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Better understanding of interplay among symptoms, cognition and functioning in first-episode psychosis (FEP) is crucial to promoting functional recovery. Network analysis is a promising data-driven approach to elucidating complex interactions among psychopathological variables in psychosis, but has not been applied in FEP.
This study employed network analysis to examine inter-relationships among a wide array of variables encompassing psychopathology, premorbid and onset characteristics, cognition, subjective quality-of-life and psychosocial functioning in 323 adult FEP patients in Hong Kong. Graphical Least Absolute Shrinkage and Selection Operator (LASSO) combined with extended Bayesian information criterion (BIC) model selection was used for network construction. Importance of individual nodes in a generated network was quantified by centrality analyses.
Our results showed that amotivation played the most central role and had the strongest associations with other variables in the network, as indexed by node strength. Amotivation and diminished expression displayed differential relationships with other nodes, supporting the validity of two-factor negative symptom structure. Psychosocial functioning was most strongly connected with amotivation and was weakly linked to several other variables. Within cognitive domain, digit span demonstrated the highest centrality and was connected with most of the other cognitive variables. Exploratory analysis revealed no significant gender differences in network structure and global strength.
Our results suggest the pivotal role of amotivation in psychopathology network of FEP and indicate its critical association with psychosocial functioning. Further research is required to verify the clinical significance of diminished motivation on functional outcome in the early course of psychotic illness.
The main goal of this paper is to provide insights into swash flow dynamics, generated by a non-breaking solitary wave on a steep slope. Both laboratory experiments and numerical simulations are conducted to investigate the details of runup and rundown processes. Special attention is given to the evolution of the bottom boundary layer over the slope in terms of flow separation, vortex formation and the development of a hydraulic jump during the rundown phase. Laboratory experiments were performed to measure the flow velocity fields by means of high-speed particle image velocimetry (HSPIV). Detailed pathline patterns of the swash flows and free-surface profiles were also visualized. Highly resolved computational fluid dynamics (CFD) simulations were carried out. Numerical results are compared with laboratory measurements with a focus on the velocities inside the boundary layer. The overall agreement is excellent during the initial stage of the runup process. However, discrepancies in the model/data comparison grow as time advances because the numerical model does not simulate the shoreline dynamics accurately. Introducing small temporal and spatial shifts in the comparison yields adequate agreement during the entire rundown process. Highly resolved numerical solutions are used to study physical variables that are not measured in laboratory experiments (e.g. pressure field and bottom shear stress). It is shown that the main mechanism for vortex shedding is correlated with the large pressure gradient along the slope as the rundown flow transitions from supercritical to subcritical, under the developing hydraulic jump. Furthermore, the bottom shear stress analysis indicates that the largest values occur at the shoreline and that the relatively large bottom shear stress also takes place within the supercritical flow region, being associated with the backwash vortex system rather than the plunging wave. It is clearly demonstrated that the combination of laboratory observations and numerical simulations have indeed provided significant insights into the swash flow processes.
Universal health coverage is a key health target in the Sustainable Development Goals (SDGs) that has the means to link equitable social and economic development. As a concept firmly based on equity, it is widely accepted at international and national levels as important for populations to attain ‘health for all’ especially for marginalised groups. However, implementing universal coverage has been fraught with challenges and the increasing privatisation of health care provision adds to the challenge because it is being implemented in a health system that rests on a property regime that promotes inequality. This paper asks the question, ‘What does an equitable health system look like?’ rather than the usual ‘How do you make the existing health system more equitable?’ Using an ethnographic approach, the authors explored via interviews, focus group discussions and participant observation a health system that uses the commons approach such as which exists with indigenous peoples and found features that helped make the system intrinsically equitable. Based on these features, the paper proposes an alternative basis to organise universal health coverage that will better ensure equity in health systems and ultimately contribute to meeting the SDGs.
Carbapenem-resistant Acinetobacter baumannii (CRAB) with diverse multilocus sequence typing emerged among our nursing home residents (6.5%) with a high background rate of MRSA (32.2%). Rectal swabs yielded a higher rate of CRAB detection than axillary or nasal swabs. Bed-bound status, use of adult diapers, and nasogastric tube were risk factors for CRAB colonization.
During the early stage of an epidemic, timely and reliable estimation of the severity of infections are important for predicting the impact that the influenza viruses will have in the population. We obtained age-specific deaths and hospitalizations for patients with laboratory-confirmed H1N1pdm09 infections from June 2009 to December 2009 in Hong Kong. We retrospectively obtained the real-time estimates of the hospitalization fatality risk (HFR), using crude estimation or allowing for right-censoring for final status in some patients. Models accounting for right-censoring performed better than models without adjustments. The risk of deaths in hospitalized patients with confirmed H1N1pdm09 increased with age. Reliable estimates of the HFR could be obtained before the peak of the first wave of H1N1pdm09 in young and middle-aged adults but after the peak in the elderly. In the next influenza pandemic, timely estimation of the HFR will contribute to risk assessment and disease control.
The current Ebola virus disease (EVD) epidemic in West Africa is unprecedented in scale, and Sierra Leone is the most severely affected country. The case fatality risk (CFR) and hospitalization fatality risk (HFR) were used to characterize the severity of infections in confirmed and probable EVD cases in Sierra Leone. Proportional hazards regression models were used to investigate factors associated with the risk of death in EVD cases. In total, there were 17 318 EVD cases reported in Sierra Leone from 23 May 2014 to 31 January 2015. Of the probable and confirmed EVD cases with a reported final outcome, a total of 2536 deaths and 886 recoveries were reported. CFR and HFR estimates were 74·2% [95% credibility interval (CrI) 72·6–75·5] and 68·9% (95% CrI 66·2–71·6), respectively. Risks of death were higher in the youngest (0–4 years) and oldest (⩾60 years) age groups, and in the calendar month of October 2014. Sex and occupational status did not significantly affect the mortality of EVD. The CFR and HFR estimates of EVD were very high in Sierra Leone.
Hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) is becoming increasingly established in Asian hospitals. The primary aim of this study was to decompose the risk factors for HA-MRSA based on conceptual clinical pathways. The secondary aim was to show the amount of effect attributable to antibiotic exposure and total length of stay before outcome (LBO) so that institutions can manage at-risk patients accordingly. A case-control study consisting of 1200 inpatients was conducted in a large tertiary hospital in Singapore between January and December 2006. Results from the generalized structural equation model (GSEM) show that LBO [adjusted odds ratio (aOR) 14·9, 95% confidence interval (CI) 8·7–25·5], prior hospitalization (aOR 6·2, 95% CI 3·3–11·5), and cumulative antibiotic exposure (aOR 3·5, 95% CI 2·3–5·3), directly affected HA-MRSA acquisition. LBO accounted for the majority of the effects due to age (100%), immunosuppression (67%), and surgery (96%), and to a lesser extent for male gender (22%). Our model enabled us to account and quantify effects of intermediaries. LBO was found to be an important mediator of age, immunosuppression and surgery on MRSA infection. Traditional regression approaches will not only give different conclusions but also underestimate the effects. Hospitals should minimize the hospital stay when possible to reduce the risk of MRSA.
To assess the effectiveness of infection control preparedness for human infection with influenza A H7N9 in Hong Kong.
A descriptive study of responses to the emergence of influenza A H7N9.
A university-affiliated teaching hospital.
Healthcare workers (HCWs) with unprotected exposure (not wearing N95 respirator during aerosol-generating procedure) to a patient with influenza A H7N9.
A bundle approach including active and enhanced surveillance, early airborne infection isolation, rapid molecular diagnostic testing, and extensive contact tracing for HCWs with unprotected exposure was implemented. Seventy HCWs with unprotected exposure to an index case were interviewed especially regarding their patient care activities.
From April 1, 2013, through May 31, 2014, a total of 126 (0.08%) of 163,456 admitted patients were tested for the H7 gene by reverse transcription-polymerase chain reaction per protocol. Two confirmed cases were identified. Seventy (53.8%) of 130 HCWs had unprotected exposure to an index case, whereas 41 (58.6%) and 58 (82.9%) of 70 HCWs wore surgical masks and practiced hand hygiene after patient care, respectively. Sixteen (22.9%) of 70 HCWs were involved in high-risk patient contacts. More HCWs with high-risk patient contacts received oseltamivir prophylaxis (P=0.088) and significantly more had paired sera collected for H7 antibody testing (P<0.001). Ten (14.3%) of 70 HCWs developed influenza-like illness during medical surveillance, but none had positive results by reverse transcription-polymerase chain reaction. Paired sera was available from 33 of 70 HCWs with unprotected exposure, and none showed seroconversion against H7N9.
Despite the delay in airborne precautions implementation, no patient-to-HCW transmission of influenza A H7N9 was demonstrated.
Calcium sulfoaluminate (CSA) cements are being developed using a novel processing method having as its objective lowering specific CO2 emissions by ∼50% relative to a Portland cement benchmark. We need to be able to measure the properties of the products. Porosity and permeability measurements help define the engineering properties but their quantification is influenced by the choice of experimental protocols. In the present study we used ordinary Portland cement (PC) paste as a benchmark and hydrated ye’elimite, which is a main component of CSA cements, to understand its pore structure. We report on the use of synchrotron-sourced radiation for µCT (Computerized Tomography) and 3D image re-construction of the internal micro-pore structure of PC and ye’elimite-gypsum pastes. As a comparison, porosity and permeability measurements were traditionally obtained using Mercury Intrusion Porosimetry (MIP). The Mori-Tanaka method and the polynomial statistical model were used to analyze the effects of different 3-D micro-pore structures on mechanical properties. The results show that e micro-pore structures differ considerably between PC and ye’elimite pastes and their bulk modulus is significantly affected by the shapes of their micro-pore structures.
We employ intense and short pulses of energetic lithium (Li+) ions to investigate the relaxation dynamics of radiation induced defects in single crystal silicon samples. Ions both create damage and track damage evolution simultaneously at short time scales when we use the channeling effect as a diagnostic tool. Ion pulses, ∼20 to 600 ns long and with peak currents of up to ∼1 A are formed in an induction type linear accelerator, the Neutralized Drift Compression eXperiment at Lawrence Berkeley National Laboratory. By rotating silicon (<100>) membranes of different thicknesses and changing the incident ion energy, the fraction of channeled ions in the transmitted beam could be varied. In preliminary experiments we find that the Li ion intensity is not high enough to generate overlapping cascades (in time and space) that would be necessary to measure a change in the shape of the current waveform of the transmitted ion beam. We discuss the concept of pump-probe type experiments with short ion beam pulses to access defect dynamics in materials and outline a path to increasing damage rates with heavier ions and by the application of longitudinal and lateral pulse compression techniques.
Atom probe is a powerful technique for studying the composition of nano-precipitates, but their morphology within the reconstructed data is distorted due to the so-called local magnification effect. A new technique has been developed to mitigate this limitation by characterizing the distribution of the surrounding matrix atoms, rather than those contained within the nano-precipitates themselves. A comprehensive chemical analysis enables further information on size and chemistry to be obtained. The method enables new insight into the morphology and chemistry of niobium carbonitride nano-precipitates within ferrite for a series of Nb-microalloyed ultra-thin cast strip steels. The results are supported by complementary high-resolution transmission electron microscopy.
Continued monitoring of the seriousness of influenza viruses is a public health priority. We applied time-series regression models to data on cardio-respiratory mortality rates in Hong Kong from 2001 to 2011. We used surveillance data on outpatient consultations for influenza-like illness, and laboratory detections of influenza types/subtypes to construct proxy measures of influenza activity. In the model we allowed the regression coefficients for influenza to drift over time, and adjusted for temperature and humidity. The regression coefficient for influenza A(H3N2) increased significantly in 2005. The regression coefficients for influenza A(H1N1) and B were relatively stable over the period. Our model suggested an increase in seriousness of A(H3N2) in 2005, the year after the appearance of the A/Fujian/411/2002(H3N2)-like virus when the drifted A/California/7/2004(H3N2)-like virus appeared. Ongoing monitoring of mortality and influenza activity could permit identification of future changes in seriousness of influenza virus infections.
Cantonese has six lexical tones (T), but some tone pairs appear to be merging: T2  vs. T5 , T3  vs. T6 , and T4  vs. T6 . Twenty-eight merging participants and thirty control participants in Hong Kong were recruited for a perception experiment. Both accuracy rate and reaction time data were collected. Seventeen merging participants also participated in a production experiment. Predictive discriminant analysis of the fundamental frequency data and judgments by native transcribers were used to assess production accuracy. Results show that the merging participants still had six tone categories in production, although their “tone space” was more reduced. Tones with lower type frequency were more prone to change. The merging group was significantly slower in tone perception than the control group was. In illustrating the patterns of the ongoing tone merging process in Cantonese, this study contributes to a better understanding of the forces of sound change in general.
Certain probiotics may prevent the development of antibiotic-associated diarrhoea (AAD) and Clostridium difficile-associated diarrhoea (CDAD), but their effectiveness depends on both strain and dose. There are few data on nutritional interventions to control AAD/CDAD in the spinal cord injury (SCI) population. The present study aimed to assess (1) the efficacy of consuming a commercially produced probiotic containing at least 6·5 × 109 live Lactobacilluscasei Shirota (LcS) in reducing the incidence of AAD/CDAD, and (2) whether undernutrition and proton pump inhibitors (PPI) are risk factors for AAD/CDAD. A total of 164 SCI patients (50·1 (sd 17·8) years) with a requirement for antibiotics (median 21 d, range 5–366) were randomly allocated to receive LcS (n 76) or no probiotic (n 82). LcS was given once daily for the duration of the antibiotic course and continued for 7 days thereafter. Nutritional risk was assessed by the Spinal Nutrition Screening Tool. The LcS group had a significantly lower incidence of AAD (17·1 v. 54·9 %, P< 0·001). At baseline, 65 % of patients were at undernutrition risk. Undernutrition (64·1 v. 33·3 %, P< 0·01) and the use of PPI (38·4 v. 12·1 %, P= 0·022) were found to be associated with AAD. However, no significant difference was observed in nutrient intake between the groups. The multivariate logistic regression analysis identified poor appetite ( < 1/2 meals eaten) (OR 5·04, 95 % CI 1·28, 19·84) and no probiotic (OR 8·46, 95 % CI 3·22, 22·20) as the independent risk factors for AAD. The present study indicated that LcS could reduce the incidence of AAD in hospitalised SCI patients. A randomised, placebo-controlled study is needed to confirm this apparent therapeutic success in order to translate into improved clinical outcomes.
Ion beam synthesis of CoSi2 layers in Si by MEVVA (Metal Vapor Vacuum Arc) implantation has been performed under various conditions. The formation and characteristics of these CoSi2 layers have been studied by XTEM, RBS, AFM, X-ray diffraction, ellipsometry, electrical and Hall effect measurements. It was found that a higher substrate temperature during implantation results in an as-implanted Co distribution closer to the surface and hence the formation of a shallower CoSi2 layer after annealing. Buried CoSi2 layers of good crystal quality and low resistivity CoSi2 can be formed by MEVVA implantation and annealing under appropriate conditions. A strong temperature dependence of the Hall coefficient showing a large peak at around 100K was observed for the CoSi2 layers formed in p-type Si substrates but not in n-type substrates. The properties and their dependence on the processing conditions, in particular, the substrate temperature during implantation, are presented and discussed.
Thioredoxins (Trxs) are widely distributed, small proteins that function in redox regulation in a broad spectrum of cellular reactions. Experimental work with barley, wheat and a legume (Medicago truncatula) has established thioredoxin h (Trx h) as a central regulatory protein in seeds, reducing disulphide (S–S) groups of diverse seed proteins, including storage proteins, enzymes and enzyme inhibitors. Trxs appear to be particularly important in plants, as a large number of genes are present compared to mammalian organisms. In Arabidopsis thaliana there are approximately 20 different genes for classical Trxs, and large Trx gene families have also been found in cereals, such as rice, barley, wheat and sorghum. Extensive evidence indicates that adding Trx, reduced nicotinamide adenine dinucleotide phosphate (NADPH) and NADP-thioredoxin reductase (NTR) to cereal flour or seed preparations reduces disulphide (S–S) linkages of storage proteins. The early in vitro studies have been complemented with transgenic barley seed, overexpressing Trx h in protein bodies of the barley endosperm, which showed accelerated germination and early or enhanced expression of associated enzymes, i.e., α-amylase and pullulanase. Overexpression of Trx h levels in wheat was subsequently shown to (1) enhance protein solubility and digestibility, (2) reduce allergenicity of wheat gliadins, and (3) improve dough quality from poor-quality wheat flour. Most recently, we have demonstrated that down-regulation in wheat of Trx h9, a unique thioredoxin, leads to a reduction in the incidence of pre-harvest sprouting, demonstrated in several varieties over multiple generations with field-grown material. Yield and starch content were increased while baking quality in the high-gluten variety remained unchanged. These observations led to the intriguing question of how changes in the endosperm are communicated to the embryo. Studies of Trx h9, a membrane-associated Trx h that can move from cell to cell, provide suggestive evidence for a role of Trx h9 in intercellular communication of redox state.
Erbium atoms were implanted into p-type Si (111) wafers at an extraction
voltage of 60 kV to doses ranging from 5×1016 to
2×1017 cm−2 using a metal vapour vacuum arc (MEVVA)
ion source. The implantation was performed with beam current densities from
3 to 26 µA/cm2 corresponding to substrate temperatures ranging
from 85 to 245°C. The characterization of the as-implanted and annealed
samples was performed using Rutherford backscattering spectrometry, atomic
force microscopy and x-ray diffraction. To determine the sputtering yield,
masked implantation experiments were performed so that the thickness of the
sputtered layer at different substrate temperatures can be obtained directly
by an α-step surface profiler. The results showed that ErSi2-xwas
directly formed by MEVVA implantation when the substrate temperature was
higher than about 160°C. The effects of the implant dose and the beam
current density on the retained dose, the sputtering yield and the surface
morphology of the implanted samples were also studied.