We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
High-quality primary care reduces premature mortality in the general population, but evidence for psychiatric patients in China is scarce.
Aims
To confirm excess mortality in patients with severe mental illness (SMI), and to examine the impact of community-based mental healthcare and other risk factors on their mortality.
Method
We included 93 655 patients in 2012 and 100 706 in 2013 from the national mental health surveillance system in Sichuan, China to calculate the standardised mortality ratio (SMR). A total of 112 576 patients were followed up from 2009 to 2014 for model analyses. We used growth models to quantify the patterns of change for community management measures, high-risk behaviour, disease stability and medication adherence of patients over time, and then used multilevel proportional hazard models to examine the association between change patterns of management measures and mortality.
Results
The SMR was 6.44 (95% CI 4.94–8.26) in 2012 and 7.57 (95% CI 5.98–9.44) in 2013 among patients with SMI aged 15–34 years, and diminished with age. Unfavourable baseline socioeconomic status increased the hazard of death by 38–50%. Positive changes in high-risk behaviour, disease stability and medication adherence had a 54% (95% CI 47–60%), 69% (95% CI 63–73%) and 20% (4–33%) reduction in hazard of death, respectively, versus in those where these were unchanged.
Conclusions
High excess mortality was confirmed among younger patients with SMI in Sichuan, China. Our findings on the relationships between community management and socioeconomic factors and mortality can inform community-based mental healthcare policies to reduce excess mortality among patients with SMI.
We present 63 new multi-site radial velocity (RV) measurements of the K1III giant HD 76920, which was recently reported to host the most eccentric planet known to orbit an evolved star. We focused our observational efforts on the time around the predicted periastron passage and achieved near-continuous phase coverage of the corresponding RV peak. By combining our RV measurements from four different instruments with previously published ones, we confirm the highly eccentric nature of the system and find an even higher eccentricity of
$e=0.8782 \pm 0.0025$
, an orbital period of
$415.891^{+0.043}_{-0.039}\,\textrm{d}$
, and a minimum mass of
$3.13^{+0.41}_{-0.43}\,\textrm{M}_{\textrm{J}}$
for the planet. The uncertainties in the orbital elements are greatly reduced, especially for the period and eccentricity. We also performed a detailed spectroscopic analysis to derive atmospheric stellar parameters, and thus the fundamental stellar parameters (
$M_*, R_*, L_*$
), taking into account the parallax from Gaia DR2, and independently determined the stellar mass and radius using asteroseismology. Intriguingly, at periastron, the planet comes to within 2.4 stellar radii of its host star’s surface. However, we find that the planet is not currently experiencing any significant orbital decay and will not be engulfed by the stellar envelope for at least another 50–80 Myr. Finally, while we calculate a relatively high transit probability of 16%, we did not detect a transit in the TESS photometry.
To assess extent of a healthcare-associated outbreak of SARS-CoV-2 and evaluate effectiveness of infection control measures, including universal masking
Design:
Outbreak investigation including 4 large-scale point-prevalence surveys
Setting:
Integrated VA Health Care System with 2 facilities and 330 beds
Participants:
Index patient and 250 exposed patients and staff
Methods:
We identified exposed patients and staff and classified them as probable and confirmed cases based on symptoms and testing. We performed a field investigation and assessment of patient and staff interactions to develop probable transmission routes. Infection prevention interventions implemented included droplet and contact precautions, employee quarantine, and universal masking with medical and cloth facemasks. Four point-prevalence surveys of patient and staff subsets were conducted using real-time reverse-transcriptase polymerase chain reaction for SARS-CoV-2.
Results:
Among 250 potentially exposed patients and staff, 14 confirmed cases of Covid-19 were identified. Patient roommates and staff with prolonged patient contact were most likely to be infected. The last potential date of transmission from staff to patient was day 22, the day universal masking was implemented. Subsequent point-prevalence surveys in 126 patients and 234 staff identified 0 patient cases and 5 staff cases of Covid-19, without evidence of healthcare-associated transmission.
Conclusions:
Universal masking with medical facemasks was effective in preventing further spread of SARS-CoV-2 in our facility in conjunction with other traditional infection prevention measures.
The rotating instability in a contra-rotating axial flow compressor is investigated by experiments. Twenty-four pressure sensors were installed on the casing to capture the unsteady flow in the rotor tip region simultaneously. A double-phase-locking technique suitable for the contra-rotating compressor was proposed to characterise the static pressure contours of the rotor tip. The mean and root-mean-square pressure contours indicate that rotating instability occurs before the rotating stall happened, and the rotor tip clearance vortex is located upstream of the rear rotor leading edge plane before stall. Fourier spectrum shows that rotating instability and rotating stall both happened under the stall condition, and the frequency band of rotating instability does not change with the flow rate. In the front rotor, the frequency of rotating instability is half of the blade passing frequency. It is verified that the modal estimation method can be implemented by using the average azimuthal phase velocity, which significantly reduced the number of pressure sensors required. Modal estimation results show that each peak of the rotating instability frequency band corresponds to a unique dominant circumferential mode. By optimising average azimuthal phase velocity, an improved modal estimation method is obtained, which can further improve the reliability of the modal estimation results.
To examine associations between diet and risk of developing gastro-oesophageal reflux disease (GERD).
Design:
Prospective cohort with a median follow-up of 15·8 years. Baseline diet was measured using a FFQ. GERD was defined as self-reported current or history of daily heartburn or acid regurgitation beginning at least 2 years after baseline. Sex-specific logistic regressions were performed to estimate OR for GERD associated with diet quality scores and intakes of nutrients, food groups and individual foods and beverages. The effect of substituting saturated fat for monounsaturated or polyunsaturated fat on GERD risk was examined.
Setting:
Melbourne, Australia.
Participants:
A cohort of 20 926 participants (62 % women) aged 40–59 years at recruitment between 1990 and 1994.
Results:
For men, total fat intake was associated with increased risk of GERD (OR 1·05 per 5 g/d; 95 % CI 1·01, 1·09; P = 0·016), whereas total carbohydrate (OR 0·89 per 30 g/d; 95 % CI 0·82, 0·98; P = 0·010) and starch intakes (OR 0·84 per 30 g/d; 95 % CI 0·75, 0·94; P = 0·005) were associated with reduced risk. Nutrients were not associated with risk for women. For both sexes, substituting saturated fat for polyunsaturated or monounsaturated fat did not change risk. For both sexes, fish, chicken, cruciferous vegetables and carbonated beverages were associated with increased risk, whereas total fruit and citrus were associated with reduced risk. No association was observed with diet quality scores.
Conclusions:
Diet is a possible risk factor for GERD, but food considered as triggers of GERD symptoms might not necessarily contribute to disease development. Potential differential associations for men and women warrant further investigation.
We elucidate the physics underlying the birth, evolution and breakup of ligaments on a rim bounding an unsteady liquid sheet. This rim destabilizes into corrugations that can grow into ligaments, which in turn, break into secondary droplets via end-pinching. Combining experiments and theory, we show that not all corrugations can grow into ligaments. The number of corrugations is captured by linear instability coupled with nonlinear rim thickness self-adjustment ($\text {Bond number} = 1 \text { criterion}$, Wang et al. (Phys. Rev. Lett., vol. 120, 2018, 204503)) and scales as $N_c \sim We^{3/4}$ with Weber number, $We$. The number of ligaments scales as $N_{\ell } \sim We^{3/8}$. The growth of a ligament is governed by the competition between the constraint imposed by the geometry of the local rim–ligament junction; the local force balance including the fictitious force from the continuously decelerating rim; and the global rim mass conservation constraint. The temporal evolution of the average width of ligaments is predicted. Key to understanding the ligament population, a minimum distance between two corrugations is required to enable their actual transition into ligaments. By predicting this minimal distance, we derive the evolution of the number of ligaments. We show that droplets are shed, one at a time, following a chaotic dripping end-pinching regime independent of $We$. Finally, the number of droplets shed per unit of time decreases over time and scales as $S_d \sim We^{3/4}$; while the volume shed per unit of time increases over time and is independent of $We$. Theoretical predictions are validated without fitting parameters.
To investigate the influences of dietary riboflavin (RF) addition on nutrient digestion and rumen fermentation, eight rumen cannulated Holstein bulls were randomly allocated into four treatments in a repeated 4 × 4 Latin square design. Daily addition level of RF for each bull in control, low RF, medium RF and high RF was 0, 300, 600 and 900 mg, respectively. Increasing the addition level of RF, DM intake was not affected, average daily gain tended to be increased linearly and feed conversion ratio decreased linearly. Total tract digestibilities of DM, organic matter, crude protein (CP) and neutral-detergent fibre (NDF) increased linearly. Rumen pH decreased quadratically, and total volatile fatty acids (VFA) increased quadratically. Acetate molar percentage and acetate:propionate ratio increased linearly, but propionate molar percentage and ammonia-N content decreased linearly. Rumen effective degradability of DM increased linearly, NDF increased quadratically but CP was unaltered. Activity of cellulase and populations of total bacteria, protozoa, fungi, dominant cellulolytic bacteria, Prevotella ruminicola and Ruminobacter amylophilus increased linearly. Linear increase was observed for urinary total purine derivatives excretion. The data suggested that dietary RF addition was essential for rumen microbial growth, and no further increase in performance and rumen total VFA concentration was observed when increasing RF level from 600 to 900 mg/d in dairy bulls.
Lifestyle interventions are an important and viable approach for preventing cognitive deficits. However, the results of studies on alcohol, coffee and tea consumption in relation to cognitive decline have been divergent, likely due to confounds from dose–response effects. This meta-analysis aimed to find the dose–response relationship between alcohol, coffee or tea consumption and cognitive deficits.
Methods
Prospective cohort studies or nested case-control studies in a cohort investigating the risk factors of cognitive deficits were searched in PubMed, Embase, the Cochrane and Web of Science up to 4th June 2020. Two authors searched the databases and extracted the data independently. We also assessed the quality of the studies with the Newcastle-Ottawa scale. Stata 15.0 software was used to perform model estimation and plot the linear or nonlinear dose–response relationship graphs.
Results
The search identified 29 prospective studies from America, Japan, China and some European countries. The dose–response relationships showed that compared to non-drinkers, low consumption (<11 g/day) of alcohol could reduce the risk of cognitive deficits or only dementias, but there was no significant effect of heavier drinking (>11 g/day). Low consumption of coffee reduced the risk of any cognitive deficit (<2.8 cups/day) or dementia (<2.3 cups/day). Green tea consumption was a significant protective factor for cognitive health (relative risk, 0.94; 95% confidence intervals, 0.92–0.97), with one cup of tea per day brings a 6% reduction in risk of cognitive deficits.
Conclusions
Light consumption of alcohol (<11 g/day) and coffee (<2.8 cups/day) was associated with reduced risk of cognitive deficits. Cognitive benefits of green tea consumption increased with the daily consumption.
The coronavirus disease 2019 (COVID-19) pandemic represents an unprecedented threat to mental health. Herein, we assessed the impact of COVID-19 on subthreshold depressive symptoms and identified potential mitigating factors.
Methods
Participants were from Depression Cohort in China (ChiCTR registry number 1900022145). Adults (n = 1722) with subthreshold depressive symptoms were enrolled between March and October 2019 in a 6-month, community-based interventional study that aimed to prevent clinical depression using psychoeducation. A total of 1506 participants completed the study in Shenzhen, China: 726 participants, who completed the study between March 2019 and January 2020 (i.e. before COVID-19), comprised the ‘wave 1’ group; 780 participants, who were enrolled before COVID-19 and completed the 6-month endpoint assessment during COVID-19, comprised ‘wave 2’. Symptoms of depression, anxiety and insomnia were assessed at baseline and endpoint (i.e. 6-month follow-up) using the Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder-7 (GAD-7) and Insomnia Severity Index (ISI), respectively. Measures of resilience and regular exercise were assessed at baseline. We compared the mental health outcomes between wave 1 and wave 2 groups. We additionally investigated how mental health outcomes changed across disparate stages of the COVID-19 pandemic in China, i.e. peak (7–13 February), post-peak (14–27 February), remission plateau (28 February−present).
Results
COVID-19 increased the risk for three mental outcomes: (1) depression (odds ratio [OR] = 1.30, 95% confidence interval [CI]: 1.04–1.62); (2) anxiety (OR = 1.47, 95% CI: 1.16–1.88) and (3) insomnia (OR = 1.37, 95% CI: 1.07–1.77). The highest proportion of probable depression and anxiety was observed post-peak, with 52.9% and 41.4%, respectively. Greater baseline resilience scores had a protective effect on the three main outcomes (depression: OR = 0.26, 95% CI: 0.19–0.37; anxiety: OR = 1.22, 95% CI: 0.14–0.33 and insomnia: OR = 0.18, 95% CI: 0.11–0.28). Furthermore, regular physical activity mitigated the risk for depression (OR = 0.79, 95% CI: 0.79–0.99).
Conclusions
The COVID-19 pandemic exerted a highly significant and negative impact on symptoms of depression, anxiety and insomnia. Mental health outcomes fluctuated as a function of the duration of the pandemic and were alleviated to some extent with the observed decline in community-based transmission. Augmenting resiliency and regular exercise provide an opportunity to mitigate the risk for mental health symptoms during this severe public health crisis.
An acute gastroenteritis (AGE) outbreak caused by a norovirus occurred at a hospital in Shanghai, China, was studied for molecular epidemiology, host susceptibility and serological roles. Rectal and environmental swabs, paired serum samples and saliva specimens were collected. Pathogens were detected by real-time polymerase chain reaction and DNA sequencing. Histo-blood group antigens (HBGA) phenotypes of saliva samples and their binding to norovirus protruding proteins were determined by enzyme-linked immunosorbent assay. The HBGA-binding interfaces and the surrounding region were analysed by the MegAlign program of DNAstar 7.1. Twenty-seven individuals in two care units were attacked with AGE at attack rates of 9.02 and 11.68%. Eighteen (78.2%) symptomatic and five (38.4%) asymptomatic individuals were GII.6/b norovirus positive. Saliva-based HBGA phenotyping showed that all symptomatic and asymptomatic cases belonged to A, B, AB or O secretors. Only four (16.7%) out of the 24 tested serum samples showed low blockade activity against HBGA-norovirus binding at the acute phase, whereas 11 (45.8%) samples at the convalescence stage showed seroconversion of such blockade. Specific blockade antibody in the population played an essential role in this norovirus epidemic. A wide HBGA-binding spectrum of GII.6 supports a need for continuous health attention and surveillance in different settings.
We discuss observational strategies to detect prompt bursts associated with gravitational wave (GW) events using the Australian Square Kilometre Array Pathfinder (ASKAP). Many theoretical models of binary neutron stars mergers predict that bright, prompt radio emission would accompany the merger. The detection of such prompt emission would greatly improve our knowledge of the physical conditions, environment, and location of the merger. However, searches for prompt emission are complicated by the relatively poor localisation for GW events, with the 90% credible region reaching hundreds or even thousands of square degrees. Operating in fly’s eye mode, the ASKAP field of view can reach
$\sim1\,000$ deg$^2$ at $\sim$$888\,{\rm MHz}$. This potentially allows observers to cover most of the 90% credible region quickly enough to detect prompt emission. We use skymaps for GW170817 and GW190814 from LIGO/Virgo’s third observing run to simulate the probability of detecting prompt emission for GW events in the upcoming fourth observing run. With only alerts released after merger, we find it difficult to slew the telescope sufficiently quickly as to capture any prompt emission. However, with the addition of alerts released before merger by negative-latency pipelines, we find that it should be possible to search for nearby, bright prompt fast radio burst-like emission from GW events. Nonetheless, the rates are low: we would expect to observe $\sim$0.012 events during the fourth observing run, assuming that the prompt emission is emitted microseconds around the merger.
Litigation cannot solve a public health crisis. But litigation can be an effective complementary tool to regulation by increasing the salience of a public health issue, eliciting closely guarded information to move public opinion, and prompting legislative action. From tobacco to opioids, litigants have successfully turned to courts for monetary relief, to initiate systemic change, and to hold industry accountable
For years, litigators have been trying to push firearm suits into their own litigation moment. But litigation against the gun industry poses special challenges. Not only has the regulatory regime failed to prevent a public safety hazard, Congress has consistently underfunded and understaffed the relevant regulatory actors. And in 2005 it legislatively immunized the gun industry from suit with the Protection of Lawful Commerce in Arms Act (PLCAA).
This paper surveys the field of litigation in response to gun violence, tracking the limited successes of victims and stakeholders suing the gun industry. We find that victories remain confined to individual actors and unlike high-impact public litigations in other areas, aggregate class actions and major public litigation led by state attorneys general are noticeably absent in the firearm context.
Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.
Stratospheric airships are promising aircraft, usually designed as a non-rigid airship. As an essential part of the non-rigid airship, the envelope plays a significant role in maintaining its shape and bearing the external force load. Generally, the envelope material of a flexible airship consists of plain-weave fabric, composed of warp and weft fibre yarn. At present, biaxial tensile experiments are the primary method used to study the stress–strain characteristics of such flexible airship materials. In this work, biaxial tensile testing of UN-5100 material was carried out. The strain on the material under unusual stress and the stress ratio were obtained using Digital Image Correlation (DIC) technology. Also, the stress–strain curve was corrected by polynomial fitting. The slope of the stress–strain curve at different points, the Membrane Structures Association of Japan (MSAJ) standard and the Radial Basis Function (RBF) model were compared to identify the stress–strain characteristics of the materials. Some conclusions on the mechanical properties of the flexible airship material can be drawn and will play a significant role in the design of such envelopes.
Background:
Infection prevention and control (IPC) workflows are often retrospective and manual. New tools, however, have entered the field to facilitate rapid prospective monitoring of infections in hospitals. Although artificial intelligence (AI)–enabled platforms facilitate timely, on-demand integration of clinical data feeds with pathogen whole-genome sequencing (WGS), a standardized workflow to fully harness the power of such tools is lacking. We report a novel, evidence-based workflow that promotes quicker infection surveillance via AI-assisted clinical and WGS data analysis. The algorithm suggests clusters based on a combination of similar minimum inhibitory concentration (MIC) data, timing of sample collection, and shared location stays between patients. It helps to proactively guide IPC professionals during investigation of infectious outbreaks and surveillance of multidrug-resistant organisms and healthcare-acquired infections. Methods: Our team established a 1-year workgroup comprised of IPC practitioners, clinical experts, and scientists in the field. We held weekly roundtables to study lessons learned in an ongoing surveillance effort at a tertiary care hospital—utilizing Philips IntelliSpace Epidemiology (ISEpi), an AI-powered system—to understand how such a tool can enhance practice. Based on real-time case discussions and evidence from the literature, a workflow guidance tool and checklist were codified. Results: In our workflow, data-informed clusters posed by ISEpi underwent triage and expert follow-up analysis to assess: (1) likelihood of transmission(s); (2) potential vector(s) identity; (3) need to request WGS; and (4) intervention(s) to be pursued, if warranted. In a representative sample (spanning October 17, 2019, to November 7, 2019) of 67 total isolates suggested for inclusion in 19 unique cluster investigations, we determined that 9 investigations merited follow-up. Collectively, these 9 investigations involved 21 patients and required 115 minutes to review in ISEpi and an additional 70 minutes of review outside of ISEpi. After review, 6 investigations were deemed unlikely to represent a transmission; the other 3 had potential to represent transmission for which interventions would be performed. Conclusions: This study offers an important framework for adaptation of existing infection control workflow strategies to leverage the utility of rapidly integrated clinical and WGS data. This workflow can also facilitate time-sensitive decisions regarding sequencing of specific pathogens given the preponderance of available clinical data supporting investigations. In this regard, our work sets a new standard of practice: precision infection prevention (PIP). Ongoing effort is aimed at development of AI-powered capabilities for enterprise-level quality and safety improvement initiatives.
Funding: Philips Healthcare provided support for this study.
Disclosures: Alan Doty and Juan Jose Carmona report salary from Philips Healthcare.
Due to urbanisation in China, about 7.74 million older people have migrated to urban centres, where their adult children reside and work, to care for their grandchildren. While older migrants may benefit from family reunion and mutual support, empirical studies have identified challenges to adaptation, integration and mental health. Employing a systematic literature review approach, this paper examines recent empirical studies on the mental health of older migrants migrating along with adult children in China, focusing on mental health and wellbeing outcomes and determinants and directions for social work interventions. It identifies directions for considering diversity in conceptualisations of mental health and in theoretical perspectives to enrich understanding of the experiences of Chinese older migrants migrating along with adult children and potential interventions.