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Doctors working in a tertiary psychiatric hospital will have to treat acute medical ailments e.g. hypotension, seizures, in addition to psychiatric conditions. In our setting, doctors on call duty will attend to acute medical conditions for the psychiatric inpatients and decide which cases need a referral out for further treatment at the medical emergency department.
To investigate the sentiments of medical officers working in a tertiary psychiatric hospital with regards to management of acute medical conditions.
An anonymous online survey was sent to 67 medical officers working in a tertiary psychiatric hospital to explore their sentiments with regards to managing acute medical conditions whilst on call duty. 3 of the questions were 'Do you feel confident managing acute medical conditions?”, 'Would you be more inclined to refer a patient out for medical treatment if he/she wasn’t from your own ward.” and 'I feel unsure managing medical conditions of patients not directly under my care.”
39 (58%) medical officers completed the survey. 72% felt confident about managing acute medical conditions. 51% felt unsure managing medical conditions of patients not directly under their care whilst 62% would be more inclined to refer such patients out.
Most medical officers working in our tertiary psychiatry hospital feel confident about managing acute medical conditions. The confidence drops however if the patients were not under their direct care prior to the call duty and they would be more inclined to refer such patients to the medical emergency department for treatment.
The present study compared the expression profile and made the classification with the leukocytes by using whole-genome cRNA microarrays among patients with SSD, major depressive disorder (MDD) and healthy controls.
Gene expression profiling was conducted in peripheral blood leucocytes from drug-free first-episode subjects with SSD, MDD, and matched controls (8 subjects in each group) using global mRNA expression arrays. Support vector machines (SVMs) were utilized for training and testing on candidate signature expression profiles from signature selection step.
We identified SSD and MDD gene signatures from blood-based gene expression profile and build a SSD- MDD disorder model with higher predictive power. Firstly, we identified 63 differentially expressed SSD signatures in contrast to control (P <= 5.0E-4) and 30 differentially expressed MDD signatures in contrast to control, respectively. Then, 123 gene signatures were identified with significantly differential expression level between SSD and MDD. Secondly, in order to conduct priority selection for biomarkers for SSD and MDD together, we selected top gene signatures from each group of pair-wise comparison results, and merged the signatures together to generate better profiles used for clearly classify SSD and MDD sets in the same time. In details, we tried different combination of signatures from the three pair-wise compartmental results and finally determined 48 gene expression signatures with 100% accuracy.
Blood cell-derived RNA may have significant value for performing diagnostic functions and identifying disease biomarkers in SSD and MDD. These 48 gene model could classify SSD, MDD, and healthy controls.
Alpine glaciers are valuable archives for the reconstruction of human impact on the environment. Besides dating purposes, measurement of radiocarbon (14C) content provides a powerful tool for long-term source apportionment studies on the carbonaceous aerosols incorporated in ice cores. In this work, we present an extraction system for 14C analyses of dissolved organic carbon (DOC) in ice cores. The setup can process ice samples of up to 350 g mass and offers ultra-clean working conditions for all extraction steps. A photo-oxidation method is applied by means of external UV irradiation of the sample. For an irradiation time of 30 min with catalyzation by addition of Fe2+ and H2O2, we achieve an efficiency of 96 ± 6% on average. Inert gas working conditions and stringent decontamination procedures enable a low overall blank of 1.9 ± 1.6 μg C with a F14C value of 0.68 ± 0.13. This makes it possible to analyze the DOC in ice samples with a carbon content of as low as 25 μg C kg−1 ice. For a first validation, the new method was applied to ice core samples from the Swiss Alps. The average DOC concentration and F14C values for the Fiescherhorn ice core samples show good agreement with previously reported data for the investigated period of 1925–1936 AD.
At present, the number of people with tuberculosis in China is second only to India and ranks second in the world. Under such a severe case of tuberculosis in China, prevention and control of pulmonary tuberculosis are urgently needed. This study aimed to study the temporal and geographical relevance of the pathogenesis of pulmonary tuberculosis and the factors affecting the incidence of tuberculosis. Spatial autocorrelation model was used to study the spatial distribution characteristics of pulmonary tuberculosis from a quantitative level. The research results showed that the overall incidence of pulmonary tuberculosis (IPT) in China was low in the east, high in the west and had certain seasonal characteristics. We use Spatial Lag Model to explore influencing factors of pulmonary tuberculosis. It indicates that the IPT is high in areas with underdeveloped economics, poor social services and low average smoking ages. Additionally, the IPT is high in areas with high AIDS prevalence. Also, compared with Classical Regression Model and Spatial Error Model, our model has smaller values of Akaike information criterion and Schwarz criterion. Besides, our model has bigger values of coefficient of determination (R2) and log-likelihood (log L) than the other two models. Apart from that, it is more significant than Spatial Error Models in the spatial dependence test for the IPT.
Many women experience both vasomotor menopausal symptoms (VMS) and depressed mood at midlife, but little is known regarding the prospective bi-directional relationships between VMS and depressed mood and the role of sleep difficulties in both directions.
A pooled analysis was conducted using data from 21 312 women (median: 50 years, interquartile range 49−51) in eight studies from the InterLACE consortium. The degree of VMS, sleep difficulties, and depressed mood was self-reported and categorised as never, rarely, sometimes, and often (if reporting frequency) or never, mild, moderate, and severe (if reporting severity). Multivariable logistic regression models were used to examine the bi-directional associations adjusted for within-study correlation.
At baseline, the prevalence of VMS (40%, range 13–62%) and depressed mood (26%, 8–41%) varied substantially across studies, and a strong dose-dependent association between VMS and likelihood of depressed mood was found. Over 3 years of follow-up, women with often/severe VMS at baseline were more likely to have subsequent depressed mood compared with those without VMS (odds ratios (OR) 1.56, 1.27–1.92). Women with often/severe depressed mood at baseline were also more likely to have subsequent VMS than those without depressed mood (OR 1.89, 1.47–2.44). With further adjustment for the degree of sleep difficulties at baseline, the OR of having a subsequent depressed mood associated with often/severe VMS was attenuated and no longer significant (OR 1.13, 0.90–1.40). Conversely, often/severe depressed mood remained significantly associated with subsequent VMS (OR 1.80, 1.38–2.34).
Difficulty in sleeping largely explained the relationship between VMS and subsequent depressed mood, but it had little impact on the relationship between depressed mood and subsequent VMS.
Previous studies showed that spermine could protect the organism from oxidative damage in vivo. However, in vivo information on the antioxidant-related underlying molecular mechanism of spermine is limited. In this experiment, we further evaluated the effects of spermine supplementation and extended spermine administration on the antioxidant status and antioxidant-related signaling molecules gene expression in the liver and longissimus dorsi of piglets. A total of 80 piglets were randomly distributed to two groups, that is, those with adequate nutrient intake administrated with spermine (0.4 mmol/kg BW) or those with restricted nutrient intake supplemented by saline. The piglets were fed in pairs for 7 h or 3, 6, or 9 days. The results are as follows: (1) spermine can promote the antioxidant capacity by increasing enzymatic antioxidant capacity, glutathione content and clearance of oxygen radicals; (2) spermine significantly increased the mRNA levels of enzymatic antioxidant substances, NF-E2-related nuclear factor 2, Kelch-like ECH-associated protein 1, and the mammalian target of rapamycin but decreased the mRNA levels of ribosomal p70 S6 kinase in the liver and longissimus dorsi of the piglets.
To explore the effects of maternal nutrition on offspring muscle characteristics, a total of 56 sows were assigned to one of the four dietary groups during gestation: control (CON), or control diets supplemented with methyl donor (MET), bisphenol A (BPA), and combined BPA and MET (BPA+MET). Compared with CON offspring, MET offspring showed a higher meat redness value, but lower glycogen content in the longissimus thoracis (LT). Moreover, compared with CON offspring, MET offspring showed lower LT glycogen synthase (GS) mRNA levels at birth and the finishing stage, and increased methylation at the GS promoter. Prenatal BPA exposure reduced the pH and redness value of meat, but increased the lightness value, lactate content, glycolytic potential and lactate dehydrogenase (LDH) enzyme activity in the LT muscle. Prenatal BPA exposure increased LDH mRNA levels in the LT muscle at birth and the finishing stage, and reduced methylation at the LDH promoter. Thus, maternal MET affects muscle GS and LDH expression via DNA methylation, thereby resulting in persistent effects on pork quality.
The tea green leafhopper, Empoasca vitis Göthe, is one of the most serious pests in tea growing areas. This study investigated the roles played by olfaction and vision in host orientation behavior. The compound eye of E. vitis was found to be a photopic eye; few olfactory sensilla were found on the antennae, while abundant gustatory sensilla were recorded on the mouthparts. Three opsin genes (EV_LWop, EV_UVop, EV_Bop) were isolated and found to be mainly expressed in the compound eye compared with other parts of the body. Immunolocalization indicated that the opsins mainly located in the different regions of rhabdom. The transcription levels of EV_LWop, EV_Bop and EV_UVop were reduced by 77.3, 70.0 and 40.0%, respectively, by RNA interference induced by being fed a special RNA-rich diet for 6 days. The rate of tropism to host color was effectively impaired by 67.6 and 29.5% in the dsEV_LWop and dsEV_Bop treatment groups, but there was no significant change in the dsEV_UVop group. The determination of the cause of the tropism indicated that odors from the host over long distances were unable to attract E. vitis and were only detected when the insects were close to the host. The developed compound eye of E. vitis plays a leading role in host location, and the long-wavelength opsin significantly affects the tropism to host color; the lack of olfactory sensilla results in long-distance odors not being able to be detected until the insect is near to the host-plant. The understanding of these behavioral mechanisms, especially the importance of opsin genes is expected to be useful for pest management.
The nearby triple star HIP 101955 with strongly inclined orbit still remains. Thus the long-term dynamical stability deserves to be discussed based on the new dynamical state parameters (component masses and kinematic parameters) derived from fitting the accurate three-body model to the radial velocity, the Hipparcos Intermediate Astrometric Data (HIAD), and the accumulated speckle and visual data. It is found that the three-body system remains integrated and most likely undergoes Kozai cycles. With the already accumulated high-precision data, the three-body effects cannot always be neglected in the determination of the dynamical state. And it is expected that this will be the general case under the available Gaia data.
Background: Few studies have tracked stroke survivors through transitions across the health system and identified the most common trajectories and quality of care received. The objectives of our study were to examine the trajectories that incident stroke patients experience and to quantify the extent to which their care adhered to the best practices for stroke care. Methods: A population-based cohort of first-ever stroke/transient ischemic attack (TIA) patients from the 2012/13 Ontario Stroke Audit was linked to administrative databases using an encrypted health card number to identify dominant trajectories (N=12,362). All trajectories began in the emergency department (ED) and were defined by the transitions that followed immediately after the ED. Quality indicators were calculated to quantify best practice adherence within trajectories. Results: Six trajectories of stroke care were identified with significant variability in patient characteristics and quality of care received. Almost two-thirds (64.5%) required hospital admission. Trajectories that only involved the ED had the lowest rates of brain and carotid artery imaging (91.5 and 44.2%, respectively). Less than 20% of patients in trajectories involving hospital admissions received care on a stroke unit. The trajectory involving inpatient rehabilitation received suboptimal secondary prevention measures. Conclusions: There are six main trajectories stroke patients follow, and adherence to best practices varies by trajectory. Trajectories resulting in patients being transitioned to home care following ED management only are least likely and those including inpatient rehabilitation are most likely to receive stroke best practices. Increased time in facility-based care results in greater access to best practices. Stroke patients receiving only ED care require closer follow-up by stroke specialists.
HBsAg reappearance may constitute not only a risk for liver disease but also an infectious source. We aimed to determine whether HBsAg may reappear after spontaneous HBsAg seroclearance. A cohort of 2999 HBsAg-positive subjects aged 30–55 years was recruited in Guangxi, China in 2004. HBsAg was tested every 6 months from July 2004 to June 2007, then, one more time in December 2013. The results showed that spontaneous HBsAg seroclearance occurred in 41 subjects in the first 3 years, giving a 0·54% annual seroclearance rate. Thirteen of the 41 subjects were randomly tested for HBsAg in 2013. Four subjects became HBsAg positive. S gene sequences of HBV were analysed from serum collected before seroclearance and after reappearance, respectively, for subject QS840 (11 and 12 clones), subject TN98 (13 and 13 clones) and subject WX227 (10 and 8 clones). Serotype, subgenotype and amino-acid substitution pattern in each sample collected after reappearance was observed in the sample collected before HBsAg seroclearance. Nucleotide similarity between the two sequences from each subject was >99% and five sequences from subject TN98 were the same. In conclusion, following reactivation, HBsAg may reappear in individuals with spontaneous HBsAg seroclearance many years previously.
Post-traumatic stress disorder (PTSD) is associated with elevated risk for metabolic syndrome (MetS). However, the direction of this association is not yet established, as most prior studies employed cross-sectional designs. The primary goal of this study was to evaluate bidirectional associations between PTSD and MetS using a longitudinal design.
A total of 1355 male and female veterans of the conflicts in Iraq and Afghanistan underwent PTSD diagnostic assessments and their biometric profiles pertaining to MetS were extracted from the electronic medical record at two time points (spanning ~2.5 years, n = 971 at time 2).
The prevalence of MetS among veterans with PTSD was just under 40% at both time points and was significantly greater than that for veterans without PTSD; the prevalence of MetS among those with PTSD was also elevated relative to age-matched population estimates. Cross-lagged panel models revealed that PTSD severity predicted subsequent increases in MetS severity (β = 0.08, p = 0.002), after controlling for initial MetS severity, but MetS did not predict later PTSD symptoms. Logistic regression results suggested that for every 10 PTSD symptoms endorsed at time 1, the odds of a subsequent MetS diagnosis increased by 56%.
Results highlight the substantial cardiometabolic concerns of young veterans with PTSD and raise the possibility that PTSD may predispose individuals to accelerated aging, in part, manifested clinically as MetS. This demonstrates the need to identify those with PTSD at greatest risk for MetS and to develop interventions that improve both conditions.
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 first observations by a worldwide network of advanced interferometric gravitational wave detectors offer a unique opportunity for the astronomical community. At design sensitivity, these facilities will be able to detect coalescing binary neutron stars to distances approaching 400 Mpc, and neutron star–black hole systems to 1 Gpc. Both of these sources are associated with gamma-ray bursts which are known to emit across the entire electromagnetic spectrum. Gravitational wave detections provide the opportunity for ‘multi-messenger’ observations, combining gravitational wave with electromagnetic, cosmic ray, or neutrino observations. This review provides an overview of how Australian astronomical facilities and collaborations with the gravitational wave community can contribute to this new era of discovery, via contemporaneous follow-up observations from the radio to the optical and high energy. We discuss some of the frontier discoveries that will be made possible when this new window to the Universe is opened.
While oral antidepressants reach efficacy after weeks, single-dose intravenous (i.v.) ketamine has rapid, yet time-limited antidepressant effects. We aimed to determine the efficacy and safety of single-dose i.v. ketamine augmentation of escitalopram in major depressive disorder (MDD).
Thirty outpatients with severe MDD (17-item Hamilton Rating Scale for Depression total score ⩾24) were randomized to 4 weeks double-blind treatment with escitalopram 10 mg/day+single-dose i.v. ketamine (0.5 mg/kg over 40 min) or escitalopram 10 mg/day + placebo (0.9% i.v. saline). Depressive symptoms were measured using the Montgomery–Asberg Depression Rating Scale (MADRS) and the Quick Inventory of Depressive Symptomatology – Self-Report (QIDS-SR). Suicidal ideation was evaluated with the QIDS-SR item 12. Adverse psychopathological effects were measured with the Brief Psychiatric Rating Scale (BPRS)-positive symptoms, Young Mania Rating Scale (YMRS) and Clinician Administered Dissociative States Scale (CADSS). Patients were assessed at baseline, 1, 2, 4, 24 and 72 h and 7, 14, 21 and 28 days. Time to response (⩾50% MADRS score reduction) was the primary outcome.
By 4 weeks, more escitalopram + ketamine-treated than escitalopram + placebo-treated patients responded (92.3% v. 57.1%, p = 0.04) and remitted (76.9% v. 14.3%, p = 0.001), with significantly shorter time to response [hazard ratio (HR) 0.04, 95% confidence interval (CI) 0.01–0.22, p < 0.001] and remission (HR 0.11, 95% CI 0.02–0.63, p = 0.01). Compared to escitalopram + placebo, escitalopram + ketamine was associated with significantly lower MADRS scores from 2 h to 2 weeks [(peak = 3 days–2 weeks; effect size (ES) = 1.08–1.18)], QIDS-SR scores from 2 h to 2 weeks (maximum ES = 1.27), and QIDS-SR suicidality from 2 to 72 h (maximum ES = 2.24). Only YMRS scores increased significantly with ketamine augmentation (1 and 2 h), without significant BPRS or CADSS elevation.
Single-dose i.v. ketamine augmentation of escitalopram was safe and effective in severe MDD, holding promise for speeding up early oral antidepressant efficacy.
The thermal shock resistance (TSR) of ZnS wave-transparent ceramic depends on not only the mechanical and thermal properties of materials, but also the aerodynamic heating, pneumatic pressure, external constraint, size, aspect ratio and other factors in its actual service process. The theoretical model was established by introducing the analytical solution of transient heat conduction problem of ZnS plate under aerodynamic heating into its thermal stress field model and the pneumatic pressure was introduced. The present work mainly focused on the influences of constraint, size and aspect ratio on the critical rupture temperature difference of ZnS plate subjected to aerodynamic heating and pneumatic pressure. The numerical simulation was also conducted to verify the theoretical model. The results show that the large heat transfer condition corresponds to the poor TSR unless the constraint is too strong; the square plate provides the better TSR in case of different pneumatic pressures; a reasonable side length according to the range of pneumatic pressure would lead to the better TSR.
Mutations in the major hydrophilic region (MHR) of the surface antigen of hepatitis B virus (HBV) may result in vaccine escape, failure of immunotherapy and antiviral resistance. These mutants may be transmitted and constitute a public health threat. We aimed to determine the prevalence of MHR mutations of HBV in areas of high endemicity in Guangxi, China. HBV surface gene was analysed from 278 HBsAg-positive asymptomatic individuals recruited from Guangxi using cluster sampling. Three genotypes, B, C and I, were identified. The overall prevalence of MHR mutations is 17·6%. The prevalence of MHR mutations in genotype B (15·1%) is not significantly different from that in genotype C (16·4%). However, the prevalence in subgenotype C5 (31·1%) is significantly higher than in subgenotype C2 (13·0%) (χ2 = 6·997, P < 0·05). The prevalence of escape mutations and overlapping polymerase substitutions in subgenotype C5 is significantly higher than in subgenotypes B2 and C2. In total, 7·9% of MHR mutants are escape mutations and 72·1% of MHR mutations produced amino-acid changes in the overlapping polymerase, including resistance mutations to entecavir. Our results suggest that the prevalence of MHR mutations varies with subgenotype. The prevalence of escape mutations and polymerase mutations may be associated with subgenotype.
In this work, we report on development of one-dimensional reaction-diffusion simulator needed to understand the kinetics of Cu-related metastabilities observed in CdTe PV devices. Evolution of intrinsic and Cu-related defects in CdTe solar cells has been studied in time-space domain self-consistently with free carrier transport. Resulting device performance was simulated as a function of stress time, thus showing pronounced effect that the evolution of associated acceptor and donor states can cause on device characteristics. Although 1D simulation has intrinsic limitations when applied to poly-crystalline films, the results presented confirm the validity and the potential of the approach presented in better understanding of the performance and metastabilities of CdTe photovoltaic devices.
Two-step growth method of low pressure chemical vapor deposition(LPCVD) process was employed to fabricate the ZnO:B-TCO film; For the first layer, the seed layer with a heavy doping concentration was deposited on the glass substrate, the film having higher deposition rate were then grown on the top of the first layer; It shows that the doping situations of the seed layer play an important role in electrical and optical performance of the whole ZnO:B-TCO layer, and the combination of this two properties is optimal when the doping ratio (B2H6/DEZ) was 0.4;
The unique properties of silicon oxide materials, no matter intrinsic or doped, utilized in thin film solar cells (TFSCs) in the area of photovoltaic (PV) are making TFSCs one of the most attractive photovoltaic technologies for the development of high-performing electricity production units to be integrated in everyday life. In comparison to other silicon materials, the particular diphasic structure of silicon oxide materials, in which hydrogenated microcrystalline silicon (μc-Si:H) crystallites are surrounded by an oxygen-rich hydrogenated amorphous silicon (a-Si:H) phase, causes them present excellent photoelectrical material properties, such as a low-parasitic absorption in the broadband spectral range, independent controllability of longitudinal and lateral conductivity, refractive indices (3.5-2.0), band gap (2.0-2.6 eV) and conductivity tenability (with orders of 1-10-9 S/cm) with oxygen doping, and so on. Various types of silicon oxide materials, including intrinsic, p- or n- type, further applied in TFSCs have also played significant roles in improving the efficiency of various types of single-, dual-, and triple-junction thin-film solar cells from both the optical and electrical points of view. In this paper, we present our latest progress in studying the performance improvement role of intrinsic or doped silicon oxide materials in pin-type a-Si:H, a-SiGe:H, and μc-Si:H single-junction solar cells. By effectively tuning the band gap values of intrinsic a-SiOx:H materials with oxygen doping and adopting the layers with a suitable band gap (1.86 eV) as the P/I buffer layers of a-Si:H solar cells fabricated on metal organic chemical vapor deposition (MOCVD) boron-doped zinc oxide (ZnO:B) substrates, a significant Voc increases up to 909 mV and an excellent external quantum efficiency (EQE) response of 75% at the 400 nm typical wavelength can be achieved by matching the band gap discontinuity between the p-type nc-SiOx:H window and a-Si:H intrinsic layers. The serious leakage current characteristics of pin-type narrow-gap (Eg<1.5 eV) a-SiGe:H single-junction solar cells can also be finely tuned by integrating an n-type μc-SiOx:H layer with a small oxygen content in addition to improving the long-wavelength response, an effective approach gives rise to the highest FF of 70.62% for pin-type a-SiGe:H single-junction solar cells with an average band gap of 1.48 eV. In addition, our studies proved that the application of p-type μc-SiOx:H window layers in μc-Si:H single-junction solar cells can effectively improve the short-wavelength light coupling by suppressing the parasitic absorption and promoting the anti-reflectivity with a graded refractive index profile. On the basis of the optimum single-junction solar cells with omnipotent silicon oxide materials, an initial efficiency of 16.07% has been achieved for pin-type a-Si:H/a-SiGe:H/μc-Si:H triple-junction solar cells with an active area of 0.25 cm2. The omnipotent properties of silicon oxide layers in TFSCs, including effective optical coupling and trapping, suitability in compensating for the band gap discontinuity, the shunt-quenching capacity, and so on, make them likely to be extended to other types of solar cells such as polycrystalline chalcopyrite Cu(In,Ga)Se2 (CIGS) and perovskite-sensitized solar cells, opening up new opportunities for acquiring solar cells with higher performance.