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To explore whether and how group cognitive-behavioural therapy (GCBT) plus medication differs from medication alone for the treatment of generalised anxiety disorder (GAD).
Hundred and seventy 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, the Severity Subscale of Clinical Global Impression Scale, Global Assessment of Functioning, and the 12-item Short-Form Health Survey. Assessments were conducted at baseline, 4-week, 8-week, and 3-month follow-up.
At 4 weeks, HAMA response (GCBT group 57.0% vs. control group 24.4%, p=0.000, Cohen’s 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-month 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 [odds ratio (OR)=2.12, 95% confidence interval (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 that GCBT was effective in changing cognitive style.
Altered heart rate variability (HRV), an index of autonomic nervous system function, has been reported in generalized anxiety disorder (GAD), but the results have been mixed. Thus, the present study, using a large sample size and better methodology, aims to examine whether GAD is associated with impaired HRV, both at rest and in response to posture challenges.
In total, 1832 participants were recruited in this study, consisting of 682 patients with GAD (including 326 drug- and comorbidity-free GAD patients) and 1150 healthy controls. Short-term HRV was measured during the supine-standing-supine test (5-min per position). Propensity score matching (PSM), a relatively novel method, was used to control for potential confounders.
After PSM algorithm, drug- and comorbidity-free GAD patients had reductions in resting (baseline) high-frequency power (HF), an index for parasympathetic modulation, and increases in the low-frequency/HF ratio (LF/HF), an index for sympathovagal balance as compared to matched controls. Furthermore, the responses of HF and LF/HF to posture changes were all attenuated when compared with matched controls. Effect sizes, given by Cohen's d, for resting HF and HF reactivity were 0.42 and 0.36–0.42, respectively.
GAD is associated with altered sympathovagal balance, characterized by attenuation in both resting vagal modulation and vagal reactivity, with an almost medium effect size (Cohen's d ≈ 0.4), regardless of medication use or comorbidity status.
This paper is aimed at the risk assessment of operational safety for oil tankers. Based on the operational features of oil tankers and relevant literature, the Risk Factors (RFs) of operational safety were first identified. A revised risk matrix based on a fuzzy Analytical Hierarchy Process (AHP) approach was then proposed to assess the risk classes of the RFs. Finally, to validate the research model, the oil tanker fleet of Chinese Petroleum Corporation (CPC) in Taiwan was empirically investigated. The results can provide practical information for oil carriers to improve their ships' operational safety. Furthermore, the revised risk matrix may provide a theoretical reference for methodological researches in safety risk assessments.
Effective perioperative hand antisepsis is crucial for the safety of patients and medical staff in surgical rooms. The antimicrobial effectiveness of different antiseptic methods, including conventional hand scrubs and waterless hand rubs, has not been well evaluated.
DESIGN, SETTING, AND PARTICIPANTS
A randomized controlled trial was conducted to investigate the effectiveness of the 3 antiseptic methods among surgical staff of Taipei Medical University—Shuang Ho Hospital. For each method used, a group of 80 participants was enrolled.
Surgical hand cleansing with conventional 10% povidone–iodine scrub, conventional 4% chlorhexidine scrub, or waterless hand rub (1% chlorhexidine gluconate and 61% ethyl alcohol).
Colony-forming unit (CFU) counts were collected using the hand imprinting method before and after disinfection and after surgery. After surgical hand disinfection, the mean CFU counts of the conventional chlorhexidine (0.5±0.2, P<0.01) and waterless hand rub groups (1.4±0.7, P<0.05) were significantly lower than that of the conventional povidone group (4.3±1.3). No significant difference was observed in the mean CFU count among the groups after surgery. Similar results were obtained when preexisting differences before disinfection were considered in the analysis of covariance. Furthermore, multivariate regression indicated that the antiseptic method (P=.0036), but not other variables, predicted the mean CFU count.
Conventional chlorhexidine scrub and waterless hand rub were superior to a conventional povidone–iodine product in bacterial inhibition. We recommend using conventional chlorhexidine scrub as a standard method for perioperative hand antisepsis. Waterless hand rub may be used if the higher cost is affordable.
The purpose of the present study was to examine the influence of maternal pre-pregnancy BMI and gestational weight gain (GWG) on initiation and duration of infant breast-feeding in a prospective birth cohort study.
Breast-feeding information was collected at 1, 3, 6 and 12 months postpartum. The association of pre-pregnancy BMI and GWG with delayed lactogenesis II and termination of exclusive breast-feeding was assessed with logistic regression analysis. The risk of early termination of any breast-feeding during the first year postpartum was assessed with Cox proportional hazards models.
Urban city in China.
Women with infants from the Ma’anshan Birth Cohort Study (n 3196).
The median duration of any breast-feeding in this cohort was 7·0 months. Pre-pregnancy obese women had higher risks of delayed lactogenesis II (risk ratio=1·89; 95 % CI 1·04, 3·43) and early termination of any breast-feeding (hazard ratio=1·38; 95 % CI 1·09, 1·75) adjusted for potential maternal and infant confounders, when compared with normal-weight women. No differences in breast-feeding initiation or duration of exclusive breast-feeding according to pre-pregnancy BMI were found. Moreover, GWG was not associated with any poor breast-feeding outcomes.
The present study indicated that pre-pregnancy obesity increases the risks of delayed lactogenesis II and early termination of any breast-feeding in Chinese women.
The long-term outcome of never-treated patients with schizophrenia is
To compare the 14-year outcomes of never-treated and treated patients
with schizophrenia and to establish predictors for never being
All participants with schizophrenia (n = 510) in Xinjin,
Chengdu, China were identified in an epidemiological investigation of 123
572 people and followed up from 1994 to 2008.
The results showed that there were 30.6%, 25.0% and 20.4% of patients who
received no antipsychotic medication in 1994, 2004 and 2008 respectively.
Compared with treated patients, those who were never treated in 2008 were
significantly older, had significantly fewer family members, had higher
rates of homelessness, death from other causes, being unmarried, living
alone, being without a caregiver and poor family attitudes. Partial and
complete remission in treated patients (57.3%) was significantly higher
than that in the never-treated group (29.8%). Predictors of being in the
never-treated group in 2008 encompassed baseline never-treated status,
being without a caregiver and poor mental health status in 1994.
Many patients with schizophrenia still do not receive antipsychotic
medication in rural areas of China. The 14-year follow-up showed that
outcomes for the untreated group were worse. Community-based mental
healthcare, health insurance and family intervention are crucial for
earlier diagnosis, treatment and rehabilitation in the community.
Obesity and hyperlipidaemia increase the risk of CVD. Some strains of probiotics have been suggested to have potential applications in cardiovascular health by lowering serum LDL-cholesterol. In this work, high-fat diet-induced hyperlipidaemia in hamsters was treated with different doses (5×108 and 2·5×109 cells/kg per d) of heat-killed Lactobacillus reuteri GMNL-263 (Lr263) by oral gavage for 8 weeks. The serum lipid profile analysis showed that LDL-cholesterol and plasma malondialdehyde (P-MDA) were reduced in the GMNL-263 5×108 cells/kg per d treatment group. Total cholesterol and P-MDA were reduced in the GMNL-263 2·5×109 cells/kg per d treatment group. In terms of heart function, the GMNL-263 2·5×109 cells/kg per d treatments improved the ejection fraction from 85·71 to 91·81 % and fractional shortening from 46·93 to 57·92 % in the high-fat diet-fed hamster hearts. Moreover, the GMNL-263-treated, high-fat diet-fed hamster hearts exhibited reduced Fas-induced myocardial apoptosis and a reactivated IGF1R/PI3K/Akt cell survival pathway. Interestingly, the GMNL-263 treatments also enhanced the heat-shock protein 27 expression in a dose-dependent manner, but the mechanism for this increase remains unclear. In conclusion, supplementary heat-killed L. reuteri GMNL-263 can slightly reduce serum cholesterol. The anti-hyperlipidaemia effects of GMNL-263 may reactivate the IGF1R/PI3K/Akt cell survival pathway and reduce Fas-induced myocardial apoptosis in high-fat diet-fed hamster hearts.
In this paper, the hole carrier mobility of organic semiconductor N,N′-diphenyl-N,N′bis(1,1′-biphenyl)-4,4′-diamine (NPD) was researched by negative differential susceptance spectra (−ΔB = −w(C − Cgeo) ~ f). Under the condition of space charge limited current (SCLC), through solving the drift current equation and Poisson equation and simulating the spectra −ΔB = −w(C − Cgeo) ~ f, the relationship between the peak of −ΔB = −w(C − Cgeo) ~ f spectra (1/ƒp = τp) and the transfer time of carrier (τdc) could be achieved to be τdc = k × τp. So the hole-only device of ITO/NPD/Ag was fabricated to determine the capacitance spectra, and through which its −ΔB = −w(C − Cgeo) ~ f could be plotted. According to the relationship of τdc = k × τp, where k was determined to be 0.56, the transfer time and further the carrier mobility could be obtained. The carrier mobility depended on the electric field according to Poole-Frenkel model was further investigated in this report.
The present study aimed to compare the effects of a general dietary intervention and an intervention with low glycaemic load (GL) on glycaemic control, blood lipid metabolism and pregnancy outcomes in women with gestational diabetes mellitus.
Participants were randomly assigned to two groups, receiving either an individualized general dietary intervention (Control group) or an intensive low-GL intervention (Low-GL group) every two weeks, from 24–26 weeks of gestation to delivery.
The Center of Maternal Primary Care in Guangdong General Hospital, China.
Ninety-five women with gestational diabetes mellitus were enrolled from June 2008 to July 2009.
After the intervention, both groups significantly decreased their dietary intakes of energy, fat and carbohydrate. The Low-GL group had significantly lower values for GL (122 v. 136) and glycaemic index (50 v. 54) but greater dietary fibre intake (33 v. 29 g/d) than did the Control group (all P<0·01). Significantly greater decreases in fasting plasma glucose (−0·33 v. −0·02 mmol/l, P<0·01) and 2 h postprandial glucose (−2·98 v. −2·51 mmol/l, P<0·01), significantly lower increases in total cholesterol (0·12 v. 0·23 mmol/l) and TAG (0·41 v. 0·56 mmol/l) and a significantly lower decrease in HDL cholesterol (−0·01 v. −0·11 mmol/l) were also observed in the Low-GL group compared with the Control group (all P<0·05). There were no significant differences in body weight gain, birth weight or other maternal–fetal perinatal outcomes between the two groups.
The low-GL targeted dietary intervention outperformed the general dietary intervention in glycaemic control and the improvement of blood lipid levels in women with gestational diabetes mellitus.
Neurosyphilis (NS) may present with neuropsychiatric disorders characterized by cognitive impairment, personality disorders, and confusion, among others. Very few studies have focused on neuropsychiatric disorders secondary to NS in elderly people.
A retrospective chart review was performed to characterize the psychiatric findings, clinical signs and symptoms, laboratory findings, and brain magnetic resonance imaging results of ten elderly inpatients with NS.
In these ten patients, the most common presenting symptoms included a wide variety of psychiatric manifestations. The serum rapid plasma regain (RPR) and Treponema pallidum particle agglutination assay (TPPA) of the ten patients were positive, with positive CSF TPPA and RPR rates of 100% and 60%, respectively. In addition, 90% of the patients demonstrated abnormal imaging, including cerebral atrophy, infarct ischemic stroke, and hydrocephalus.
Our findings support the importance of serological tests for syphilis as a routine component of the evaluation of patients with clinically evident neurological or psychiatric symptoms. If the serology is positive, all of the patients should be examined with a lumbar puncture. Moreover, psychiatric illnesses secondary to NS in the elderly also deserve medical attention.
The junction characteristics between ZnO:Ga (GZO) film and p-Si substrate are discussed in the research. For the transparent semiconductor ZnO, the element Ga is chosen to be the dopant source to produce a high quality n-type ZnO thin film. The ZnO:Ga (GZO) film shows a average transmittance is 84.7% (above 400 nm), a bandgap energy of 3.37 eV, a carrier concentration of 7.29×1013 cm−3and a resistivity of 118 Ω-cm. For the GZO/p-Si junction, it shows a junction barrier height of 0.54 eV with an ideality factor of 1.24. The capacitance-voltage measurement shows that it has a uniform reverse bias depletion layer. The Cheung function is also brought to discussion the diode characteristics.
Ultrashort electron bunch trains can be used for plasma wake field acceleration (PWFA) to overcome the limit of transformer ratio of a single electron bunch, or high-power terahertz (Thz) radiation production by various radiation mechanisms. Basic facility for high-power THz radiation development based on ultrashort electron beam has been set up at accelerator lab of TUB. Using birefringent crystal serials, ultraviolet (UV) pulse shaping for photocathode radio frequency gun to produce THz-repetition-rate pulse train was realized. Driven by such pulses, ultrashort electron bunch train with picosecond (ps) spacing was obtained for THz production. Measurement of the stacked UV pulse trains was done by difference frequency generation (DFG), and the measured group velocity mismatch of α-BBO crystal at 266.7-nm wavelength was 0.8 ps/mm. This method may also be applied to form ramped electron bunch trains for PWFA.
To determine the association between major dietary patterns characterized by factor analysis and risk of depression and anxiety symptoms among adolescents.
Diet and symptoms of depression and anxiety were assessed in a cross-sectional survey among students attending junior high school. Dietary patterns were derived from a self-reported FFQ, which consisted of thirty-eight items. Anthropometric measurements were also performed.
Four junior high schools in Bengbu city, China.
A random sample of 5003 adolescents, 11–16 years of age (mean 13·21 years).
Three major dietary patterns were identified in the study based on factor analysis: ‘snack’, ‘animal food’ and ‘traditional’. The prevalence of depression symptoms, anxiety disorders and the coexistence of both were 11·2 % (560/5003), 14·6 % (732/5003) and 12·6 % (629/5003), respectively. After adjustment for potential confounders, adolescents in the highest tertile of snack dietary pattern scores had a higher odds for ‘pure’ psychological symptoms (‘depression without anxiety’, OR = 1·64; 95 % CI 1·30, 2·06; and ‘anxiety without depression’, OR = 1·87; 95 % CI 1·51, 2·31) compared with coexisting depression and anxiety (OR = 1·93; 95 % CI 1·54, 2·43). Similar to snacks, high consumption of animal foods was associated with a higher risk of psychological symptoms. Compared with low consumption, adolescents in the highest tertile of traditional dietary pattern scores had lower odds for ‘pure’ depression (OR = 0·38; 95 % CI 0·30, 0·49), ‘pure’ anxiety (OR = 0·85; 95 % CI 0·69, 1·04) and coexisting anxiety and depression (OR = 0·50; 95 % CI 0·39, 0·63).
Data from Chinese secondary-school adolescents validated findings from adult populations. Dietary patterns should be considered as important predictors of depression and anxiety among adolescents in further studies.
A high performance of wavelength 870nm resonant cavity LED (RCLED) was fabricated. The high performance of InGaAs/GaAs multiple quantum wells (MQWs) and distributed Bragg reflector (DBR) were employed to achieve the high transmission rate. Two devices A and B were fabricated in this paper. Device A has an offset of 10nm between active region gain and resonant gain, and device B without it. Due to the wavelength shift of active region gain is faster than that of DBR's resonant gain at higher temperature. Device A shows the better temperature performances than device B. A cutoff frequency of 60MHz, a low forward voltage of 1.6V, a output power of 1mW at 10mA and a output power temperature variation (ΔP/ΔT) of –0.02dBm/ °C with chip dimensions of 220um × 220um and 85um diameter emitting window are obtained.
The ZnO thin film was successfully deposited on a glass substrate at RT by a RF reactive magnetron sputtering method. Structural, chemical, optical, and hydrophilic/hydrophobic properties are measured by using a surface profilometer, an x-ray diffractometry (XRD), an x-ray photoelectron spectroscopy (XPS), a UV-VIS spectrophotometer, and a contact angle system, respectively. Results show that the deposition rate decreases with increasing O2/(Ar+O2) ratio. Otherwise, the best stoichiometric and quality of ZnO thin film was observed at 0.30 of O2/(Ar+O2) ratio by the smallest FWHM and the strong O-Zn bonds. Regardless of O2/(Ar+O2) ratio effect or thickness effect, high transmittance (> 86%) in the visible region is observed, while the UV-shielding characteristics depend upon both the magnitude of film thickness. The film thickness plays a more prominent role in controlling optical properties, especially in the UV-shielding characteristics, than the O2/(Ar+O2) ratio. However, the hydrophobic characteristics can be obtained when the glass coating with ZnO thin films. In general, with properly coated ZnO thin film, we can obtain a glass substrate which is highly transparent in the visible region, has good UV-shielding characteristics, and possesses highly hydrophobic characteristics (self-clean capability), which is highly suitable for applications in the glass industries.
Bitter melon (Momordica charantia; BM) has been shown to ameliorate diet-induced obesity and insulin resistance. To examine the effect of BM supplementation on cell size and lipid metabolism in adipose tissues, three groups of rats were respectively fed a high-fat diet supplemented without (HF group) or with 5 % lyophilised BM powder (HFB group), or with 0·01 % thiazolidinedione (TZD) (HFT group). A group of rats fed a low-fat diet was also included as a normal control. Hyperinsulinaemia and glucose intolerance were observed in the HF group but not in HFT and HFB groups. Although the number of large adipocytes (>180 μm) of both the HFB and HFT groups was significantly lower than that of the HF group, the adipose tissue mass, TAG content and glycerol-3-phosphate dehydrogenase activity of the HFB group were significantly lower than those of the HFT group, implying that BM might reduce lipogenesis in adipose tissue. Experiment 2 was then conducted to examine the expression of lipogenic genes in adipose tissues of rats fed low-fat, HF or HFB diets. The HFB group showed significantly lower mRNA levels of fatty acid synthase, acetyl-CoA carboxylase-1, lipoprotein lipase and adipocyte fatty acid-binding protein than the HF group (P < 0·05). These results indicate BM can reduce insulin resistance as effective as the anti-diabetic drug TZD. Furthermore, BM can suppress the visceral fat accumulation and inhibit adipocyte hypertrophy, which may be associated with markedly down regulated expressions of lipogenic genes in the adipose.
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