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To explore whether and how group cognitive-behavioural therapy (GCBT) plus medication differs from medication alone for the treatment of generalized anxiety disorder (GAD).
170 patients were randomly assigned to the GCBT plus duloxetine (n=89) or duloxetine group (n=81). The primary outcomes were Hamilton Anxiety Scale (HAMA) response and remission rates. The explorative secondary measures included score reductions from baseline in the HAMA total, psychic and somatic anxiety subscales (HAMA-PA, HAMA-SA), the Hamilton Depression Scale (HAMD), the Severity Subscale of Clinical Global Impression Scale (CGI-S), Global Assessment Function (GAF), and the 12-item Short-Form Health Survey (SF-12). Assessments were conducted at baseline, 4-weeks, 8-weeks and 3-monthsfollow-up.
At 4-weeks, HAMA response (GCBT group 57.0% vs. control group 24.4%, p=0.000, Cohen d=0.90) and remission rates (GCBT group 21.5%vs. control group 6.2%, p=0.004; d=0.51), and most secondary outcomes (all p<0.05, d=0.36-0.77) showed that the combined therapy was superior. At 8-weeks, all the primary and secondary significant differences found at 4-weeks were maintained with smaller effect sizes (p<0.05, d=0.32-0.48) . At 3-months follow-up, the combined therapy was only significantly superior in the HAMA total (p<0.045, d=0.43) and HAMA-PA score reductions (p<0.001, d=0.77). Logistic regression showed superiority of the combined therapy for HAMA response rates (OR=2.12, 95% CI 1.02-4.42, p=0.04); and remission rates (OR=2.80, 95% CI 1.27-6.16, p=0.01).
Compared with duloxetine alone, GCBT plus duloxetine showed significant treatment response for GAD over a shorter period of time, particularly for psychic anxiety symptoms, which may suggest GCBT was effective in changing cognitive style.
Schizophrenia is a complex mental disorder with high heritability and polygenic inheritance. Multimodal neuroimaging studies have also indicated that abnormalities of brain structure and function are a plausible neurobiological characterisation of schizophrenia. However, the polygenic effects of schizophrenia on these imaging endophenotypes have not yet been fully elucidated.
To investigate the effects of polygenic risk for schizophrenia on the brain grey matter volume and functional connectivity, which are disrupted in schizophrenia.
Genomic and neuroimaging data from a large sample of Han Chinese patients with schizophrenia (N = 509) and healthy controls (N = 502) were included in this study. We examined grey matter volume and functional connectivity via structural and functional magnetic resonance imaging, respectively. Using the data from a recent meta-analysis of a genome-wide association study that comprised a large number of Chinese people, we calculated a polygenic risk score (PGRS) for each participant.
The imaging genetic analysis revealed that the individual PGRS showed a significantly negative correlation with the hippocampal grey matter volume and hippocampus–medial prefrontal cortex functional connectivity, both of which were lower in the people with schizophrenia than in the controls. We also found that the observed neuroimaging measures showed weak but similar changes in unaffected first-degree relatives of patients with schizophrenia.
These findings suggested that genetically influenced brain grey matter volume and functional connectivity may provide important clues for understanding the pathological mechanisms of schizophrenia and for the early diagnosis of schizophrenia.
Information systems (IS) have facilitated workflow in the health care system for years. However, the utilization of IS in disaster medical assistance teams (DMATs) has been less studied.
In Taiwan, we started a program in 2008 to build up an information system, MEDical Assistance and Information Dashboard (MED-AID), to improve the capability and increase the efficiency of our national DMAT.
Method: The mission of our national DMAT was to provide acute trauma care and subacute outpatient care in the field after an emergency event (e.g., earthquakes). We built the IS through a user-oriented process to fit the need of the DMAT. We first analyzed the response work in the DMAT missions and reviewed the current paperwork. We evaluated the eligibility and effectiveness of the core functions of DMATs by experts in Taiwan and then developed the IS. The IS was then tested and revised each year in two table-top exercises and one regional full-scale exercise by the DMAT staffs who came from different hospitals in Taiwan.
During the past 10 years, we identified several core concepts of IS of DMAT: patient tracking, medical record, continuity of care, integration of referral resources, disease surveillance, patient information reporting, and medical resources management. The application of the IS facilitate the DMAT in providing safe patient care with continuous recording and integrate patient referral resources based on geographic information. The IS also help the planning in real-time disease surveillance and logistic function in the medical resources monitoring.
Information systems could facilitate patient care and relieve the workload on information analysis and resources management for DMATs.
In this paper, we first derive the CR volume doubling property, CR Sobolev inequality, and the mean value inequality. We then apply them to prove the CR analogue of Yau’s conjecture on the space consisting of all pseudoharmonic functions of polynomial growth of degree at most
in a complete noncompact pseudohermitian
-manifold. As a by-product, we obtain the CR analogue of the volume growth estimate and the Gromov precompactness theorem.
In several lately published studies, the association between single-nucleotide polymorphism (SNP, rs12252) of IFITM3 and the risk of influenza is inconsistent. To further understand the association between the SNP of IFITM3 and the risk of influenza, we searched related studies in five databases including PubMed published earlier than 9 November 2017. Ten sets of data from nine studies were included and data were analysed by Revman 5.0 and Stata 12.0 in our updated meta-analysis, which represented 1365 patients and 5425 no-influenza controls from four different ethnicities. Here strong association between rs12252 and influenza was found in all four genetic models. The significant differences in the allelic model (C vs. T: odds ratio (OR) = 1.35, 95% confidence interval (CI) (1.03–1.79), P = 0.03) and homozygote model (CC vs. TT: OR = 10.63, 95% CI (3.39–33.33), P < 0.00001) in the Caucasian subgroup were discovered, which is very novel and striking. Also novel discoveries were found in the allelic model (C vs. T: OR = 1.37, 95% CI (1.08–1.73), P = 0.009), dominant model (CC + CT vs. TT: OR = 1.48, 95% CI (1.08–2.02), P = 0.01) and homozygote model (CC vs. TT: OR = 2.84, 95% CI (1.36–5.92), P = 0.005) when we compared patients with mild influenza with healthy individuals. Our meta-analysis suggests that single-nucleotide T to C polymorphism of IFITM3 associated with increasingly risk of severe and mild influenza in both Asian and Caucasian populations.
The present study aim to explore temporal–spatial patterns of water use (WU) efficiency and its influencing factors of maize production in China during 1998–2010. WU and productivity (WP) were quantified by taking irrigation loss into account and the links between WP and nine selected indicators were revealed by the partial least squares regression (PLSR) model. Results showed that national WU and WP in maize production were 138.56 cubic gigametres (Gm3; 0.755 green and 0.245 blue) and 1.079 kg/m3, respectively. WP was enhanced in the present study due to an increase in irrigated crop yield. Provinces located in the middle–lower part of the Yellow River had high proportions of green water and WP, while high proportions of irrigation water and low WP were found in Northwest China. The dosage of pesticides per unit area, relative humidity, average temperature and precipitation were the dominant factors that affected WP. However, the relationships between WP and solar radiation, fertilizer, agricultural machinery power, irrigation proportion and irrigated efficiency were not significant. Findings of the present research may also provide a reference for regional agricultural water management.
There are abundant data on secular trends in BMI; however, information on the change in subcutaneous fat is limited. The present study examined the trends in the prevalence of elevated skinfold thickness among children and adolescents over the past 19 years (1995–2014) in Shandong Province, China.
Data for the study were obtained from two cross-sectional surveys of schoolchildren carried out in 1995 and 2014. Triceps and subscapular skinfold thicknesses (SFT) of all participants were measured. The sum of triceps and subscapular SFT (SSFT) was applied. Children and adolescents with SSFT above or equal to the national age- and sex-specific 85th percentile were defined as ‘high SFT’.
Shandong Province, China.
A total of 16 917 students aged 7–18 years were included.
For both boys and girls, an increasing trend in ‘high SFT’ was observed between 1995 and 2014. The overall prevalence of ‘high SFT’ increased from 10·31 % for boys and 13·40 % for girls in 1995 to 33·94 % for boys and 29·30 % for girls in 2014 (P<0·01).
There are more children and adolescents with very high levels of SFT. These trends describe very unfavourable changes in the body composition and should give cause for concern.
Benhabib and Farmer show that in a laissez-faire one-sector real business cycle model under aggregate increasing returns, under sufficiently high degrees of productive externality, the demand-side effect in the labor market triggered by agents' expectations about the economy's future outweighs the supply-side effect, making agents' expectations become self-fulfilling. This paper analytically demonstrates that the conduct of monetary policy under nominal gross domestic product (GDP) targeting reinforces the supply-side effect in the labor market, thereby making belief-driven aggregate fluctuations more difficult to occur. This reinforcement effect on labor supply is absent under nominal consumption targeting and inflation targeting. Hence, under these two monetary regimes, the necessary and sufficient conditions for the economy to display equilibrium indeterminacy and sunspot fluctuations are identical to those in Benhabib and Farmer's laissez-faire economy. The results are robust to an endogenous growth extension of the model, implying that targeting the nominal GDP growth rate is more desirable than targeting the nominal consumption growth rate or the inflation rate in terms of macroeconomic stability.
Background: Among patients with schizophrenia, there is evidence of a negative association between self-stigma and subjective quality of life (SQoL), and self-esteem was an important mediator in the association. We attempted to use a longitudinal study to investigate the aforementioned mediation on a sample with schizophrenia. Methods: We used longitudinal data retrieved from medical records of a psychiatric centre between June 2014 and December 2015. In the data, we retrieved information of self-stigma using the Self-Stigma Scale — Short; SQoL, using the WHO questionnaire on the Quality of Life — Short Form; and self-esteem, using the Rosenberg Self-Esteem Scale. All the measures were evaluated five times. Linear mixed-effect models accompanied by Sobel tests were used to tackle the mediating effects. Results: Data from 74 patients (57 males) with schizophrenia were eligible for analysis; their mean (SD) age was 39.53 (10.67); mean age of onset was 22.95 (8.38). Self-esteem was a mediator for patients in physical (p = .039), psychological (p = .003), and social SQoL (p = .004), but not in environment SQoL (p = .051). Conclusion: Based on our findings, mental health professionals could tailor different programs to patients with schizophrenia, such as self-stigma reduction and self-esteem improvement programs. However, treatment as a whole should be sensitive to both self-stigma and self-esteem. Also, we should consider individuals’ health and wellbeing from social perspectives of disability rather than the medical model of disability emphasising symptoms and medications.
Late Carboniferous magmatism in the Chinese Altai provides an important view of geodynamic processes active during crustal growth in the Central Asian Orogenic Belt (CAOB). In this study, five representative peraluminous granite plutons from the Chinese Altai were selected for systematic geochronological, geochemical and Sr–Nd–Hf isotopic analyses (Table 1). These granites were emplaced between 449 and 327 Ma in an active subduction zone, and have moderate to high SiO2 (66.54–76.13 wt%), moderate Na2O+K2O (6.27–7.66 wt%), and high Al2O3 contents (12.43–16.18 wt%). All granite samples in this study showed significant decoupling of the Nd and Hf isotope systems. Results show negative εNd(t) values (−3.3 to −0.9), and predominantly positive εHf(t) values (+0.24 to +8.01, n=57) except for a few negative εHf(t) values (−7.44 to −0.03, n=9), high Mg# values (28.69–53.33), high Nd/Hf ratios (4.26–43.57), and enrichment of large-ion lithophile elements (LILEs; e.g. Pb, Th, and U), suggesting that the granites were derived from the partial melting of oceanic sediments and the associated mantle wedge, with fractionation of plagioclase, K-feldspar and biotite. In situ zircon Hf isotopic analyses yield negative εHf(t) values from −30.6 to −13.7 for the zircon xenocrysts. The U–Pb ages and Hf isotopic ratios of these zircon xenocrysts were probably inherited from oceanic sediments. Zircon saturation temperatures suggest that these peraluminous granites were emplaced at 537–765°C. We propose that: (1) the Nd isotopic system more faithfully reflects the source of peraluminous magmas in the Chinese Altai than the Hf isotopic system, and (2) the oceanic sediment recycling was an important process during continental growth in the CAOB.
This paper examines the relationships of income with education and health using heterogeneous panel cointegration techniques to account for the potential cross-country heterogeneity in the effects of education and health. Our main results are: (i) education and health are, on average, income-enhancing; (ii) for different schooling levels, although primary education lowers income, both secondary and tertiary education raise income with larger impacts for the former than the latter, on average; (iii) there is considerable heterogeneity in the effects of education and health on income across countries; and (iv) the effect of education (health) on income tends to be greater (smaller) in countries with higher levels of development, greater (less) trade openness, less abundant natural resources, less corruption, higher levels of democracy, and a more homogeneous society.
China's trade with Taiwan has a political motive: winning the hearts and minds of the Taiwanese people. The effectiveness of China's economic statecraft can be examined in the Syuejia (Xuejia) case, where Taiwan put up strong resistance to the generous benefits offered by China. This article investigates the political implications of the Chinese-designed contract farming programme in Syuejia and argues that if economic favours are delivered, and positive impressions also created, political attitudes can be revised. Without these two prerequisites, however, replicating the Syuejia results elsewhere and thus disturbing the cross-Strait status quo will be difficult. When put in a theoretical context, the changes in the political landscape of Syuejia illustrate the interplay of economic interests and political identity.
Ralstonia pickettii has caused contamination of pharmaceutical solutions in many countries, resulting in healthcare infections or outbreak events. We determined the source of the outbreak of R. pickettii bloodstream infection (BSI).
This study was conducted in a 3,000-bed tertiary referral medical center in Taiwan with >8,500 admissions during May 2015. Patients had been treated in the injection room or chemotherapy room at outpatient departments, emergency department, or hospital wards. All patients who were culture positive for R. pickettii from May 3 to June 11, 2015, were eligible for the study. The aim of the survey was to conduct clinical epidemiological and microbiological investigations to identify possible sources of infection.
We collected 57 R. pickettii–positive specimens from 30 case patients. We performed 24 blood cultures; 14 of these revealed >2 specimens and 6 used fluid withdrawn from Port-a-Cath implantable venous access devices. All patients received an injection of 20 mL 0.9% normal saline via catheter flushing. In addition, 2 unopened ampules of normal saline solution (20 mL) were confirmed positive for R. pickettii. The Taiwan Centers for Disease Control and Prevention performed sampling and testing of the same manufactured batch and identified the same strain of R. pickettii. Pulsed-field gel electrophoresis tests revealed that all clinical isolates had similarity of >90%, validating the outbreak of the same clone of R. pickettii.
R. pickettii can grow in saline solutions and cause bloodstream infections. Hospital monitoring mechanisms are extremely important measures in identifying and ending such outbreaks.
The objectives of this study were (1) to evaluate the measurement structure of the Perceived Empathic and Social Self-Efficacy Scale amongst 194 individuals with serious mental illness (SMI) and (2) to establish construct validity for the Perceived Empathic and Social Self-Efficacy Scale. Confirmatory factor analysis yielded a two-factor measurement structure of the Perceived Empathic and Social Self-Efficacy Scale, which was positively associated with insight, social support, and life satisfaction. The Perceived Empathic and Social Self-Efficacy Scale is a useful measure to assess social skills amongst individuals with SMI in rehabilitation counselling.
In this paper, an asymmetric coplanar strip (ACS)-fed quad-band monopole antenna for the global positioning system (GPS), wireless local area network (WLAN), and worldwide interoperability for microwave access (WiMAX) applications is proposed. It is composed of an F-shaped monopole and a partial ground plane, which are both printed on one side of a low-cost FR4 substrate with a compact volume of 40 × 20 × 1.6 mm3. By cutting an open-ended Γ-shaped slot into the F-shaped monopole, four distinct resonant modes are successfully generated. The design process, especially the geometrical configuration of the critical Γ-shaped slot is studied in detail. The proposed antenna has been fabricated and experimental results show that the −10 dB impedance bandwidth can fully cover the 1.575-GHz GPS (1.57–1.59 GHz), 2.4/5.2/5.8-GHz WLAN (2.4–2.485, 5.15–5.35, and 5.725–5.825 GHz), and 2.5/3.5/5.5-GHz WiMAX (2.50–2.69, 3.30–3.70, and 5.25–5.85 GHz) applications with nearly omni-directional radiation patterns and satisfactory gains.
In this paper, a simplified lattice Boltzmann method (SLBM) without evolution of the distribution function is developed for simulating incompressible viscous flows. This method is developed from the application of fractional step technique to the macroscopic Navier-Stokes (N-S) equations recovered from lattice Boltzmann equation by using Chapman-Enskog expansion analysis. In SLBM, the equilibrium distribution function is calculated from the macroscopic variables, while the non-equilibrium distribution function is simply evaluated from the difference of two equilibrium distribution functions. Therefore, SLBM tracks the evolution of the macroscopic variables rather than the distribution function. As a result, lower virtual memories are required and physical boundary conditions could be directly implemented. Through numerical test at high Reynolds number, the method shows very nice performance in numerical stability. An accuracy test for the 2D Taylor-Green flow shows that SLBM has the second-order of accuracy in space. More benchmark tests, including the Couette flow, the Poiseuille flow as well as the 2D lid-driven cavity flow, are conducted to further validate the present method; and the simulation results are in good agreement with available data in literatures.
Annual bluegrass is a weed species in turfgrass environments known for exhibiting resistance to multiple herbicide modes of action, including photosystem II (PSII) inhibitors. To evaluate populations of annual bluegrass for susceptibility to PSII inhibitors of varied chemistries, populations were treated with herbicides from triazolinone, triazine, and substituted urea families: amicarbazone, atrazine, and diuron, respectively. Sequencing of the psbA gene confirmed the presence of a Ser264 to Gly amino acid substitution within populations that exhibited resistance to both atrazine and amicarbazone. A single biotype, DR3, which lacked any previously reported psbA gene point mutation, exhibited resistance to diuron, atrazine, and amicarbazone. DR3 had a significantly lower rate of absorption and translocation of atrazine and had enhanced atrazine metabolism when compared with both the Ser264 to Gly resistant mutant and susceptible biotypes. We thus report possible nontarget mechanisms of resistance to PSII-inhibiting herbicides in annual bluegrass.
A novel small embedded long-term evolution/wireless wide area network (LTE/WWAN) antenna integrated with the keyboard ground plane in a laptop computer is presented. The antenna is installed on a notched region (40 × 8 mm2) of the keyboard ground plane at a distance of 10 mm from the laptop computer hinge. A coupled-fed loop antenna was used because of its suitability for integration with the ground plane and achieving wide operating bands. This antenna can not only be configured to have a compact configuration but also be designed to excite several resonant modes of the hinge slot between the display ground plane and the keyboard ground plane. The proposed antenna comprises a hook-shaped strip and a shorted strip, which together form a coupled-fed loop that not only has a compact size when printed on a 0.8-mm-thick FR4 substrate 40 × 8 mm2 in size but also provides eight-band LTE/WWAN operation. The proposed antenna can cover LTE/WWAN operation in the 698–960 and 1710–2690 MHz bands. Details of the antenna structure are provided here. The proposed antenna was fabricated and tested, and measurement and simulation results are presented. The measured antenna efficiency was approximately 45–80% in the lower band and approximately 52–75% in the upper band.
The increasing demand for high-data rate communications in the connected world imposes various challenges in analog and radio frequency (RF) circuits. Although continued scaling in advanced processes offers faster devices, it is accompanied by increasing complexity in circuit design and layout strategy, resulting in diminishing benefits for analog/RF circuits. In order to enable new breakthroughs in speed, cost, and power efficiency, simplifying analog/RF circuits with the assistance of signal processing is becoming a clear trend. This paper provides an overview of this trend by reviewing the signal processing algorithms commonly deployed in wireless communications, data converters, and wired data links. The discussion covers design considerations, as well as algorithms used to compensate for circuit imperfections, so as to demonstrate the cross-discipline interactions between signal processing and analog/RF circuit design.