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Little is known about long-term employment outcomes for patients with first-episode schizophrenia-spectrum (FES) disorders who received early intervention services.
We compared the 10-year employment trajectory of patients with FES who received early intervention services with those who received standard care. Factors differentiating the employment trajectories were explored.
Patients with FES (N = 145) who received early intervention services in Hong Kong between 1 July 2001 and 30 June 2002 were matched with those who entered standard care 1 year previously. We used hierarchical clustering analysis to explore the 10-year employment clusters for both groups. We used the mixed model test to compare cluster memberships and piecewise regression analysis to compare the employment trajectories of the two groups.
There were significantly more patients who received the early intervention service in the good employment cluster (early intervention: N = 98 [67.6%]; standard care: N = 76 [52.4%]; P = 0.009). In the poor employment cluster, there was a significant difference in the longitudinal pattern between early intervention and standard care for years 1–5 (P < 0.0001). The number of relapses during the first 3 years, months of full-time employment during the first year and years of education were significant in differentiating the clusters of the early intervention group.
Results suggest there was an overall long-term benefit of early intervention services on employment. However, the benefit was not sustained for all patients. Personalisation of the duration of the early intervention service with a focus on relapse prevention and early vocational reintegration should be considered for service enhancement.
Declaration of interests
No relevant conflicts of interests reported by C.L.M.H., Y.N.S., P.S., H.H.P. and K.K.Y. S.K.W.C., W.C.C. and E.H.M.L. report that they are members of the working group of the Early Assessment Service for Young People with Psychosis (EASY) programme of the Hospital Authority in Hong Kong. E.Y.H.C. is the convener of the working group of the EASY programme of the Hospital Authority in Hong Kong.
We present possible conceptual designs of a laser system for driving table-top free-electron lasers based on terahertz acceleration. After discussing the achievable performances of laser amplifiers with Yb:YAG at cryogenic and room temperature and Yb:YLF at cryogenic temperature, we present amplification modules with available results and concepts of amplifier chains based on these laser media. Their performances are discussed in light of the specifications for the tasks within the table-top light source. Technical and engineering challenges, such as cooling, control, synchronization and diagnostics, are outlined. Three concepts for the laser layout feeding the accelerator are eventually derived and presented.
Evidence regarding the relationships between the socioeconomic status and
long-term outcomes of individuals with bipolar affective disorder (BPD)
We aimed to estimate the effects of baseline socioeconomic status on
A national cohort of adult participants with newly diagnosed BPD was
identified in 2008. The effects of personal and household socioeconomic
status were explored on outcomes of hospital treatment, mortality and
healthcare costs, over a 3-year follow-up period (2008–2011).
A total of 7987 participants were recruited. The relative risks of
hospital treatment and mortality were found elevated for the ones from
low-income households who also had higher healthcare costs. Low premium
levels did not correlate with future healthcare costs.
Socioeconomic deprivation is associated with poorer outcome and higher
healthcare costs in BPD patients. Special care should be given to those
with lower socioeconomic status to improve outcomes with potential
benefits of cost savings in the following years.
To secure the reliability of flexible electronics, the effect of multicomponent stress on the device properties during complex mechanical deformation needs to be thoroughly understood. The electrical resistances of metal interconnects are investigated by in situ monitoring at different twisting angles and with different pattern positions. As the twisting angle increased, the electrical resistance increased earlier. Furthermore, in the line pattern located far from the central axis, severe electrical degradation and fatigue damage formation were observed. Multicomponent stress evolution during twisting was analyzed by the finite-element simulation method. For easy practical application for estimating the representative twisting strain, an analytic solution of twisting deformation was formulated and compared with the simulation. Using the equivalent strain, the fatigue lifetime was fitted, and the exponents were obtained for lifetime expectation. This systematic study provides the guidelines for highly reliable flexible devices and the tools for determining the expected fatigue lifetime.
The flow and the turbulence structure generated by a circular porous cylinder of diameter
containing solid cylinders of diameter
placed in an open channel of depth
are investigated using eddy-resolving simulations which resolve the wakes past the individual solid cylinders in the array. The solid cylinders extend from the bed through the water surface. This geometrical set-up is directly relevant to understand the physics of flow past an emerged patch of aquatic vegetation developing in a river channel or over its floodplain. Simulations are conducted with different solid volume fractions (SVFs) of the porous cylinder (
), relative diameters of the solid cylinders (
and 0.06) and with flat and equilibrium scour bathymetry corresponding to the start and respectively the end of the erosion and deposition process. Comparison with the limiting case of a solid cylinder (
) is also discussed. The bed shear stress distributions and the turbulent flow fields are used to explain the sediment erosion mechanisms inside and around the porous cylinder. Simulations of the flat-bed cases reveal that for sufficiently large SVF values (
), necklace vortices form around the upstream face of the cylinder, the downflow penetrates partially inside the porous cylinder and a region of strong flow acceleration forms on the sides of the porous cylinder. These flow features are used to explain the development of scour around high-SVF porous cylinders. The effects of the SVF and
on generating ‘corridors’ of strong flow acceleration in between the solid cylinders and energetic eddies in the wake of these cylinders are discussed, as these flow features control the amplification of the bed shear stress inside the porous cylinder. Simulations results are also used to quantify the time-averaged drag forces on the cylinders in the array, to identify the regions where these forces are comparable to those induced on an isolated cylinder and the percentage of cylinders in the array subject to relatively large mean drag forces. A logarithmic decrease of the mean time-averaged streamwise drag coefficient of the solid cylinders,
, with increasing non-dimensional frontal area per unit volume of the porous cylinder,
, is observed. Behind the cylinder, the eddies shed in the separated shear layers (SSLs) of the porous cylinder, and, for sufficiently large SVFs, the von Kármán wake billows are the main coherent structures responsible for the amplification of the bed shear stress and sediment entrainment. This paper also analyses the vertical non-uniformity of the mean flow and turbulent kinetic energy, and discusses how the SVF and bathymetry affect the spatial extent of the wake region (e.g. length of the SSLs and steady wake, total wake length) and other relevant variables (e.g. strength of the bleeding flow, dominant wake frequencies, turbulence amplification in the near wake). For the relatively shallow flow conditions (
) considered, the simulation results show that the antisymmetric (von Kármán) shedding of wake billows behind the porous cylinder is greatly weakened once equilibrium scour conditions are approached. Comparison with data from laboratory experiments and from 3-D and 2-D simulations conducted for long porous cylinders (no bed) is also discussed.
A sediment core (14DH-C01) obtained from the mouth of Gomso Bay, on the west coast of South Korea, was used to obtain high-resolution palynomorph, grain-size, and 14C age data to investigate the Holocene sedimentary environment. The results indicated a transgressive depositional process with four stages controlled by sea-level change, as follows: river-dominated fluvial deposition from the early Holocene to 8.48 cal ka BP; tide-dominated tidal channel fill transgression from 8.48 to 8.08 cal ka BP; tide- to wave-dominated tidal channel fill transgression from 8.08 to 6.98 cal ka BP; and wave-dominated marine transgression from 6.98 cal ka BP to the present. Tidal channel filling was the primary mid-Holocene depositional process, accounting for the high sedimentation rate observed. The different hydrodynamics of the river-dominated, tide-dominated, tide- to wave-dominated, and wave-dominated processes following the changes in sea level may have controlled the transgressive depositional process. This transgressive sedimentary model differs from those of other large river mouth areas (e.g., the Changjiang River) since the mid-Holocene, perhaps resulting from the limited sediment supply in the study area.
The predictability of modified constitutive model, based on Arrhenius type equation, for illustrating the flow behavior of Fe–36%Ni Invar alloy was investigated via isothermal hot compression tests. The hot deformation tests were carried out in a temperature range of 850–1100 °C and strain rates from 0.01 to 10 s−1. True stress-true strain curves exhibited the dependence of the flow stress on deformation temperatures and strain rates, which then described in Arrhenius-type equation by Zener–Holloman parameter. Moreover, the related material constants and hot deformation activation energy (Q) in the constitutive model were calculated by considering the effect of strain as independent function on them and employing sixth polynomial fitting. Subsequently, the performance of the modified constitutive equation was verified by correlation coefficient and average absolute relative error which were estimated in accordance with experimental and predicted data. The results showed that the modified constitutive equation possess reliable and stable ability to predict the hot flow behavior of studied material under different deformation conditions. Meanwhile, Zener–Holloman parameter map was established according to the modified constitutive equation and used to estimate the extent of dynamic recrystallization.
The purpose of this study was to investigate the effects of 8-week green tea extract (GTE) supplementation on promoting postexercise muscle glycogen resynthesis and systemic energy substrate utilisation in young college students. A total of eight healthy male participants (age: 22·0 (se 1·0) years, BMI: 24·2 (se 0·7) kg/m2, VO2max: 43·2 (se 2·4) ml/kg per min) participated in this study. GTE (500 mg/d for 8 weeks) was compared with placebo in participants in a double-blind/placebo-controlled and crossover study design with an 8-week washout period. Thereafter, all participants performed a 60-min cycling exercise (75 % VO2max) and consumed a carbohydrate-enriched meal immediately after exercise. Vastus lateralis muscle samples were collected immediately (0 h) and 3 h after exercise, and blood and gaseous samples were collected during the 3-h postexercise recovery period. An 8-week oral GTE supplementation had no effects on further promoting muscle glycogen resynthesis in exercised human skeletal muscle, but the exercise-induced muscle GLUT type 4 (GLUT4) protein content was greater in the GTE supplementation trial (P<0·05). We observed that, during the postexercise recovery period, GTE supplementation elicited an increase in energy reliance on fat oxidation compared with the placebo trial (P<0·05), although there were no differences in blood glucose and insulin responses between the two trials. In summary, 8-week oral GTE supplementation increases postexercise systemic fat oxidation and exercise-induced muscle GLUT4 protein content in response to an acute bout of endurance exercise. However, GTE supplementation has no further benefit on promoting muscle glycogen resynthesis during the postexercise period.
In this study, we have developed a facile and simple route for preparation of ultrafine CoO/reduced graphene oxide (rGO) nanohybrids with tunable particle size and crystallinity for lithium-ion battery (LIB) application. At the optimized calcination time of 60 min, the homogeneous and ultrafine CoO nanoparticles with mean size of 4.5 nm can be intimately attached onto rGO surface to rapidly transport Li ions and electrons. The CoO/rGO exhibits excellent rate capability and high specific capacity of 520 mAh/g at 2400 mA/g. In addition, the capacity can be recovered to 900 mAh/g at 150 mA/g after 60 cycles, indicating the superior electrochemical performance of CoO/rGO for LIB applications.
The prevalence of CHD has been well described worldwide except in Tibet. This study aimed to illustrate the prevalence and composition of CHD in Tibetan children according to altitude.
Methods and results
In the first part, we prospectively recruited 7088 unselected Tibetan children (4–17 years) from south-west Tibet. The total prevalence of CHD increased from 4.6/1000 below 4200 m to 13.4/1000 above 4700 m, with a female-to-male ratio of 1.3:3.1. The total prevalence and female prevalence of patent ductus arteriosus increased more than 10-fold. Females living above 4700 m had exceptionally high prevalence of patent ductus arteriosus (14.9/1000). The prevalence of atrial septal defect was comparable among different altitudes (3.3–3.8/1000). The prevalence of ventricular septal defect was 1.3/1000 below 4700 m, and no cases were found above this altitude. In the second part, we retrospectively reviewed the clinical data of 383 CHD children in Tibet and 73 children at lower altitudes. The percentage of isolated ventricular septal defect decreased from 54.8 to 3.1%, and the percentage of isolated patent ductus arteriosus increased from 8.2 to 68.4% with elevation. Children living below 4200 m (10.4–13.7%) had a larger proportion of complex CHD than those above this altitude (2.0–3.1%). Of the 20 Tibetan children with complex CHD, 14 (70.0%) lived below 4200 m.
A wide variation in CHD prevalence and composition existed in Tibetan children among different altitudes.
The hydrobaric effect on photoactivity of titanium dioxide (TiO2) fabricated by cathodic deposition in an aqueous solution was evaluated in this study. When the applied pressure was increased to 35 MPa, the water-splitting performance was improved by almost fourfold of the performance of the TiO2 prepared at atmospheric pressure. The surface states effect was significant in the deposited TiO2, which was exploited to affect the charges recombination of TiO2, and thereby enhance the resultant photoelectrochemical water-splitting performance. The hydrobaric cathodic deposition could be extended to fabrication of other metal oxides to eliminate the negative influence from the high-temperature process.
The (conditional or unconditional) distribution of the continuous scan statistic in a one-dimensional Poisson process may be approximated by that of a discrete analogue via time discretization (to be referred to as the discrete approximation). Using a change of measure argument, we derive the first-order term of the discrete approximation which involves some functionals of the Poisson process. Richardson's extrapolation is then applied to yield a corrected (second-order) approximation. Numerical results are presented to compare various approximations.
The aim of this study was to determine the fatty acid (FA) composition of breast milk, and its association with mothers’ FA intake. Milk samples were obtained from 238 healthy lactating women who volunteered to participate in the Human Milk Micronutrients Analysis Research. Dietary intake during lactation was assessed using a 3-d food record, and fat content and FA composition of the breast milk samples were analysed by IR spectrometry using MilkoScan FT2 and GC flame ionisation detector, respectively. The fat content was 3·31 (sd 1·41) g/100 ml breast milk. The concentrations of arachidonic acid (20 : 4 n-6), EPA (20 : 5 n-3) and DHA (22 : 6 n-3) in breast milk were 0·48 (sd 0·13), 0·15 (sd 0·12) and 0·67 (sd 0·47) % of total FA, respectively. Fat content and FA composition of breast milk were associated with maternal age, BMI, supplement use and infant age. Dietary intakes of EPA, DHA, n-3 FA, n-6 FA, SFA and PUFA were positively correlated with the corresponding FA in the milk samples. FA levels in breast milk and maternal diet are highly correlated. Further studies are warranted to explore factors that may be associated with changes in FA composition in human milk.