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Electroconvulsive therapy (ECT) remains irreplaceable in the treatment of several psychiatric conditions. However, evidence derived using data from a national database to support its safety is limited. The aim of this study was to investigate in-hospital mortality among patients with psychiatric conditions treated with and without ECT.
Using data from the Taiwan National Health Insurance Research Database from 1997 to 2013, we identified 828,899 inpatients with psychiatric conditions, among whom 0.19% (n = 1571) were treated with ECT.
We found that ECT recipients were more frequently women, were younger and physically healthier, lived in more urbanized areas, were treated in medical centers, and had longer hospital stays. ECT recipients had lower odds of in-hospital mortality than did those who did not receive ECT. Moreover, no factor was identified as being able to predict mortality in patients who underwent ECT. Among all patients, ECT was not associated with in-hospital mortality after controlling for potential confounders.
ECT was indicated to be safe and did not increase the odds of in-hospital mortality. However, ECT appeared to be administered only on physically healthy but psychiatrically compromised patients, a pattern that is in opposition with the scientific evidence supporting its safety. Moreover, our data suggest that ECT is still used as a treatment of last resort in the era of modern psychiatry.
Guangxi, a province in southwestern China, has the second highest reported number of HIV/AIDS cases in China. This study aimed to develop an accurate and effective model to describe the tendency of HIV and to predict its incidence in Guangxi. HIV incidence data of Guangxi from 2005 to 2016 were obtained from the database of the Chinese Center for Disease Control and Prevention. Long short-term memory (LSTM) neural network models, autoregressive integrated moving average (ARIMA) models, generalised regression neural network (GRNN) models and exponential smoothing (ES) were used to fit the incidence data. Data from 2015 and 2016 were used to validate the most suitable models. The model performances were evaluated by evaluating metrics, including mean square error (MSE), root mean square error, mean absolute error and mean absolute percentage error. The LSTM model had the lowest MSE when the N value (time step) was 12. The most appropriate ARIMA models for incidence in 2015 and 2016 were ARIMA (1, 1, 2) (0, 1, 2)12 and ARIMA (2, 1, 0) (1, 1, 2)12, respectively. The accuracy of GRNN and ES models in forecasting HIV incidence in Guangxi was relatively poor. Four performance metrics of the LSTM model were all lower than the ARIMA, GRNN and ES models. The LSTM model was more effective than other time-series models and is important for the monitoring and control of local HIV epidemics.
Giardia duodenalis is the most common intestinal parasite of humans in the USA, but the risk factors for sporadic (non-outbreak) giardiasis are not well described. The Centers for Disease Control and Prevention and the Colorado and Minnesota public health departments conducted a case-control study to assess risk factors for sporadic giardiasis in the USA. Cases (N = 199) were patients with non-outbreak-associated laboratory-confirmed Giardia infection in Colorado and Minnesota, and controls (N = 381) were matched by age and site. Identified risk factors included international travel (aOR = 13.9; 95% CI 4.9–39.8), drinking water from a river, lake, stream, or spring (aOR = 6.5; 95% CI 2.0–20.6), swimming in a natural body of water (aOR = 3.3; 95% CI 1.5–7.0), male–male sexual behaviour (aOR = 45.7; 95% CI 5.8–362.0), having contact with children in diapers (aOR = 1.6; 95% CI 1.01–2.6), taking antibiotics (aOR = 2.5; 95% CI 1.2–5.0) and having a chronic gastrointestinal condition (aOR = 1.8; 95% CI 1.1–3.0). Eating raw produce was inversely associated with infection (aOR = 0.2; 95% CI 0.1–0.7). Our results highlight the diversity of risk factors for sporadic giardiasis and the importance of non-international-travel-associated risk factors, particularly those involving person-to-person transmission. Prevention measures should focus on reducing risks associated with diaper handling, sexual contact, swimming in untreated water, and drinking untreated water.
The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.
The current experiment was conducted to evaluate the effects of different dietary protein levels and rumen-protected folic acid (RPFA) supplementation on ruminal fermentation, microbial enzyme activity, bacterial populations and urinary excretion of purine derivatives (PD) in growing beef steers. Low-protein (LP) or high-protein (HP) diets were fed to eight ruminally cannulated first-generation cross-bred (Blonde d'Aquitaine × Simmental) beef steers with or without RPFA supplementation. Steers were fed a total mixed ration, and dietary concentrate to maize silage ratio was 50 : 50 (dry matter (DM) basis). No interaction between dietary crude protein (CP) levels and RPFA supplementation was observed during the experiment. Ruminal pH was unaffected by RPFA supplementation, but decreased with increasing dietary CP levels. Ruminal total volatile fatty acid concentration increased with increasing dietary CP levels or RPFA supplementation. Molar proportion of acetate increased with RPFA supplementation, but tended to decrease with increasing dietary CP levels. The proportion of propionate decreased with RPFA supplementation, but was unaffected by dietary CP levels. As a result, the acetate to propionate ratio increased with RPFA supplementation, but tended to be lower for the HP diets than the LP diets. Ammonia-nitrogen content decreased with RPFA supplementation, but increased with increasing dietary CP levels. In situ ruminal degradability of maize straw and concentrate increased with increasing dietary CP levels or RPFA supplementation. Microbial enzyme (carboxymethyl-cellulase, cellobiase, xylanase, pectinase, α-amylase and protease) activity, bacterial populations (Ruminococcus albus, Ruminococcus flavefaciens, Butyrivibrio fibrisolvens, Prevotella ruminicola, Fibrobacter succinogenes and Ruminobacter amylophilus) and urinary PD excretion increased with increasing dietary CP levels or RPFA supplementation. The current study showed that increasing dietary CP levels from 109·1 to 130·7 g/kg DM or supplementing 75 mg RPFA improved ruminal fermentation and microbial protein synthesis by increasing bacterial population and microbial enzyme activity.
This paper will present a dynamic Variable Rate Irrigation System developed by the University of Georgia. The system consists of the EZZone management zone delineation tool, the UGA Smart Sensor Array (UGA SSA) and an irrigation scheduling decision support tool. An experiment was conducted in 2015 and 2016 in two different peanut fields to evaluate the performance of using the UGA SSA to dynamically schedule Variable Rate Irrigation (VRI). For comparison reasons strips were designed within the fields. These strips were irrigated according to either UGA SSA or Irrigator Pro recommendations. The results showed that Irrigator Pro is a conservative irrigation method which results in high yields. On the other hand the UGA SSA recommendations worked very well with the VRI system and in both years it recommended an average of 25% less irrigation water than the Irrigator Pro.
crAssphage is a newly discovered gut bacteriophage. However, its pathogenicity and molecular epidemiology in humans are as yet unclear. In this study, we investigated the association between crAssphage and diarrhoea, as well as the molecular epidemiology of crAssphage in Chinese patients from our hospital. Our results indicated that there were no significant differences in the crAssphage-positive ratio and viral loads in faecal supernatants between adults with diarrhoea and healthy adults. Of infants and children with diarrhoea, 2·8% were found to be crAssphage-positive, including two infants aged <1 month. Markedly, of all confirmed crAssphage-positive strains, 100% had the ORF00039 deletion and 77·8% had low identity of ORF00018 compared to crAssphage (GenBank accession no. NC_024711, designated genotype 1). Thus, crAssphage was not associated with diarrhoea and most strains of crAssphage in Chinese patients (designated genotype 2) were characterized by the ORF00039 deletion and low identity of ORF00018.
A new approach for the analysis of stress intensity factors (SIFs) for cracked plane plate is proposed based on the wavelet finite element method using the scaling functions of B-spline wavelet on the interval (BSWI). The performance of the method is investigated through the comparison of the results with the available numerical examples in the literate. It is shown that the solution quality is much better than that of the traditional adaptive finite element method. Though the method is applied to plane structures in this paper, it can be extended to solving problems for other classes of structures.
Biased assessment of tillage impacts on soil organic carbon (SOC) sequestration are often associated with a lack of information on the initial level of SOC stocks. The present study reported the changes in SOC concentrations and stocks following 10-year different tillage practices relative to the initial SOC levels. The tillage trial included no tillage (NT), ridge tillage (RT) and mouldboard plough (MP) on a Black soil (Hapludolls) in Northeast China. Results showed that tillage, soil depth and time significantly affected SOC concentration and SOC stock. Tillage and crop residue retention had great impacts on the SOC concentrations in the top 0·1 m layer. Compared with MP and NT, RT resulted in higher SOC concentration and SOC stock in the plough layer (0–0·2 m), which became more obvious with time. The soil under NT and RT had higher stratification ratios (SR) of SOC (SR, the ratio of SOC concentration in 0–0·05 m to that in 0·1–0·2 m) than under MP. Significant positive and nearly identical linear relationships between the SR of SOC and the duration of tillage practices occurred for both NT and RT soils; the increased SR in NT resulted from both SOC increase in surface and SOC decrease in subsurface soils, but in RT, the increased SR was only from a substantial SOC increase in surface soil. Accordingly, the present study highlights that RT was more helpful than NT in carbon sequestration for the studied Black soil in Northeast China.
Saline-sodic soils are widely distributed in the western Songnen Plain of Northeast China and planting rice has been found to be an effective and feasible approach for improving saline-sodic soil and increasing food production. Assessment of the effectiveness and sustainability of this method requires monitoring of the changes in soil salinity and nutrient content. The objective of the current study was to investigate the changes of soil salinity and nitrogen (N) contents over 1, 3, 6 and 9 years of cultivation, four application rates of N (N0: no N, N1: 100 kg N/ha, N2: 200 kg N/ha and N3: 300 kg N/ha) and two irrigation water types: ground water irrigation (GWI) and river water irrigation (RWI). Salinity and N contents of soil and water samples were analysed before planting and after harvest throughout the experiments. Soil pH and electrical conductivity (EC), especially in the surface layer of 0–40 cm depth, decreased with years of cultivation with both GWI and RWI, while soil inorganic N and total N contents increased. Moreover, with increasing N application rates, soil inorganic N and total N contents increased significantly in the 0–20 cm soil layer. Increasing N application had little effect on soil pH and EC. Reclaiming and planting rice promoted desalination of the surface and formation of a fertile tillage layer in saline-sodic paddy fields. In terms of irrigation and drainage in saline-sodic paddy fields, both soil salinity and N contents increased. Soil total salinity increased annually by 34 and 12·8 kg/ha, and inorganic N contents increased annually by 9 and 13·5 kg/ha with GWI and RWI, respectively. Therefore, comprehensive agricultural practices should be adopted for improving and cropping rice in saline-sodic paddy fields.
We examine the roles of actuaries in UK life offices, along with trends, challenges to and opportunities for actuaries. We carry out an analysis of senior roles in life offices, a questionnaire survey and interviews with relevant senior personnel. We find that actuaries occupy many important roles in life offices and are regarded as having good industry knowledge and technical skills, especially in financial modelling. There are fewer executive directors and more non-executive directors of life offices who are actuaries compared with the position in 1990. A higher proportion of reserved roles is outsourced to consultants than was the case in 1990. Only a small number of Actuarial Function Holders are directors. Actuaries are more siloed than was the case in the past, although actuaries are well represented in the finance and risk functions of many offices. Although actuarial work in connection with the preparation for Solvency II will decline, there will be important ongoing requirements for actuaries following Solvency II implementation. We also see opportunities for actuaries in four areas: in risk management, in financial analysis and management based on Solvency II and international financial reporting standards, in connection with “big data”, and in product development and the customer proposition. There are implications for the examination syllabus, continuing professional development and research.
Tramadol hydrochloride (HCl) is a centrally acting synthetic opioid analgesic. Psychotic symptoms are relatively rare in reported adverse events. Here, we report a patient who presented with tramadol-related psychotic symptoms.
A 59-year-old female had underlying bipolar I disorder and received lithium treatment with stable affective status. 1 month before hospitalisation, she had been taking tramadol HCl/acetaminophen for joint pain. She then developed obvious persecutory delusion. However, her clinical picture did not meet the criteria of any mood episode. After treatment of risperidone in addition to lithium, she was discharged without any psychotic symptom. She remained euthymic without any psychotic symptom on monotherapy of lithium (300 mg) three tablets once daily.
Tramadol HCl is commonly prescribed in clinical practice and psychotic symptoms related to it are uncommon. We should be careful about the rare but important adverse events while prescribing tramadol HCl.
Fundamental understanding of the oxygen reduction reaction (ORR) electrocatalyzed by nitrogen-doped carbon requires a well-defined structure to correlate structure to function. Well-characterized N-doped graphitic nanostructures derived from benzene derivatives have been synthesized in our group, and shown to catalyze a four-electron ORR under alkaline conditions. Density functional theory calculations have been performed on a model N-doped graphitic nanostructure, C50N2H20, to determine an oxygen activation mechanism. With guidance through an experimentally determined Pourbaix diagram, DFT calculations clearly indicate that the catalyst must undergo a 2e−,1H+ reduction to generate a reactive carbanionic intermediate that activates oxygen with a spin inversion.
Radio-glaciological parameters from the Moore’s Bay region of the Ross Ice Shelf, Antarctica, have been measured. The thickness of the ice shelf in Moore’s Bay was measured from reflection times of radio-frequency pulses propagating vertically through the shelf and reflecting from the ocean, and is found to be 576 ± 8 m. Introducing a baseline of 543 ± 7m between radio transmitter and receiver allowed the computation of the basal reflection coefficient, R, separately from englacial loss. The depth-averaged attenuation length of the ice column, 〈L〉 is shown to depend linearly on frequency. The best fit (95% confidence level) is 〈L(ν)〉= (460±20) − (180±40)ν m (20 dB km−1), for the frequencies ν = [0.100–0.850] GHz, assuming no reflection loss. The mean electric-field reflection coefficient is (1.7 dB reflection loss) across [0.100–0.850] GHz, and is used to correct the attenuation length. Finally, the reflected power rotated into the orthogonal antenna polarization is <5% below 0.400 GHz, compatible with air propagation. The results imply that Moore’s Bay serves as an appropriate medium for the ARIANNA high-energy neutrino detector.
Delayed senescence, or stay-green, contributes to a longer grain-filling period and has been regarded as a desirable characteristic for the production of a number of crops including wheat. In the present study, in order to identify quantitative trait loci (QTLs) for traits related to the progression of wheat flag leaf senescence, green leaf area duration (GLAD) of a doubled haploid (DH) population, derived from two winter wheat varieties Hanxuan10 and Lumai14, was visually estimated under two water conditions and was recorded at 3-day intervals from 10 days after anthesis to physiological maturity using a 0–9 scale. According to GLAD, parameters related to the progression of senescence of DH lines and their parents were estimated by the Gompertz statistical model. Based on the model parameters, DH lines were categorized into three groups under drought stress and four groups under well-watered conditions. A total of 24 additive QTLs and 23 pairs of epistatic QTLs for parameters related to the progression of senescence were identified on 18 chromosomes, except for 3B, 1D and 6D. Of the QTLs detected, 14 and 10 additive QTLs were associated with the investigated traits under drought stress and well-watered conditions, respectively. Furthermore, 4, 7, 6, 2 and 2 additive QTLs for traits related to progression of senescence were clustered around the same or similar regions of chromosomes 1A, 1B, 5A, 5B and 7A, respectively. The present data provided the genetic basis for high phenotypic correlations among traits related to the progression of wheat flag leaf senescence. In addition, 17 loci were co-located or linked with previously reported QTLs regulating chlorophyll fluorescence, high-light-induced photo-oxidation, or heat stress and dark-induced senescence. The marker Xwmc336 on chromosome 1A, responsible for the onset and end times of leaf senescence, the time to maximum rate of senescence, the time to reach 75% senescence and chlorophyll content under drought stress may be helpful for marker-assisted selection breeding of wheat.
Two Cloisonné enamel architectural components from Fuwangge in the Forbidden City that were produced from Yangzhou (one production center) in Qing Dynasty (1616-1911 A.D.) were chosen and analyzed. A combination of Laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) and micro-Raman spectroscopy was successfully used to analyze eight colors in enamel glazes (yellow, white, pink, turquoise, yellow green, deep blue, red and deep green). Chemical composition results reveal that the enamel glaze matrix belongs to lead-potash-lime glass (PbO-K2O-CaO-SiO2). Based on Raman spectroscopy, lead-tin yellow types II, cassiterite, lead arsenate, fluorite and hematite were found as opacifiers and/or colorants. In addition, a detailed discussion of raw materials, such as fluorite and borax, might provide valuable information to trace manufacturing technology and provenance.
Exact analysis of displacements and stresses in 2-D orthotopic laminates under extension is conducted. On the basis of the Hamiltonian state space approach and the transfer matrix method, a complete solution, in the context of generalized strain, which exactly satisfies the state space equation, the traction-free BC on the top and bottom surfaces of the rectangular section, the interfacial continuity conditions in multi-layered laminates, and the end conditions on free edges, is obtained by combing the eigensolutions and the particular solution. Evaluating of the stresses in the boundary layer for verification shows that the stress decay in laminates under uniform extension may be slow and the edge effects may be pronounced.
To assess correlations between cruciferous vegetable intake and urinary isothiocyanate (ITC) level, in addition to glutathione S-transferase (GST) genotypes and other individual factors.
The study included cohort participants whose urinary ITC levels had been previously ascertained. Urinary ITC was assessed using HPLC. Usual dietary intake of cruciferous vegetables was assessed using a validated FFQ and total dietary ITC intake was calculated. Recent cruciferous vegetable intake was determined. GST genotypes were assessed using duplex real-time quantitative PCR assays. Spearman correlations were calculated between the covariates and urinary ITC levels and linear regression analyses were used to calculate the mean urinary ITC excretion according to GST genotype.
Urban city in China.
The study included 3589 women and 1015 men from the Shanghai Women’s and Men’s Health Studies.
Median urinary ITC level was 1·61 nmol/mg creatinine. Self-reported usual cruciferous vegetable intake was weakly correlated with urinary ITC level (rs=0·1149; P<0·0001), while self-reported recent intake was more strongly correlated with urinary ITC (rs=0·2591; P<0·0001). Overall, the GST genotypes were not associated with urinary ITC level, but significant differences according to genotype were observed among current smokers and participants who provided an afternoon urine sample. Other factors, including previous gastrectomy or gastritis, were also related to urinary ITC level.
The study suggests that urinary secretion of ITC may provide additional information on cruciferous vegetable intake and that GST genotypes are related to urinary ITC level only in some subgroups.
Despite substantial research, uncertainty remains about the clinical and etiological heterogeneity of major depression (MD). Can meaningful and valid subtypes be identified and would they be stable cross-culturally?
Symptoms at their lifetime worst depressive episode were assessed at structured psychiatric interview in 6008 women of Han Chinese descent, age ⩾30 years, with recurrent DSM-IV MD. Latent class analysis (LCA) was performed in Mplus.
Using the nine DSM-IV MD symptomatic A criteria, the 14 disaggregated DSM-IV criteria and all independently assessed depressive symptoms (n = 27), the best LCA model identified respectively three, four and six classes. A severe and non-suicidal class was seen in all solutions, as was a mild/moderate subtype. An atypical class emerged once bidirectional neurovegetative symptoms were included. The non-suicidal class demonstrated low levels of worthlessness/guilt and hopelessness. Patterns of co-morbidity, family history, personality, environmental precipitants, recurrence and body mass index (BMI) differed meaningfully across subtypes, with the atypical class standing out as particularly distinct.
MD is a clinically complex syndrome with several detectable subtypes with distinct clinical and demographic correlates. Three subtypes were most consistently identified in our analyses: severe, atypical and non-suicidal. Severe and atypical MD have been identified in multiple prior studies in samples of European ethnicity. Our non-suicidal subtype, with low levels of guilt and hopelessness, may represent a pathoplastic variant reflecting Chinese cultural influences.