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Adolescents have been largely neglected from tuberculosis control efforts. In low- to medium burden settings much of the tuberculosis burden in this age group occurs from school outbreaks. We report on a large tuberculosis outbreak in adolescents from a boarding high school in Jiangsu Province, China. From March to June 2018, a tuberculosis outbreak occurred in a boarding high school. We conducted an outbreak investigation involving clinical diagnostic tests and molecular analysis to determine the outbreak origin. Cases were detected through symptom screening, tuberculin skin testing (TST), chest radiography, sputum smear, solid sputum culture and GeneXpert MTB/RIF. Mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) genotyping and spoligotyping methods were performed on Mycobacterium tuberculosis (M. tuberculosis) isolates to identify the outbreak origin. A total of 845 students and 131 teachers/staff attended a TST screening for tuberculosis infection. The prevalence of elevated tuberculin reactions at ≥5, ≥10 and ≥15 mm was 12.19% (119/976), 6.35% (62/976) and 3.28% (32/976), respectively. Radiographic abnormalities were present in 5.73% (56 of 976) individuals, 40 students and 16 teachers/staff. Of these, 12 students were diagnosed with confirmed tuberculosis. In total, 14 students (two index cases and 12 confirmed cases) were diagnosed and reported in the tuberculosis outbreak, an attack rate of 1.7% (14/847) among students (two index cases and 845 screened students). Results from MIRU-VNTR typing and spoligotyping analyses demonstrated that three M. tuberculosis strains belong to the Beijing family with corresponding MIRU-VNTR alleles. This school-based tuberculosis outbreak among adolescents demonstrates that transmission among individuals in this age group is common and must be prioritised. It suggests that identifying and timely diagnosis of smear-positive cases, especially in the early phase of outbreaks, is the key to preventing further spread among close contacts.
This study aimed to investigate endoscopic revision septoplasty with semi-penetrating straight and circular incisions in patients for whom septoplasty was unsuccessful.
Patients in this study (n = 14) had a deviation of the nasal septum after septoplasty. Pre-operative and post-operative assessments were performed using a visual analogue scale and nasal endoscope. Semi-penetrating straight and circular incisions in front of the caudal septum and at the margin of the nasal septal cartilage–bone defect, respectively, were made. The mucoperichondrium and mucoperiosteum were bilaterally dissected until interlinkage with the cartilage–bone defect was achieved. Mucous membranes within the circular incision as well as the right mucoperichondrium and mucoperiosteal flaps were protected by pushing them to the right. This exposed the osteocartilaginous framework and allowed correction of the residual deviation. The patients were followed up for 30–71 months.
For nasal obstruction and headaches, a significant improvement was noted in post-operative compared to pre-operative visual analogue scale scores. No patients had septal deviations, saddle nose, false hump nose or contracture of the nasal columella.
The technique allowed exposure of the septal osteocartilaginous framework and a broad operational vision, which enabled successful correction of various deformities of the nasal septum.
Much of the interest in youth at clinical high risk (CHR) of psychosis has been in understanding conversion. Recent literature has suggested that less than 25% of those who meet established criteria for being at CHR of psychosis go on to develop a psychotic illness. However, little is known about the outcome of those who do not make the transition to psychosis. The aim of this paper was to examine clinical symptoms and functioning in the second North American Prodrome Longitudinal Study (NAPLS 2) of those individuals whose by the end of 2 years in the study had not developed psychosis.
In NAPLS-2 278 CHR participants completed 2-year follow-ups and had not made the transition to psychosis. At 2-years the sample was divided into three groups – those whose symptoms were in remission, those who were still symptomatic and those whose symptoms had become more severe.
There was no difference between those who remitted early in the study compared with those who remitted at one or 2 years. At 2-years, those in remission had fewer symptoms and improved functioning compared with the two symptomatic groups. However, all three groups had poorer social functioning and cognition than healthy controls.
A detailed examination of the clinical and functional outcomes of those who did not make the transition to psychosis did not contribute to predicting who may make the transition or who may have an earlier remission of attenuated psychotic symptoms.
The autofocusing (AF) performance of cell phone cameras is critically dependent on the design of the voice-coil motor (VCM) used to drive the lens module. Also, the metal springs in the AF module should combine high stiffness with a good actuation response and a light weight. The present study utilizes a reverse engineering approach to construct three-dimensional finite element models of the top and bottom springs in the VCM mechanism. Simulations are then performed to investigate the von Mises stress distribution and stiffness characteristics of the two springs given horizontal and vertical orientations of the AF module, respectively. In performing the simulations, the actuation force is computed using two different analysis methods, namely a simplify structure method and a coupled electromagnetic-structural method. It is shown that the simplify structure method has the advantages of a lower computational complexity and a more comprehensive modeling capability. A further series of simulations is thus to examine the effects of the spring shape parameters on the reaction force developed by the spring stiffness. The results show that the spring stiffness increases with an increasing thickness and a decreasing rib length. The simulation results obtained for different spring shape parameter settings are summarized in the form of a parameter design chart for predicting the reaction force given known values of the spring rib length and spring thickness.
Dengue fever (DF) is the most prevalent and rapidly spreading mosquito-borne disease globally. Control of DF is limited by barriers to vector control and integrated management approaches. This study aimed to explore the potential risk factors for autochthonous DF transmission and to estimate the threshold effects of high-order interactions among risk factors. A time-series regression tree model was applied to estimate the hierarchical relationship between reported autochthonous DF cases and the potential risk factors including the timeliness of DF surveillance systems (median time interval between symptom onset date and diagnosis date, MTIOD), mosquito density, imported cases and meteorological factors in Zhongshan, China from 2001 to 2013. We found that MTIOD was the most influential factor in autochthonous DF transmission. Monthly autochthonous DF incidence rate increased by 36·02-fold [relative risk (RR) 36·02, 95% confidence interval (CI) 25·26–46·78, compared to the average DF incidence rate during the study period] when the 2-month lagged moving average of MTIOD was >4·15 days and the 3-month lagged moving average of the mean Breteau Index (BI) was ⩾16·57. If the 2-month lagged moving average MTIOD was between 1·11 and 4·15 days and the monthly maximum diurnal temperature range at a lag of 1 month was <9·6 °C, the monthly mean autochthonous DF incidence rate increased by 14·67-fold (RR 14·67, 95% CI 8·84–20·51, compared to the average DF incidence rate during the study period). This study demonstrates that the timeliness of DF surveillance systems, mosquito density and diurnal temperature range play critical roles in the autochthonous DF transmission in Zhongshan. Better assessment and prediction of the risk of DF transmission is beneficial for establishing scientific strategies for DF early warning surveillance and control.
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that was caused by a novel bunyavirus, SFTSV. The study aimed to disclose the epidemiological and clinical characteristics of SFTSV infection in China so far. An integrated clinical database comprising 1920 SFTS patients was constructed by combining first-hand clinical information collected from SFTS sentinel hospitals (n = 1159) and extracted data (n = 761) from published literature. The considered variables comprised clinical manifestations, routine laboratory tests of acute infection, hospitalization duration and disease outcome. SFTSV-IgG data from 19 119 healthy subjects were extracted from the published papers. The key clinical variables, case-fatality rate (CFR) and seroprevalence were estimated by meta-analysis. The most commonly seen clinical manifestations of SFTSV infection were fever, anorexia, myalgia, chill and lymphadenopathy. The major laboratory findings were elevated lactate dehydrogenase, aminotransferase, followed by thrombocytopenia, lymphocytopenia, elevated alanine transaminase and creatine kinase. A CFR of 12·2% was estimated, significantly higher than that obtained from national reporting data, but showing no geographical difference. In our paper, the mortality rate was about 1·9 parts per million. Older age and longer delay to hospitalization were significantly associated with fatal outcome. A pooled seroprevalence of 3·0% was obtained, which increased with age, while comparable for gender. This study represents a clinical characterization on the largest group of SFTS patients up to now. A higher than expected CFR was obtained. A wider spectrum of clinical index was suggested to be used to identify SFTSV infection, while the useful predictor for fatal outcome was found to be restricted.
Intra-individual variability (IIV) and the change of attentional functions have been reported to be susceptible to both healthy ageing and pathological ageing. The current study aimed to evaluate the IIV of attention and the age-related effect on alerting, orienting, and executive control in cognitively healthy older adults.
We evaluated 145 Chinese older adults (age range of 65–80 years, mean age of 72.41 years) with a comprehensive neuropsychological battery and the Attention network test (ANT). A two-step strategy of analytical methods was used: Firstly, the IIV of older adults was evaluated by the intraindividual coefficient of variation of reaction time (ICV-RT). The correlation between ICV-RT and age was used to evaluate the necessity of subgrouping. Further, the comparisons of ANT performance among three age groups were performed with processing speed adjusted.
Person's correlation revealed significant positive correlations between age and IIV (r = 0.185, p = 0.032), age and executive control (r = 0.253, p = 0.003). Furthermore, one-way ANOVA comparisons among three age groups revealed a significant age-related disturbance on executive control (F = 4.55, p = 0.01), in which oldest group (group with age >75 years) showed less efficient executive control than young-old (group with age 65–70 years) (Conventional score, p = 0.012; Ratio score, p = 0.020).
Advancing age has an effect on both IIV and executive attention in cognitively healthy older adults, suggesting that the disturbance of executive attention is a sensitive indicator to reflect healthy ageing. Its significance to predict further deterioration should be carefully evaluated with prospective studies.
We determined the prevalence and seasonality of infections by Fasciola of goats and bovine species (cattle and water buffalo) in Hubei and Anhui provinces of China. Faecal samples were collected at 2- to 3-month intervals from 200 goats in Hubei province and from 152 bovine species in Anhui province. All faecal samples were examined for the presence of parasites. We determined the nucleotide sequences of the first and second internal transcribed spacers (ITS-1 and ITS-2) of the nuclear ribosomal DNA (rDNA) of 39 Fasciola worms from Anhui province. The prevalence of Fasciola infection in goats ranged between 3.5 and 37.0%, with mean eggs per gram (EPG) ranging between 29.0 and 166.0. Prevalence and EPG exhibited downward trends over time with significant differences. The prevalence of Fasciola infection in cattle ranged between 13.3 and 46.2% (mean EPG, 36.4–100.0), and that of water buffalo ranged between 10.3 and 35.4% (mean EPG, 25.0–89.6), with a higher prevalence of infection and EPG from June to October compared with December to March. Analysis of ITS-1 and ITS-2 sequences revealed that F. hepatica and F. gigantica were present in all bovine species of Anhui province and that F. gigantica mainly infected water buffalo. This is the first demonstration of Fasciola infection in Hubei province and detection of F. hepatica and F. gigantica in Anhui province. The present study of Hubei province shows that mass treatment of livestock with closantel sodium injections in April and August/September controlled Fasciola infection effectively.
Background: Schema Theory proposes that the development of maladaptive schemas are based on a combination of memories, emotions and cognitions regarding oneself and one's relationship to others. A cognitive model of psychosis suggests that schemas are crucial to the development and persistence of psychosis. Little is known about the impact that schemas may have on those considered to be at clinical high risk (CHR) of developing psychosis. Aims: To investigate schemas over time in a large sample of CHR individuals and healthy controls. Method: Sample included 765 CHR participants and 280 healthy controls. Schemas were assessed at baseline, 6 and 12 months using the Brief Core Schema Scale (BCSS). Baseline schemas were compared to 2-year clinical outcome. Results: CHR participants evidenced stable and more maladaptive schemas over time compared to controls. Schemas at initial contact did not vary amongst the different clinical outcome groups at 2 years although all CHR outcome groups evidenced significantly worse schemas than healthy controls. Although there were no differences on baseline schemas between those who later transitioned to psychosis compared to those who did not, those who transitioned to psychosis had more maladaptive negative self-schemas at the time of transition. Associations between negative schemas were positively correlated with earlier abuse and bullying. Conclusions: These findings demonstrate a need for interventions that aim to improve maladaptive schemas among the CHR population. Therapies targeting self-esteem, as well as schema therapy may be important work for future studies.
Estimating crop nutrient requirements for winter oilseed rape (Brassica napus L.) is a crucial step in optimizing fertilization to enhance seed yield and improve fertilizer use efficiency. In the present paper, a database composed of 1035 on-farm observations collected from 2005 to 2010 across the major winter oilseed rape production regions in China was used to evaluate internal nutrient efficiencies (kg seed per kg nutrient in plant dry matter); then the Quantitative Evaluation of the Fertility of Tropical Soils (QUEFTS) model for winter oilseed rape was developed to describe the nutrient uptake-yield relationship of oilseed rape over a wide range of environmental conditions and predict the nutrient requirements for a target yield. After excluding observations with low harvest index values, <0·20, and excluding 0·025 of the highest and lowest internal nutrient efficiencies, the minimum and maximum internal nutrient efficiencies were estimated as 13·1 and 31·6 kg seed/kg nitrogen (N), 68·9 and 200·3 kg seed/kg phosphorus (P) and 8·9 and 31·1 kg seed/kg potassium (K), respectively. On the basis of the data settings, the balanced N, P and K uptake at different yield potential levels was calculated using a linear–parabolic–plateau curve with the QUEFTS model. Crop nutrient requirements increased linearly until the yield reached approximately 0·60–0·70 of the potential yield, and 46·0 kg N, 8·0 kg P and 57·1 kg K were found to be needed to produce 1000 kg of seed. The corresponding internal nutrient efficiencies were 21·8, 125·1 and 17·5 kg seed/kg N, P and K, respectively. However, when the target yields approached the yield potential, a decrease in internal nutrient efficiencies was detected in the model. The predicted nutrient requirement values simulated by the QUEFTS model compared well with observed values across a range of conditions. To conclude, the QUEFTS model was shown to be a practical and robust tool for assessing the crop nutrient requirements of winter oilseed rape.
To understand the clinical epidemiology and molecular characteristics of human bocavirus (HBoV) infection in children with diarrhoea in Guangzhou, South China, we collected 1128 faecal specimens from children with diarrhoea from July 2010 to December 2012. HBoV and five other major enteric viruses were examined using real-time polymerase chain reaction. Human rotavirus (HRV) was the most prevalent pathogen, detected in 250 (22·2%) cases, followed by enteric adenovirus (EADV) in 76 (6·7%) cases, human astrovirus (HAstV) in 38 (3·4%) cases, HBoV in 17 (1·5%) cases, sapovirus (SaV) in 14 (1·2%) cases, and norovirus (NoV) in 9 (0·8%) cases. Co-infections were identified in 3·7% of the study population and 23·5% of HBoV-positive specimens. Phylogenetic analysis revealed 14 HBoV strains to be clustered into species HBoV1 with only minor variations among them. Overall, the detection of HBoV appears to partially contribute to the overall detection gap for enteric infections, single HBoV infection rarely results in severe clinical outcomes, and HBoV sequencing data appears to support conserved genomes across strains identified in this study.
A continuation method, accompanied with a linear stability analysis, is employed to investigate the bifurcation diagram of the flow solutions, as well as the multiple flow states in a cavity with different aspect ratios for parallel motion of two facing lids. The Reynolds number proportional to the wall velocity is used as the continuation parameter, and the evolution of the bifurcation diagrams in cases with different aspect ratios is illustrated. The induced flow patterns are highly dependent upon both the aspect ratios and the moving velocity of the walls. Three different types of bifurcation diagrams and their corresponding flow states are classified according to the aspect ratios. One stable symmetric flow state and one stable asymmetric flow state are identified. The stable asymmetric flow state is obtained at a high aspect ratio and a low Reynolds number. Meanwhile, the regions of stable and unstable flows are distinguished according to the different aspect ratios.
We investigate the vertical structure and element distribution of neutrino-dominated
accretion flows around black holes in spherical coordinates with reasonable nuclear
statistical equilibrium. According to our calculations, heavy nuclei tend to be produced
in a thin region near the disk surface. In this thin region, we find that 56Ni
is dominant in the flow with low accretion rate (e.g.,
0.05M⊙s-1). The solutions indicate that
56Ni comes from the central engine, whose decay may drive the bumps in the
light curve of core-collapse supernova.
A study about the achievement of dichromatic white light-emitting diodes (LEDs) was performed. A series of dual wavelength LEDs with different last quantum-well (LQW) structure were fabricated. The bottom seven blue light QWs (close to n-GaN layer) of the four samples were the same. The LQW of sample A was 3 nm, and that of sample B, C and D were 6 nm, a special high In content ultra-thin layer was inserted in the middle of the LQW of sample C and on top of that of sample D. XRD results showed In concentration fluctuation and good interface quality of the four samples. PL measurements showed dual wavelength emitting, the blue light peak position of the four samples were almost the same, sample A with a narrower LQW showed an emission wavelength much shorter than that of sample B, C, D. EL measurement was done at an injection current of 100 mA. Sample A only showed LQW emission due to holes distribution. Because of wider LQW, the emission wavelength of sample B, C and D was longer and peak intensity was weaker. Sample D with insert layer on top of LQW showed strongest yellow light emission with a blue peak. As the injection current increased, sample A showed highest output light power due to narrower LQW. Of the other three samples with wider LQW, sample D showed highest output power. Effective yellow light emission has always been an obstacle to the achievement of dichromatic white LED. Sample D with insert layer close to p-GaN can confine the hole distribution more effectively hence the recombination of holes and electrons was enhanced, the yellow light emission was improved and dichromatic white LED was achieved.
The crystal structure of a-plane GaN/ZnO heterostructures on r-plane sapphire was investigated by using the XRD and TEM measurment. It was found the formation of (220) ZnGa2O4 and crystal orientation of semipolar (10
3) GaN at GaN/ZnO interface. The epitaxial relation of normal surface direction are the sapphire (1
02) // a-GaN (11
0) and ZnGa2O4 (220) // semi-polar GaN (10
). Beside, the emission peak energy of ZnO appears shift about 60 meV in the GaN/ZnO/GaN heterostructures due to the re-crystallization of ZnO layer with Ga or N atom and the formation of the localized state.
Previous studies support Beck's cognitive model of vulnerability to depression. However, the relationship between his cognitive triad and other clinical features and risk factors among those with major depression (MD) has rarely been systematically studied.
The three key cognitive symptoms of worthlessness, hopelessness and helplessness were assessed during their lifetime worst episode in 1970 Han Chinese women with recurrent MD. Diagnostic and other risk factor information was assessed at personal interview. Odds ratios (ORs) were calculated by logistic regression.
Compared to patients who did not endorse the cognitive trio, those who did had a greater number of DSM-IV A criteria, more individual depressive symptoms, an earlier age at onset, a greater number of episodes, and were more likely to meet diagnostic criteria for melancholia, postnatal depression, dysthymia and anxiety disorders. Hopelessness was highly related to all the suicidal symptomatology, with ORs ranging from 5.92 to 6.51. Neuroticism, stressful life events (SLEs) and a protective parental rearing style were associated with these cognitive symptoms.
During the worst episode of MD in Han Chinese women, the endorsement of the cognitive trio was associated with a worse course of depression and an increased risk of suicide. Individuals with high levels of neuroticism, many SLEs and high parental protectiveness were at increased risk for these cognitive depressive symptoms. As in Western populations, symptoms of the cognitive trio appear to play a central role in the psychopathology of MD in Chinese women.
Coronary artery disease is a major problem worldwide causing 7.2 million deaths worldwide annually, resulting from vascular occlusion, myocardial infarction and its complications. Stent implantation is a percutaneous interventional procedure that mitigates vessel stenosis, providing mechanical support within the artery. However, stenting causes physical damage to the arterial wall. It is well accepted that a valuable route to reduce in-stent re-stenosis can be based on promoting cell response to nano-structured stainless steel (SS) surfaces such as, for example, by patterning nano-pits in SS. In this regard patterning by Focussed Ion-Beam (FIB) milling offers several advantages for flexible prototyping (i) practically any substrate material that is able to withstand high vacuum conditions of the microscope chamber can be used, (ii) there is high flexibility in the obtainable shapes and geometries by modulating the ion beam current and the patterning conditions, (iii) reduced complexity of the pattering process e.g. it is a single-step process with a possibility of real-time monitoring of the milling progression. On the other hand FIB patterning of polycrystalline metals is greatly influenced by channelling effects and re-deposition. Correlative microscopy methods present an opportunity to study such effects comprehensively and derive structure-property understanding that is important for developing improved pattering. In this report we present a FIB patterning protocol for nano-structuring features (concaves) ordered in rectangular arrays on pre-polished 316L Stainless Steel (SS) surfaces. An investigation based on correlative microscopy approach of the size, shape and depth of the developed arrays in relation to the crystal orientation of the underlying SS domains, is presented. The correlative microscopy protocol is based on cross-correlation of top-view Scanning Electron Microscopy (SEM), Electron Backscattered Diffraction (EBSD), and Atomic Force Microscopy (AFM).Various dose tests were performed, aiming at improved productivity by preserving nano-size accuracy of the patterned process. The optimal FIB patterning conditions for achieving reasonably high throughput (patterned rate of about 0.03 mm2 per hour) and nano-size accuracy in dimensions and shapes of the features, are discussed as well.
In this work, Dopant Segregated Schottky Barrier (DSSB) and Schottky Barrier (SB) vertical silicon nanowire (VSiNW) diodes were fabricated on p-type Si substrate using CMOS-compatible processes to investigate the effects of segregated dopants at the silicide/silicon interface and different annealing processes on nickel silicide formation in DSSB VSiNW diodes. With segregated dopants at the silicide/silicon interface, VSiNW diodes showed higher on-current, due to an enhanced carrier tunneling, and much lower leakage current. This can be attributed to the altered energy bands caused by the accumulated Arsenic dopants at the interface. Moreover, DSSB VSiNW diodes also gave ideality factor much closer to unity and exhibited lower electron SBH (ΦBn) than SB VSiNW diodes. This proved that interfacial accumulated dopants could impede the inhomogeneous nature of the Schottky diodes and simultaneously, minimize the effect of Fermi level pinning and ionization of surface defect states. Comparing the impact of different silicide formation annealing using DSSB VSiNW diodes, the 2-step anneal process reduces the silicide intrusion length within the SiNW by ~ 5X and the silicide interface was smooth along the (100) direction. Furthermore, the 2-step DSSB VSiNW diode also exhibited much lower leakage current and an ideality factor much closer to unity, as compared to 1-step DSSB VSiNW diode.
Impulsive loading by the ground reaction force (GRF) around heelstrike during walking is closely related to joint degeneration and might be affected by joint movement of the locomotor system. Fifteen healthy males (age: 25.5 ±3 years) were studied to investigate the association between the quantitative joint angles, angular velocities and accelerations of the lower-limb joints, and the loading rates of the GRF. Apart from the gait speed, both the ipsilateral kinematics during the swing phase, and the contralateral kinematics around the beginning of the terminal double limb stance (DLS), may significantly contribute to the heelstrike and maximum loading rates of the GRF. The magnitude of the heelstrike impulsive GRF was particularly affected by the peak ankle dorsiflexion velocity during the swing phase of the ipsilateral limb. However, for generating the maximum loading rate of nearly eight times the magnitude of that of the heelstrike one needed more kinematic variables to be modulated in advance, especially the knee flexion velocities around the beginning of the terminal DLS of the contralateral limb. Knowledge of the joint mechanics of the locomotor system for controlling the magnitude of the impulsive GRF during normal walking might be helpful for gait retraining for the elderly or patients who might have excessive impulsive GRF and a high risk of joint degeneration.