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Many family characteristics were reported to increase the risk of bipolar disorder (BPD). The development of BPD may be mediated through different pathways, involving diverse risk factor profiles. We evaluated the associations of family characteristics to build influential causal-pie models to estimate their contributions on the risk of developing BPD at the population level. We recruited 329 clinically diagnosed BPD patients and 202 healthy controls to collect information in parental psychopathology, parent-child relationship, and conflict within family. Other than logistic regression models, we applied causal-pie models to identify pathways involved with different family factors for BPD. The risk of BPD was significantly increased with parental depression, neurosis, anxiety, paternal substance use problems, and poor relationship with parents. Having a depressed mother further predicted early onset of BPD. Additionally, a greater risk for BPD was observed with higher numbers of paternal/maternal psychopathologies. Three significant risk profiles were identified for BPD, including paternal substance use problems (73.0%), maternal depression (17.6%), and through poor relationship with parents and conflict within the family (6.3%). Our findings demonstrate that different aspects of family characteristics elicit negative impacts on bipolar illness, which can be utilized to target specific factors to design and employ efficient intervention programs.
This chapter provides the reader with a succinct review surround the issues with uncontrolled pain and provides methods for non-pharmacologic treatment in children. The chapter discusses the sequalae of untreated pain and provides the reader with a detailed explanation of the theory behind distraction techniques. The various distraction techniques are discussed based on age appropriate selection.
In this paper, we develop the isogeometric analysis of the dual boundary element method (IGA-DBEM) to solve the potential problem with a degenerate boundary. The non-uniform rational B-Spline (NURBS) based functions are employed to interpolate the geometry and physical function. To deal with the rank-deficiency problem due to the degenerate boundary, the hypersingular integral equation is introduced to promote the full rank for the influence matrix in the dual BEM. Finally, three numerical examples are given to verify the accuracy of our proposed method. Both circular and square domains subjected to the Dirichlet boundary condition are considered. The engineering problem containing a degenerate boundary is considered, e.g., a seepage flow problem with a sheet pile. Numerical results of the IGA-DBEM agree well with these of the exact solution and the original dual boundary element method.
Disease surveillance can be made more effective by either improving disease detection, providing cost savings, or doing both. Currently, cattle herds in low-risk areas (LRAs) for bovine tuberculosis (bTB) in England are tested once every 4 years. In Scotland, the default herd testing frequency is also 4 years, but a risk-based system exempts some herds from testing altogether. To extend this approach to other areas, a bespoke understanding of at-risk herds and how risk-based surveillance can affect bTB detection is required. Here, we use a generalized linear mixed model to inform a Bayesian probabilistic model of freedom from infection and explore risk-based surveillance strategies in LRAs and Scotland. Our analyses show that in both areas the primary herd-level risk factors for bTB infection are the size of the herd and purchasing cattle from high-risk areas of Great Britain and/or Ireland. A risk-based approach can improve the current surveillance system by both increasing detection (9% and 7% fewer latent infections), and reducing testing burden (6% and 26% fewer animal tests) in LRAs and Scotland, respectively. Testing at-risk herds more frequently can also improve the level of detection by identifying more infected cases and reducing the hidden burden of the disease, and reduce surveillance effort by exempting low-risk herds from testing.
Plasmodium knowlesi is increasingly recognized as a major cause of malaria in Southeast Asia. Anopheles leucosphyrous group mosquitoes transmit the parasite and natural hosts include long-tailed and pig-tailed macaques. Despite early laboratory experiments demonstrating successful passage of infection between humans, the true role that humans play in P. knowlesi epidemiology remains unclear. The threat posed by its introduction into immunologically naïve populations is unknown despite being a public health priority for this region. A two-host species mathematical model was constructed to analyse this threat. Global sensitivity analysis using Monte Carlo methods highlighted the biological processes of greatest influence to transmission. These included parameters known to be influential in classic mosquito-borne disease models (e.g. vector longevity); however, interesting ecological components that are specific to this system were also highlighted: while local vectors likely have intrinsic preferences for certain host species, how plastic these preferences are, and how this is shaped by local conditions, are key determinants of parasite transmission potential. Invasion analysis demonstrates that this behavioural plasticity can qualitatively impact the probability of an epidemic sparked by imported infection. Identifying key vector sub/species and studying their biting behaviours constitute important next steps before models can better assist in strategizing disease control.
The public health threat posed by zoonotic Plasmodium knowlesi appears to be growing: it is increasingly reported across South East Asia, and is the leading cause of malaria in Malaysian Borneo. Plasmodium knowlesi threatens progress towards malaria elimination as aspects of its transmission, such as spillover from wildlife reservoirs and reliance on outdoor-biting vectors, may limit the effectiveness of conventional methods of malaria control. The development of new quantitative approaches that address the ecological complexity of P. knowlesi, particularly through a focus on its primary reservoir hosts, will be required to control it. Here, we review what is known about P. knowlesi transmission, identify key knowledge gaps in the context of current approaches to transmission modelling, and discuss the integration of these approaches with clinical parasitology and geostatistical analysis. We highlight the need to incorporate the influences of fine-scale spatial variation, rapid changes to the landscape, and reservoir population and transmission dynamics. The proposed integrated approach would address the unique challenges posed by malaria as a zoonosis, aid the identification of transmission hotspots, provide insight into the mechanistic links between incidence and land use change and support the design of appropriate interventions.
Metal organic chemical vapor deposition, as well as material and basic device properties of nitride-based high electron mobility transistor structures on (111) silicon substrates varying in diameter from 4 to 8 inch were studied using in-situ and ex-situ characterization techniques. All substrates used for the growth of the nitride structures in this study were of SEMI standard thicknesses. The total thickness of the nitride structures was in the range of 1.5 – 5 µm. It is reported that nitride structures can be grown on 4, 6 and 8 inch diameter substrates with very similar post-growth wafer shape, material and device characteristics. It is also shown that their crystal quality, 2DEG transport properties and isolation blocking voltages can be improved by increasing nitride structure thickness while maintaining post-growth wafer bow and warp less than 50 µm. The maximum thickness of nitride structures that can be successfully grown on 8 inch diameter SEMI standard substrates seems to be limited to about 4.5 µm due to plastic deformation of Si. Blocking voltages of more than 700 V were achieved using 4.5 µm thick nitride-based high electron mobility transistor structures grown on 8 inch Si substrate.
Although the compartmentalization of poultry industry components has substantial economic implications, and is therefore a concept with huge significance to poultry industries worldwide, the current requirements for compartment status are generic to all OIE member countries. We examined the consequences for potential outbreaks of highly pathogenic avian influenza in the British poultry industry using a metapopulation modelling framework. This framework was used to assess the effectiveness of compartmentalization relative to zoning control, utilizing empirical data to inform the structure of potential epidemiological contacts within the British poultry industry via network links and spatial proximity. Conditions were identified where, despite the efficient isolation of poultry compartments through the removal of network-mediated links, spatially mediated airborne spread enabled spillover of infection with nearby premises making compartmentalization a more ‘risky’ option than zoning control. However, when zoning control did not effectively inhibit long-distance network links, compartmentalization became a relatively more effective control measure than zoning. With better knowledge of likely distance ranges for airborne spread, our approach could help define an appropriate minimum inter-farm distance to provide more specific guidelines for compartmentalization in Great Britain.
Biological parents pass on genotypes to their children, as well as provide home environments that correlate with their genotypes; thus, the association between the home environment and children's temperament can be genetically (i.e., passive gene–environment correlation) or environmentally mediated. Furthermore, family environments may suppress or facilitate the heritability of children's temperament (i.e., gene–environment interaction). The sample comprised 807 twin pairs (mean age = 7.93 years) from the longitudinal Wisconsin Twin Project. Important passive gene–environment correlations emerged, such that home environments were less chaotic for children with high effortful control, and this association was genetically mediated. Children with high extraversion/surgency experienced more chaotic home environments, and this correlation was also genetically mediated. In addition, heritability of children's temperament was moderated by home environments, such that effortful control and extraversion/surgency were more heritable in chaotic homes, and negative affectivity was more heritable under crowded or unsafe home conditions. Modeling multiple types of gene–environment interplay uncovered the complex role of genetic factors and the hidden importance of the family environment for children's temperament and development more generally.
Due to its substantially lower prevalence of bovine tuberculosis (bTB) relative to other areas of Great Britain, Scotland was designated as an officially (bovine) TB-free region in 2009. This paper investigates resultant possibilities for reducing surveillance by developing risk-based alternatives to current 4-year testing of eligible herds. A model of freedom of infection was used to develop strategies that specifically tested herds that are at risk of infection but would probably not be identified by slaughterhouse meat inspection. The performance of current testing is mimicked by testing all herds that slaughter fewer than 25% of their total stock per year and regularly import animals from high-incidence areas of England and Wales or from Ireland. This system offers a cost reduction by requiring 25% fewer herd and animal tests and 25% fewer false positives.
This paper presents the flow structure under a partially inundated bridge deck measured by using particle image velocimetry (PIV) and flow visualization techniques. The approaching flow was subcritical having Froude number F in the range 0.12 ∼ 0.55. The proximity ratio Pr (= ratio of clearance below the bridge deck h to the total depth of deck D) was varied from 0.57 to 2. Depending upon the Froude number F and proximity ratio Pr, four types of flow structures under the bridge deck were recognized. In flow Type I, the water surface elevation on the downstream side of bridge deck is slightly lower than the counterpart on the upstream side, and the shear layer formed at the bottom of upstream girder continuously fluctuates and touches soffit of all girders. In the case of flow Type II, the water surface on downstream side of bridge deck is lower than that on the upstream side and the shear layer originating from the upstream girder impinges near the third cavity between girders. However, in both the cases, the cavities between the girders are completely occupied by vortices. On the contrary, in the cases of flow Type III and flow Type IV, the flow is separated from the upstream girder edge. However, in flow Type III, the separated flow impinges on successive girders and cavities are partially filled by water; while in flow Type IV, the flow is totally separated from the deck bottom like orifice flow. The phenomena of vortex formation within the cavities are discussed for the cases of flow Type I and flow Type II. Also, for the vertical distribution of mean streamwise velocity in the shear layer below bridge deck, the nonlinear regression equations are developed. Using the distributions of measured mean streamwise velocity within the shear layer below the bridge deck at different streamwise distances, the similarity profile is obtained. The mean velocity deficit (usl – usu) and representative thickness bs are considered as the appropriate characteristic velocity and length scales for developing similarity profile. The proposed characteristic scales provided unique similarity profiles having promising regression coefficient. The similarity profile proposed is suitable for more general case of bridge deck having different bridge girders and even for rectangular block without girder. Further, the turbulence characteristics for the flow below the bridge deck are also presented.
Suicide rates vary widely across nations and ethnic groups. This study aims to explore potential factors contributing to inter-ethnic differences in suicide rates.
Study subjects came from a case-control psychological autopsy study conducted in Taiwan, including 116 consecutive suicides from two aboriginal groups and Taiwanese Han; 113 of them each matched with two living controls. Gender-, age- and method-specific suicide rates, population attributable fraction (PAF) of suicide for five major risk factors, help-seeking before suicide and emergency medical aid after suicide were compared between the three ethnic groups.
One aboriginal group (the Atayal) had significantly higher adjusted rate ratios (RR) of suicide than the other aboriginal group (the Ami) [RR 0.20, 95% confidence intervals (CI) 0.12–0.34] and the Han (RR 0.26, 95% CI 0.16–0.40). Such differences can be explained by higher PAFs of suicide for three major risk factors (substance dependence, PAF 47.6%, 95% CI 25.5–64.2; emotionally unstable personality disorder, PAF 52.7%, 95% CI 32.8–69.0; family history of suicidal behaviour, PAF 43.5%, 95% CI 23.2–60.2) in this group than in the other two groups. This higher suicide rate was substantially reduced from 68.2/100 000 per year to 9.1/100 000 per year, comparable with the other two groups, after stepwise removal of the effects of these three risk factors. Suicide rates by self-poisoning were also significantly higher in this group than in the other two groups.
Higher rates of specific risk factors and use of highly lethal pesticides for suicide contributed to the higher suicide rate in one ethnic group in Taiwan. These findings have implications for developing ethnicity-relevant suicide prevention strategies.
In this paper, simple techniques were proposed to fabricate germanium nanocrystal capacitors by one-step thermal oxidation and/or rapid thermal annealing on polycrystalline-SiGe (poly-SiGe) deposited with a LPCVD (low pressure chemical vapor deposition) system. This thermal oxidation method can directly result in the top-control oxide layer via the oxidation of amorphous-Si film and the formation of Ge nanocrystals from the poly-SiGe film. Otherwise, the rapid thermal annealing method can be also used to form Ge nanocrystals as comparison.
Bovine Brucellosis is a widespread, economically devastating and highly infectious zoonosis caused by Brucella abortus. In cattle it causes premature abortion around five to seven months into the normal nine month gestation and the disease can be transferred to humans through milk. Great Britain (GB) has been “Officially Brucellosis Free” (OBF) since 1991 and it is in the country’s best interest to maintain this status. There have been three reintroductions of the disease since 2003, the most recent in a beef herd in Cornwall 2004 (DEFRA, 2004). Such outbreaks threaten the UK’s OBF status. By identifying epidemiological risk factors and using data from the Cattle Tracing Scheme for GB (CTS) we examined the spatial and temporal patterns of births for both the whole of GB and the South West region in particular and used this information to identify risk periods due to cattle births. Then cattle movements originating from, or ending in Cornwall (the location of the last outbreak) were identified from the CTS database. A subset of 57 000 high-risk, potentially infectious, moves were identified and examined to establish the potential spatial spread of the disease from these movements.
The value of computational fluid dynamics, CFD, delivered to date has mainly been related to its application to high-speed cruise design. To increase its applicability CFD must apply to the full flight envelope frequently characterised by large regions of separated flows. These flows are encountered by transport aircraft at low speed with deployed high lift devices, at their structural design loads conditions, or subjected to in-flight upsets that expose them to speed and/or angle-of-attack conditions outside the envelope of normal flight conditions to name a few. Such flows can only be characterised by the Navier-Stokes equations. This paper will report the progress toward CFD for full flight envelope. The CFD methods in use at Boeing will be described. Examples presented will address high-lift, loads and stability and control concerns including Reynolds scaling from wind tunnel to flight, vortex generator simulation, spoiler and horizontal tail effectiveness. In general, results shown are in ‘good enough’ agreement with experimental data. Deficiencies and the need for further algorithm and process improvement are noted. The need for automation to enable the large scale use of CFD will also be discussed.
The annual incidence of typhoid fever in Taiwan was 2·1–3·6 cases per 1000000 population from 1995 to 2002. More than 80% of 45 patients with typhoid fever treated at National Taiwan University Hospital from 1996 to 2002 had elevated serum aminotransferase levels at presentation. Ten of these patients were treated during an outbreak in Taipei County in 2002, and seven of them who did not have pre-existing liver disease developed hepatitis, which was unrelated to other aetiologies. All Salmonella typhi isolates were susceptible to extended-spectrum cephalosporins and fluoroquinolones. Multidrug resistance (intermediate resistance to ampicillin, trimethoprim–sulphamethoxazole, and chloramphenicol) was found in one (2·5%) of the 40 isolates studied. Pulsed-field gel electrophoresis analysis demonstrated a high genetic diversity among S. typhi isolates and identified a novel clone associated with the 2002 outbreak. Physicians should be alert to the possibility of typhoid fever when patients, without other gastrointestinal symptoms, present with sustained fever and hepatitis.
White Sn (β-Sn) thin film stripe shows a voltage drop about 10% when subjected to electromigration testing. Since β-Sn has anisotropic crystal structure, it possesses different resistivity along a-, b- and c axis. The direction of the axes determines the resistance in each grain. Under electromigration, low resistance grain tends to grow in the expense of the neighboring high resistance grains. The changes of grain orientation in the Sn stripe before and after electromigration was studied by synchrotron x-ray microdiffraction (∼1νm diameter) to achieve grain-by-grain analysis. Grain growth involves grain boundary migration and rotation of neighboring high resistance grains. A model different from normal grain growth is proposed to describe the condition and mechanism of microstructural evolution under electromigration.