence of advance directives for nursing home residents with dementia in Taiwan.
Our cross-sectional study analyzed a convenience sample of 143 nursing home dyads comprised of residents with dementia and family surrogates. Documentation of residents’ advance directives, physical and cognitive status was obtained from medical charts. Surrogates completed the stress of end-of-life care decision scale and a questionnaire regarding their demographic characteristics. Nursing home characteristics were obtained from each chief administrator.
Less than half of the nursing home residents (39.2%) had advance directives and most (96.4%) had been completed by family surrogates. The following were predictors of an advance directive: surrogates had previously signed a do-not-resuscitate as a proxy and had been informed of advance directives by a healthcare provider; nursing homes had policies for advance directives and a religious affiliation.
Advance directives were uncommon for nursing home residents with dementia. Presence of an advance directive was associated with surrogate characteristics and the nursing home facilities; there was no association with characteristics of the nursing home resident. Our findings emphasize the need to develop policies and strategies, which ensure that all residents of nursing homes and their surrogates are aware of their right to an advance directive.
We examined the in vitro developmental competence of parthenogenetic activation (PA) oocytes activated by an electric pulse (EP) and treated with various concentrations of AZD5438 for 4 h. Treatment with 10 µM AZD5438 for 4 h significantly improved the blastocyst formation rate of PA oocytes in comparison with 0, 20, or 50 µM AZD5438 treatment (46.4% vs. 34.5%, 32.3%, and 24.0%, respectively; P < 0.05). The blastocyst formation rate was higher in the group treated with AZD5438 for 4 h than in the groups treated with AZD5438 for 2 or 6 h (42.8% vs. 38.6% and 37.2%, respectively; P > 0.05). Furthermore, 66.67% of blastocysts derived from these AZD5438-treated PA oocytes had a diploid karyotype. The blastocyst formation rate of PA and somatic cell nuclear transfer (SCNT) embryos was similar between oocytes activated by an EP and treated with 2 mM 6-dimethylaminopurine for 4 h and those activated by an EP and treated with 10 µM AZD5438 for 4 h (11.11% vs. 13.40%, P > 0.05). In addition, the level of maturation-promoting factor (MPF) was significantly decreased in oocytes activated by an EP and treated with 10 µM AZD5438 for 4 h. Finally, the mRNA expression levels of apoptosis-related genes (Bax and Bcl-2) and pluripotency-related genes (Oct4, Nanog, and Sox2) were checked by RT-PCR; however, there were no differences between the AZD5438-treated and non-treated control groups. Our results demonstrate that porcine oocyte activation via an EP in combination with AZD5438 treatment can lead to a high blastocyst formation rate in PA and SCNT experiments.
This work presents a brief introduction on three kinds of newly developed
-doped laser glasses in Shanghai Institute of Optics and Fine Mechanics (SIOM), China. Two
-doped phosphate glasses with lower thermal expansion coefficient and thermal shock resistance 4 times higher than that of N31 glass are developed for laser processing. Nd:Silicate and Nd:Aluminate glasses with peak emission wavelength at 1061 and 1065 nm, effective emission bandwidth of 34 and 50 nm, respectively, are developed for Exawatt-class laser system application. Fluorophosphate glasses with low nonlinear refractive index (
) and long fluorescence lifetime (
) are investigated for the purpose of decreasing B integral in high-power laser system. The properties of all these glasses are presented and compared with those of commercial neodymium laser glasses.
The effect of a superstrong magnetic field on neutron stars or white dwarfs is studied for Thomson scattering in a fully ionized collisionless. plasma. The equation of motion for an electron in the presence of both the induced electric field of the plasma and a static uniform external magnetic field is used to determine the acceleration of the electron. The collective plasma effects due to the field and density fluctuations are investigated by using the test-particle picture. The scattering of a photon by a plasma is a function of the acceleration of particles by the electric field of the incident wave and the static external magnetic field Assuming that the electrons are distributed with density the radiation field far from the scattering center is
where the delta function indicates that all quantities are to be evaluated at the retarded time and δλ is the angle between the wave vector and the Poynting vector, which is given by