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Understanding disease-modifying therapy (DMT) use and healthcare resource utilization by different geographical areas among people living with multiple sclerosis (pwMS) may identify care gaps that can be used to inform policies and practice to ensure equitable care.
Methods:
Administrative data was used to identify pwMS on April 1, 2017 (index date) in Alberta. DMT use and healthcare resource utilization were compared between those who resided in various geographical areas over a 2-year post-index period; simple logistic regression was applied.
Results:
Among the cohort (n = 12,338), a higher proportion of pwMS who resided in urban areas (versus rural) received ≥ 1 DMT dispensation (32.3% versus 27.4%), had a neurologist (67.7% versus 63.9%), non-neurologist specialist (88.3% versus 82.9%), ambulatory care visit (87.4% versus 85.3%), and MS tertiary clinic visit (59.2% versus 51.7%), and a lower proportion had an emergency department (ED) visit (46.3% versus 62.4%), and hospitalization (20.4% versus 23.0%). Across the provincial health zones, there were variations in DMT selection, and a higher proportion of pwMS who resided in the Calgary health zone, where care is managed by MS tertiary clinic neurologists, had an outpatient visit to a neurologist or MS tertiary clinic versus those who resided in other zones where delivery of MS-related care is more varied.
Conclusions:
Urban/rural inequalities in DMT use and healthcare resource utilization appear to exist among pwMS in Alberta. Findings suggest the exploration of barriers with consequent strategies to increase access to DMTs and provide timely outpatient MS care management, particularly for those pwMS residing in rural areas.
Poor social inclusion, as a cause and consequence simultaneously, has been associated with schizophrenia spectrum disorder (SSD). It can bring a substantial burden to individual families and the society. Previous studies lack 1) the quantitative exploration of (multidimensional) social inclusion which can enable the measurement and monitor of the level of social integration, 2) longitudinal and multivariate study designs, and 3) methodological comparison between the traditional and data-driven approaches for a better clinical suitability of monitoring and managing social inclusion.
Objectives
To build and compare 3-year models predictive of multidimensional social inclusion (mSI) among the SSD patients, using standard and data-driven approaches.
Methods
We used the baseline and 3-year follow-up data of 1,119 patients from the Genetic Risk and Outcome in Psychosis. Social functioning (Social Functioning Scale, SFS) and quality of life (the brief version of the World Health Organization Quality of Life, WHOQOL-BREF) were used as a proxy of mSI. K-means clustering over the 13 subscales of SFS and WHOQOL-BREF was applied to identify mSI subgroups. Prediction models were built and internally validated via multinomial logistic regression (MLR) and random forest (RF). The MLR and RF model performance was compared by accuracy and the discriminability of mSI subgroups (i.e., p-value of one-sided binomial test between the accuracy and no information rate).
Results
Five mSI groups were identified: 1) “very low (in SFS)/very low (in WHOQOL-BREF)” (8.58%), 2) “low/low” (12.87%), 3) “high/low” (49.24%), 4) “medium/high” (18.05%), and 5) “high/high” (11.26%). Both MLR and RF models included 22 predictors and demonstrated accuracies of 59.16% (95CI%: [55.75%, 62.58%], p = 0.994) and 61.61% (95%CI: [54.90%, 68.01%], p = 0.013) correspondingly. The mSI was robustly and mainly and robustly predicted by genetic predisposition, premorbid social functioning, symptoms (i.e., positive, negative and depressive), number of met needs and baseline satisfaction with the environment and social life.
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Conclusions
Notwithstanding comparable accuracies, we cautiously consider the RF model outperforming primarily due to its better discriminability. As the baseline conditions of the patients with SSD could indicate the 3-year mSI level, customized amount and types of resources and interventions can be designed to improve the level of multidimensional social inclusion of all SSD patients.
We conducted the first detailed mineral magnetic investigation of more than nine loess–paleosol couplets of the composite Titel-Stari Slankamen loess section in Serbia, which provides one of the longest and most complete terrestrial record of paleoclimatic changes in Europe since ~1.0 Ma. The results show that the ferrimagnetic mineral assemblage of the loess units is dominated by partially oxidized multidomain (MD) and pseudo-single domain (PSD) magnetite; however, with an increasing degree of pedogenesis, the eolian contribution is gradually masked by pedogenic superparamagnetic(SP) and single-domain (SD) ferrimagnets (mainly maghemite). The overall consistency of ferrimagnetic grain-size parameters indicates an absence of dissolution of the fine-grained ferrimagnetic fraction despite changes in climate regime over the past 1.0 Ma. The variations of normalized dJ/dT@120K and normalized χheating@530°C reflect a long-term stepwise increase in aridity during glacials with a major step at ~0.6–0.5 Ma, over the last 1.0 Ma. Overall, the results provide an improved basis for the future use of the magnetic properties of Serbian loess deposits for paleoclimatic reconstruction.
Over 3 months, we provided monthly education to internal medicine residents and distributed resources regarding penicillin-allergy history taking. Allergy information in the electronic record was updated more often during the intervention compared to the period before the intervention (16.1% vs 10.9%; P = .02). Education and interdepartmental collaboration have the potential to affect provider behavior.
The aeolian loess-paleosol sequences in the Chinese Loess Plateau (CLP) are an excellent archive of variations in atmospheric circulation in the geological past. However, there is no consensus regarding the roles of the East Asian winter monsoon and westerly winds in transporting the dust responsible for loess deposition during glacial and interstadial periods. We conducted detailed measurements of the anisotropy of magnetic susceptibility (AMS) on two parallel loess profiles covering the most recent 130 ka in the western CLP to determine paleowind directions. Results show that the magnetic lineations of the loess and paleosol units in both sections are significantly clustered along the northwest to southeast direction. These observations demonstrate that the prevailing wind system responsible for dust transport in the western CLP was the northwesterly winter monsoon, rather than the westerly winds. The AMS-derived dust-bearing wind direction was relatively stable during the last glacial and interglacial cycle in the western CLP, consistent with sedimentary and AMS evidence from the eastern CLP. Accordingly, it is reasonable to conclude that large areas of deserts and Gobi deserts areas located in the upwind direction were the dominant sources for the aeolian deposits of the Loess Plateau.
Chinese men who have sex with men (MSM) are at high risk for depression, anxiety and suicide. The estimated prevalence of these problems is essential to guide public health policy, but published results vary. This meta-analysis aimed to estimate the prevalence of depressive symptoms, anxiety symptoms and suicide among Chinese MSM.
Methods
Systematic searches of EMBASE, MEDLINE, PsycINFO, PubMed, CNKI and Wanfang databases with languages restricted to Chinese and English for studies published before 10 September 2019 on the prevalence of depressive symptoms, anxiety symptoms, suicidal ideation, suicide plans and suicide attempts among Chinese MSM. Studies that were published in the peer-reviewed journals and used validated instruments to assess depression and anxiety were included. The characteristics of studies and the prevalence of depression and anxiety symptoms, suicidal ideation, suicide plans and suicide attempts were independently extracted by authors. Random-effects modelling was used to estimate the pooled rates. Subgroup analysis and univariate meta-regression were conducted to explore potential sources of heterogeneity. This study followed the PRISMA and MOOSE.
Results
Sixty-seven studies were included. Fifty-two studies reported the prevalence of depressive symptoms, with a combined sample of 37 376 people, of whom 12 887 [43.2%; 95% confidence interval (CI), 38.9–47.5] reported depressive symptoms. Twenty-seven studies reported the prevalence of anxiety symptoms, with a combined sample of 10 531 people, of whom 3187 (32.2%; 95% CI, 28.3–36.6) reported anxiety symptoms. Twenty-three studies reported the prevalence of suicidal ideation, with a combined sample of 15 034 people, of whom 3416 (21.2%; 95% CI, 18.3–24.5) had suicidal ideation. Nine studies reported the prevalence of suicide plans, with a combined sample of 5271 people, of whom 401 (6.2%; 95% CI, 3.9–8.6) had suicide plans. Finally, 19 studies reported the prevalence of suicide attempts, with a combined sample of 27 936 people, of whom 1829 (7.3%; 95% CI, 5.6–9.0) had attempted suicide.
Conclusions
The mental health of Chinese MSM is poor compared with the general population. Efforts are warranted to develop interventions to prevent and alleviate mental health problems among this vulnerable population.
Carbon nanotubes (CNTs) possess impressive properties along with low density. Integration of CNTs in the form of fabrics or other preformed assemblies simplifies their handling and allows for the higher CNT content needed to better leverage their properties in multifunctional structures. Here we describe production of non-woven CNT-polyurethane fabrics made from industrial-grade CNTs via a one-step filtration method. Individual sheets were scaled to 30 cm x 30 cm size and subsequently used to fabricate thicker composites, including via lamination with itself to produce simple panels and with other materials to further tailor the nanocomposite properties and address several example applications including electrical heating, fire resistance, electromagnetic shielding, and a skin for stretchable morphing structures.
Attachment dimensions refer to how interpersonal emotion regulation strategies are utilised and have a profound impact in adulthood. Its measurement has attracted a large amount of research attention. The Experiences in Close Relationships — Revised (ECR-R) Questionnaire is one of the most widely used and researched self-report questionnaires to measure romantic attachment anxiety and avoidance in multiple language groups, despite inconsistent evidence regarding its factorial structure. The 20-item Experiences in Close Relationships — Revised — General Short Form (ECR-R-GSF) was developed based on the ECR-R to measure attachment experiences in all relationships (not just romantic ones) in an English-speaking sample. However, no short form of the ECR-R is available for the Chinese population. In order to cross-validate the first Chinese version of the ECR-R-GSF, specifically the proposed two-factor structure, against the English version, an Australian university student sample (n = 426) and a Chinese university student sample from China (n = 626) were recruited. The Anxiety and Avoidance scales were found to have good internal reliability in both samples. However, the proposed two-factor model only provided an acceptable fit even after adding modifications in the Australian sample, and the fit was not satisfactory in the Chinese sample. Multigroup confirmatory factor analysis (CFA) indicated that partial metric but not scalar invariance was achieved across cultures. Implications for relationship and cross-cultural research and practice were discussed.
In September 2016, the annual meeting of the International Union for Quaternary Research’s Loess and Pedostratigraphy Focus Group, traditionally referred to as a LoessFest, met in Eau Claire, Wisconsin, USA. The 2016 LoessFest focused on “thin” loess deposits and loess transportation surfaces. This LoessFest included 75 registered participants from 10 countries. Almost half of the participants were from outside the United States, and 18 of the participants were students. This review is the introduction to the special issue for Quaternary Research that originated from presentations and discussions at the 2016 LoessFest. This introduction highlights current understanding and ongoing work on loess in various regions of the world and provides brief summaries of some of the current approaches/strategies used to study loess deposits.
Hand, foot, and mouth disease (HFMD) has caused public health concerns worldwide. We aimed to investigate the effect of meteorological factors on the HFMD epidemic in Qingdao, a port city in China. A total of 78641 cases were reported in Qingdao between January 2007 and December 2014. Of those, 71084 (90·39%) occurred in children aged 0–5 years, with an incidence of 1691·2/100000. The incidence increased from early spring, peaked between spring and summer, and decreased in late summer. Aetiological agents in all severe cases and selected mild cases were characterized by examining throat swabs. Except for enterovirus 71 (EV71) and coxsackievirus A16 (CA16), other EVs caused >50% of the HFMD cases between 2011 and 2014. EV71 was more frequent in the off-peak months than in the peak months and prone to causing more severe cases compared to CA16 (χ2 = 46·3, P < 0·001). CA10 caused more severe HFMD than did CA6 (χ2 = 20·49, P < 0·001) and all non-CA10 EVs (χ2 = 41·01, P < 0·001). Community-derived HFMD cases accounted for 65·11%. Spearman rank correlation analysis showed that HFMD incidence in children aged 0–5 years was positively correlated with atmospheric temperature (rs = 0·77, P < 0·001), relative humidity (rs = 0·507, P < 0·001), and precipitation (rs = 0·328, P < 0·001). Climate changes and CA10 surveillance in communities should be integrated into the current prophylactic programme.
In this paper, a three-dimensional (3D) model as a new module of LAP3D code is presented to study the crossed-beam energy transfer (CBET) process. This model is not limited by the paraxial approximation and can be used to deal with a large crossing angle case. Besides, this model is also appropriate for the multi-ion species conditions and even multi-beams problems, which will be very helpful in relevant experiment analysis and the target design. In our 3D simulations, we take the overlapped beams with a 60° crossing angle as an example, and observe obvious energy transfer process, which indicates CBET process might occur between the incident laser beams with a large crossing angle when the matching condition is satisfied. This large crossing angle CBET process also can change the spatial shape of the beam spot, and may have some potential important influence on other laser–plasma interaction instabilities and the energy symmetry in hohlraum.
Bipolar disorder is a highly heritable polygenic disorder. Recent enrichment analyses suggest that there may be true risk variants for bipolar disorder in the expression quantitative trait loci (eQTL) in the brain.
Aims
We sought to assess the impact of eQTL variants on bipolar disorder risk by combining data from both bipolar disorder genome-wide association studies (GWAS) and brain eQTL.
Method
To detect single nucleotide polymorphisms (SNPs) that influence expression levels of genes associated with bipolar disorder, we jointly analysed data from a bipolar disorder GWAS (7481 cases and 9250 controls) and a genome-wide brain (cortical) eQTL (193 healthy controls) using a Bayesian statistical method, with independent follow-up replications. The identified risk SNP was then further tested for association with hippocampal volume (n = 5775) and cognitive performance(n = 342) among healthy individuals.
Results
Integrative analysis revealed a significant association between a brain eQTL rs6088662 on chromosome 20q11.22 and bipolar disorder (log Bayes factor = 5.48; bipolar disorder P = 5.85×10–5). Follow-up studies across multiple independent samples confirmed the association of the risk SNP (rs6088662) with gene expression and bipolar disorder susceptibility (P =3.54×10–8). Further exploratory analysis revealed that rs6088662 is also associated with hippocampal volume and cognitive performance in healthy individuals.
Conclusions
Our findings suggest that 20q11.22 is likely a risk region for bipolar disorder; they also highlight the informative value of integrating functional annotation of genetic variants for gene expression in advancing our understanding of the biological basis underlying complex disorders, such as bipolar disorder.
In this work, we reported the optical photometry monitoring results for two brightest nearby quasars, PHL 1811 and 3C 273 using the ST-6 camera at Abastumani Observatory, Georgia. For PHL 1811, we found 3 microvariability events with time scale of ΔT = 6.0 min. For 3C273, we found that the largest variations are ΔV = 0.369 ± 0.028 mag, ΔR = 0.495 ± 0.076 mag, and ΔI = 0.355 ± 0.009 mag. When periodicity analysis methods are adopted to the available data, a period of p = 5.80 ± 1.12 years is obtained for PHL 1811, and p = 21.10 ± 0.14, 10.00 ± 0.14, 7.30 ± 0.09, 13.20 ± 0.09, 2.10 ± 0.06, and 0.68 ± 0.05 years are obtained for 3C 273.
Variability is one of the extreme observational properties of BL Lacertae objects. AO 0235+164 is a well studied BL Lac through the whole electro-magnetic wavebands, it is violently variable in the optical bands. In the present work, we show its optical R band photometric observations carried out during the period of Nov. 2006 to Dec. 2012 using the Ap6E CCD camera attached to the primary focus of the 70 cm meniscus telescope at Abastumani Observatory, Georgia. It shows a large variation of ΔR = 4.88 mag (14.20 - 19.08 mag) during our monitoring period. When periodicity analysis methods are adopted to its R observations from our Abastumani monitoring programme and those in the literature, the signs of some periods, P1 = 8.26 yr, P2 = 0.55 yr, P3 = 0.85 yr, P4 = 1.99 yr are found.
In this talk, we will show the beaming effect for Fermi/LAT blazars, then we discuss the correlations between γ-ray luminosity and other parameters, such as radio Doppler factors, superluminal motions, and core-dominance parameters. We also compare the Doppler factors determined from the γ-ray luminosity, X-ray emissions, and the short-term time scales with those from other methods. Our discussions suggest that γ-ray emissions may be strongly beamed.
Triple supermassive black holes (SMBH) can form during the hierarchical mergers of massive galaxies with an existing binary. Perturbations by a third black hole may accelerate the merging process of an inner binary, for example through the Kozai mechanism. We analyze the evolution of simulated hierarchical triple SMBHs in galactic centers, and find resonances in the evolution of the semi-major axis, the eccentricity and the inclination, for both the inner and the outer orbits of the triple system, which are not only Kozai like. Through resonant oscillations, SMBH can trigger a significant increase of the inner SMBH binary eccentricity shortening the merger timescale expected from gravitational wave (GW) emission. As hierarchical triple SMBHs may be frequent in massive galaxies, the influence of orbital resonances is of great importance to our understanding of black hole coalescence and gravitational wave detection. Although Kozai mechanism is believed to play an important role in this process, detailed studies on the pattern of these resonances is necessary.
Collisional effects on the current-filamentation instability (CFI), accounting for the space charge effect (SCE), are investigated kinetically for a relativistic beam propagating in dense plasmas. It is shown that collisions can completely suppress the SCE in low temperature dense plasma, leading to enhancement of the CFI. This kind of decoupling mechanism is quite different from the well-known resistive mechanism [Molvig (1975). Phys. Rev. Lett. 35, 1504]. In particular, we find the present decoupling mechanism can well explain the recent numerical simulation results [Karmakar et al. (2008). Phys. Rev. Lett. doi: 101, 255001]. In the parameter regime related to the laser-solid interaction and fast ignition scenario (FIS), the CFI growth rate with SCE included is enhanced in the low plasma density region through the decoupling mechanism. In the high plasma density region, it is enhanced mainly through the resistive mechanism.
Metal-assisted chemical etching (MACE) of silicon (Si) is a simple and low-cost process to fabricate Si nanostructures with varying aspect ratio and properties. In this work, we report on the structural and vibrational properties of Si nanostructures synthesized with varying metal catalyst. The morphology of the synthesized nanowires was characterized by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The optical and vibrational properties of the Si nanostructures were studied by photoluminescence and Raman spectroscopy using three different excitation sources (UV, visible and near-infrared) and are correlated to their microstructures. We propose that the excessive injection of holes into Si at the metal-Si interface and its diffusion to the nanowire surfaces facilitate the etching of Si on these surfaces, leading to a mesoporous network of Si nanocrystallites. When etched with catalytic Au nanoparticles, “hay-stacked” mesoporous Si nanowires were obtained. The straighter nanowires etched with Ag nanoparticles, consisted of a single crystalline core with a thin porous layer that decreased in thickness towards the base of the nanowire. This difference is due to the higher catalytic activity of Au compared to Ag for H2O2 decomposition. The SERRS observed during UV and visible Raman with Ag-etched Si nanowires and near-infrared Raman with Au-etched Si nanowires is due to the presence of the sunken metal nanoparticles. In addition, we explored the influence of varying H2O2 and HF concentration as well as the influence of increased etching temperature on the resultant nanostructured Si morphology. Such Si nanostructures may be useful for a wide range of applications such as photovoltaic and biological and chemical sensing.
Distant stellar encouters can substantially affect the dynamical evolution of existing stellar and planetary systems (e.g., Malmberg et al. 2007; Spurzem et al. 2009). Although planets with small orbital periods are not directly affected by encountering stars, the secular evolution of a perturbed system may result in the ejection of the innermost planets, or physical collisions between the innermost planets and the host star, hundreds of thousands of years after a weak encounter with a neighboring star occurs. Here we present the results of our study on the cumulative effect of distant stellar encounters on multi-planet systems in star clusters, and how these results depend on the properties of the star cluster in which a planetary system is born (for details we refer to Hao & Kouwenhoven, in prep.). With our simulations we explain the scarcity of exoplanets in star clusters, not only for those in wide orbits (affected by stellar encounters), but also in close orbits (affected by the secular evolution of the system following an encounter).