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The construct of second language (L2) utterance fluency is typically operationalized through various individual temporal features. However, in natural speech, fluency (or disfluency) is often characterized by the clustering of multiple temporal features, collectively revealing the speaker’s effort in speech production or disfluency recovery. In this study, we explore the co-occurrence patterns of disfluency features in L2 speech and their associations with speakers’ L2 oral proficiency. We initially segmented all speech samples into analysis of speech (AS)-units. Within each AS-unit, six individual fluency features were manually coded, standardized, and subsequently subjected to a hierarchical-based k-means cluster analysis to examine their co-occurrence patterns. The results revealed four distinct disfluency clusters. A subsequent qualitative analysis of disfluencies in each cluster revealed distinct distributional patterns, disfluency makeup, and communicative functions. Additionally, the proportions of different disfluency clusters were significantly influenced by speakers’ proficiency level, first language background, and their interaction. These findings carry implications for L2 speaking research in general, shedding light on the intricate nature of speech fluency and presenting an alternative approach to the operationalization of this multidimensional construct.
Studies examining age-stratified risk factors for suicide among individuals with bipolar disorder in different stages of life are scant, possibly because of the insufficient number of suicide cases.
Aim
This study investigated suicide mortality rates and risk profiles of suicide mortality stratified by five age groups in individuals with bipolar disorder.
Methods
This study identified patients with a diagnosis of bipolar disorder between January 1, 2000, and December 31, 2021, from Taiwan’s National Health Insurance Research Database. The study population comprised 45,211 inpatients diagnosed with bipolar disorder, with 1,370 suicide cases during the study period. We calculated the standardized mortality ratio (SMR) of the bipolar cohort relative to the general population. In the age-stratified nested case–control study, risk set sampling was performed to match 1 suicide case with 10 living controls by age, sex, and the year of first diagnosis. The age-stratified risk associated with demographic characteristics, psychiatric and physical comorbidities was estimated using multivariable conditional logistic regression.
Results
The highest SMR (47.0) for suicide was observed in individuals with bipolar disorder aged <30 years. SMR decreased with age; patients aged >60 years had an SMR of 9.5. Among those younger than 40 years, a higher percentage of unemployment was noted among suicide cases than among controls. A significantly increased risk of the depressive phase of bipolar disorder was noted shortly before suicide mortality among patients with bipolar disorder in all age groups. Drug-induced and alcohol-induced mental disorders were associated with suicide and were highly prevalent in patients aged <30 years. Other forms of heart disease were identified in patients aged <40 years, and pneumonia was detected in the 50–59 years age group.
Conclusions
These findings aid the development of health-care intervention strategies for preventing suicide among patients with bipolar disorder in various stages of life.
Western Zhou Dynasty (ca. 1046–771 BC) was established soon after conquering the Shang Dynasty (ca. 1600–1046 BC) and brought about the earliest enfeoffment system in Chinese history. Yan was one of the vassal states of the same clan as Zhou. According to historical records, the capital of Yan state was located near Yan mountain, which is now known as the Liulihe site in the Fangshan District, Beijing. This study carries out the high-precision dating of two newly discovered Western Zhou Dynasty noble tombs at the Liulihe site. The man in tomb M1902 participated in the groundbreaking ceremony of Yan’s capital according to inscriptions on the bronze vessel found in this tomb. Samples of different materials, especially different parts of human skeletons from the tombs, were selected to form a sample series in chronological order. Wiggle-matching models were established in OxCal program based on the growth and development time of different teeth and bones of human skeletons. More accurate ages were acquired for the death of the individuals. The results indicate that the most probable distribution range of the death date of the individual in M1902 is about 1045–1010 BC. The radiocarbon dates of M1902 give important chronological information about the founding of Yan state, and they are very close to those of the year in which King Wu of Zhou conquered the Shang Dynasty.
While the first decade of the 21st century witnessed an unprecedented level of popularity in English across China, the last ten years have seen a fall in the status of English and a meteoric rise of the importance of the Chinese language and culture in the education system (Feng & Adamson, 2019; Pan & Wang, 2024). The changed status of English was exemplified in the 2017 English curriculum standards (2017 ECS) for senior high school students (aged 16–18). A few years after the implementation of this curriculum, this paper explores how teachers and students perceive the changed status of English as prescribed in the 2017 ECS, and what this means for the role of English as a ‘global language’ in China.
COVID-19’s impact on children and adolescents’ mental health has heightened global focus, leading to analysis with bibliometric and visualization tools of related studies in the Web of Science™ database from 2020 to 2023. In total, there are 5,189 studies authored by 27,102 researchers from 147 countries and significantly involving 6,926 institutions. These studies are covered by 1,246 journals. Depression, anxiety, and stress are currently well-developed and important research areas and will continue to be a priority and hot topic for further exploration and discussion in the academic research field in the future. However, certain topics, such as child maltreatment, need to be reassessed in terms of their importance. Additionally, emerging areas like telemedicine and vaccine hesitancy have emerged. Fundamental aspects such as COVID-19, family, and parenting reflect the far-reaching impact of the pandemic. Given that public health emergencies may affect the mental health of children and adolescents, it is particularly important to establish specialized response mechanisms. In addition, strengthened interdisciplinary and intersectoral cooperation focusing on the mental health of children and adolescents from vulnerable groups is crucial to ensure their healthy development and promote long-term social stability and scientific and technological progress.
Early diagnosis of acute coronary syndrome is more and more important because of its mortality and morbidity. Hypertension is one of the pathogenesis of acute coronary syndrome, which often leads to stenosis and ischaemia. Ischaemia-modified albumin is sensitive for the occurrence of ischaemia, which attracted us in the significance of ischaemia-modified albumin in patients with chest pain, especially patients complicated with hypertension.
Methods:
In total, 200 patients with acute chest pain were included in the study. According to the diagnostic criteria, patients were divided into acute coronary syndrome group and non-ischaemic chest pain group. Cardiac biomarkers were measured with 30 minutes in emergency department, including cardiac troponin T, creatine kinase MB, and ischaemia-modified albumin. Receiver operating characteristic curve (ROC) analysis was used for the sensitivity and specificity of ischaemia-modified albumin in the early diagnosis of acute coronary syndrome. Comparisons between ischaemia-modified albumin and cardiac Troponin T were done between groups.
Results:
The demographics in two groups were not significantly different in most aspects. Compared with non-ischaemic chest pain group, serum levels of ischaemia-modified albumin and cardiac Troponin T were significantly higher in acute coronary syndrome group. ROC analysis showed that ischaemia-modified albumin had a good sensitivity and specificity in early diagnosis of acute coronary syndrome. The level of ischaemia-modified albumin in acute coronary syndrome patients with hypertension was higher than that in non-ischaemic chest pain patients.
Conclusions:
In patients complained with acute chest pain, the serum measurement of ischaemia-modified albumin is potential valuable for the early diagnosis of acute coronary syndrome, especially combined with ECG. The serum level of ischaemia-modified albumin in acute coronary syndrome patients is significantly associated with hypertension.
In this study, a novel kinematic calibration method is proposed to improve the absolute positioning accuracy of 6R robot. This method can achieve indirect compensation of the 25 parameters of modified Denavit–Hartenberg (MDH). The procedures of the method are threefold. Firstly, the 25-parameter errors model of MDH is initially established. However, only the errors of 10 parameters can be directly compensated in the 25-parameter errors model, since the inverse kinematics algorithm has to meet Pieper criterion. Subsequently, a calibration method is proposed to improve accuracy of the absolute position, which uses the Newton–Raphson method to transform the 25-parameter errors into 10-parameter errors (namely T-10 parameter model). Finally, the errors corresponding to 10 parameters in the T-10 parameters model are identified through the least square method. The calibration performances of T-10 parameters model are comprehensively validated by experimentation on two ER6B-C60 robots and one RS010N robot. After kinematic calibration, the average absolute positioning accuracy of the three robots can be improved by about 90%. The results indicate that the proposed calibration method can achieve more precise absolute positioning accuracy and has a wider range of universality.
In his short list of predictions for the future of English, written in 2006, David Graddol wrote that ‘Asia may determine the future of global English’ (2006: 15). India and China especially, he suggested, were likely to be the major influences on how the concept of English as a global language would develop. As Asian economies grew, so did their political status, potentially offering a different model for the global ecology of languages. Nearly two decades on, we are beginning to see notable shifts in the way English is perceived in different parts of the world. As a variety in an Expanding Circle country (Kachru, 1985), English in China has conventionally been seen as a foreign or international language, and the concept of an indigenized variety has received less discussion than it has in Outer Circle countries. But with shifts in geopolitics, the conventional rationales for naming practices around English in China may no longer be applicable. The discussion below is centred, therefore, around the issue of what might be a better term to capture the contemporary reality of English use, and attitudes to this use, in China; and on how an emergent variety, associated with the term China English, is becoming a more and more accepted part of linguistic culture in Chinese society.
The global linear stability analysis for the magnetohydrodynamic liquid metal flow past an insulated sphere subjected to a constant streamwise magnetic field is investigated in the range of the Reynolds number $Re\leq 400$ and the interaction number $N\leq 40$ coupled with direct numerical simulations, where $N$ stands for strength of the electromagnetic force. The stability of the steady axisymmetric base flow to independent time-azimuthal modes is discussed. Five critical curves associated with various wake transitions are obtained in the $\{Re, N\}$ phase diagram. These critical curves reveal the stabilising effect of a weak magnetic field, the destabilising effect of a strong magnetic field and re-stabilising effect of a much stronger magnetic field. To explore the impact of the magnetic field on flow instability, a sensitivity analysis utilizing an adjoint method is performed for the first regular bifurcation. Sensitivity functions of growth rate to base-flow modifications and Lorentz force are defined to identify the region that has the most significant influence on flow instability, such as the recirculation region responsible for the stabilising effect at a weak magnetic field and the shear layer region responsible for the destabilising effect at a strong magnetic field. Furthermore, a competition between the stabilising and shear destabilising effects of the magnetic field is discussed. This analysis provides valuable insights into the non-monotonic effect of the magnetic field on flow instability.
Objectives: Central-line–associated bloodstream infection (CLABSI) has been the leading cause of healthcare-associated infections (HAIs) in the intensive care unit (ICU) setting. Previous studies have shown that a care bundle is effective in reducing CLABSI rates; however, the data on long-term sustainability and cost savings of bundled care are limited. Methods: From January 2011 to December 2020, a prospective surveillance was performed to monitor CLABSI at a university hospital in northern Taiwan. To reduce the CLABSI rate, a hospital-wide bundled care program for CLABSI prevention was implemented in 2013. We evaluated the long-term effect of the care bundle on CLABSI incidence and length of stay in the ICU. Results: During the study period, the overall CLABSI incidence decreased from 8.22 per 1,000 catheter days before the care bundle was implemented to 6.33 per 1,000 catheter days in 2020 (P for trend <.01). The most common pathogens causing CLABSI were gut organisms (1,420 of 2,363, 60.1%), followed by environmental organisms (734 of 2,363, 31.1%) and skin organisms (177 of 2,363, 7.5%). The decreasing trend was statistically significant in the incidence of CLABSI caused by skin organisms (P for trend < .01), but not in the incidence of CLABSI caused by environmental organisms (P for trend = .86) or gut organisms (P for trend = .06). In the multivariable analysis, implementation of this care bundle was independently associated with a decrease in the CLABSI rate (RR, 0.77; 95% CI, 0.66–0.88). Compared with patients without CLABSI, patients with CLABSI had a longer average ICU length of stay (27 vs 17 days). Conclusions: A sustainable reduction in the incidence of CLABSI caused by common commensals could be achieved through a cost-saving bundled care program.
Relatively few studies have explored the differential contributions of the accumulative dosage of psychotropic medications on mortality in patients with schizophrenia.
Methods
We aimed to explore the effects of the exposure dosage of psychotropic medications on mortality during a follow-up period of 5 years with a national cohort of individuals with schizophrenia in 2010. Causes of death were linked through Taiwan's National Mortality Registry. The mean defined daily dose of antipsychotics, antidepressants, mood stabilizers, and sedative-hypnotics, were calculated and survival analyses were conducted.
Results
A total of 102 964 individuals (54 151 men, 52.59%) with schizophrenia were included. Compared to patients with no exposure to antipsychotics, those with antipsychotic exposure had better survival outcomes, regardless of antipsychotic dosage. Antidepressant exposure, in low and moderate dosage, was associated with decreased all-cause mortality; exposure to mood stabilizers appeared to be associated with an increase in all-cause mortality. Although 89.7% of the patients had been prescribed sedative-hypnotics, exposure to sedative-hypnotics was associated with dose-related increased mortality risk [hazard ratio (HR) in low dose group: 1.16, 95% confidence interval (CI) 1.07–1.27; HR in moderate dose: 1.32, 95% CI 1.21–1.44; HR in high dose: 1.83, 95% CI 1.67–2.01)].
Conclusions
The results indicate that in the treatment of schizophrenia, antipsychotics and antidepressants are associated with lower mortality when using adequate dosages and mood stabilizers and sedative-hypnotics with higher mortality compared with no use. Furthermore, exposure to sedative-hypnotics is associated with a dose-related increased mortality risk which warrants clinical attention and further study.
Non-suicidal Self-Injury (NSSI) refers to causing damage on body tissue without attending to death. It is mostly presented among the youths and not approved by the society. Studies nowadays have explored the perspectives, feelings or experience of the youths or healthcare professionals. However, negative feelings and misunderstandings toward each other remain from both sides.
Objectives
The aim was to explore the encountering experience of the youths with NSSI and the healthcare professionals during the same hospitalization in a psychiatric acute ward.
Methods
Qualitative study was employed by using narrative approach. In-depth interview was conducted for the youths with NSSI and their primary nurse and resident from a medical center in southern Taiwan.
Results
Narratives from the patients and healthcare professionals showed that the youths seemed to be comfortable as encountering with the healthcare professionals’ caring. In contrast, the healthcare professionals’ struggles had been hidden inside and remained uneasy and unsolved. Two extreme experiences have been reported by the youths with NSSI: felt satisfied and understood about being cared vs. felt numbness and not been understood. Four kinds of experience were identified as: struggling on caring them, feeling confused and helpless, keeping a safe distance, and having contradicted values.
Conclusions
This study found that the healthcare professionals suffer from varied aspects when encountering the youths with NSSI, which they often hid inside without expressing. Future improvement such as care guideline or staff’s support system should be built to decrease the negative effects inside the healthcare professionals’ mind.
A drag correlation is established for laminar particle-laden flows, based on data from the interfaced-resolved direct numerical simulations (IR-DNS) of particle sedimentation in a periodic domain at density ratio ranging from 2 to 1000, particle concentration ranging from 0.59 % to 14.16 %, and particle Reynolds number below 132. Our drag decreases slightly with increasing density ratio when the other parameters are fixed. The drag correlation is then corrected to account for the turbulence effect by introducing the relative turbulent kinetic energy, from the IR-DNS data of the upward turbulent channel flows laden with the particles larger than the Kolmogorov length scale at relatively low particle volume fractions. A drift velocity model is developed to obtain the effective slip velocity from the interphase mean velocity difference for the vertical turbulent channel flow by considering the effects of particle inertia, particle concentration distribution and large-scale streamwise vortices.
In this paper, we propose a sparse point-plane odometry used in structured environments. Compared to a point-based odometry, we add additional planar constraints into the process of optimization, making the results more reliable. A novel grid-based plane detection algorithm is proposed to cluster sparse points in the same planes. Then, the planes are parameterized by inverse normal and take part in the windowed optimization. By reducing the size of Hessian Matrix, the process of optimization converges faster. Compared to the original point-based odometry, the proposed method performs better on both robustness and efficiency in structured environments.
To explore the relationship between parameters of Na and K excretion using 24-h urine sample and mild cognitive impairment (MCI) in general population.
Design:
This is a cross-sectional study.
Setting:
Community-based general population in Emin China.
Participants:
Totally, 1147 subjects aged ≥18 years were selected to complete the study, with a multistage proportional random sampling method. Cognitive status was assessed with Mini Mental State Examination (MMSE) questionnaire and timed 24-h urine specimens were collected. Finally, 561 participants aged ≥35 years with complete urine sample and MMSE data were included for the current analysis and divided into groups by tertiles of 24-h urinary sodium to potassium ratio (24-h UNa/K) as lowest (T1), middle (T2) and highest (T3) groups.
Results:
The MMSE score was significantly lower in T3, compared with the T1 group (26·0 v. 25·0, P = 0·002), and the prevalent MCI was significantly higher in T3 than in T1 group (11·7 % v. 25·8 %, P < 0·001). In multiple linear regression, 24-UNa/K (β: −0·184, 95 % CI −0·319, −0·050, P = 0·007) was negatively associated with MMSE score. In multivariable logistic regression, compared with T1 group, 24-h UNa/K in the T2 and T3 groups showed 2·01 (95 % CI 1·03, 3·93, P = 0·041) and 3·38 (95 % CI 1·77, 6·44, P < 0·001) fold odds for presence of MCI, even after adjustment for confounders. More augmented results were demonstrated in sensitivity analysis by excluding individuals taking anti-hypertensive agents.
Conclusions:
Higher 24-h UNa/K is in an independent association with prevalent MCI.
As essential specifications of correlation domain for signal quality evaluation, distortions of the S-curve, including bias and slope distortions of the zero-crossing point, are usually selected as indicators of optimisation in the process of designing the channels of receivers or navigation satellites. Focusing on this issue, we present a detailed analysis of slope distortion in the presence of group delay and amplitude distortions. After validating the theoretical results, we present further discussions about the impacts of different group delay terms on slope distortions. The results indicate that both the odd-order and the even-order terms have impacts on the slope distortion, and higher odd-order terms have less slope distortion compared with the lower odd-order terms. These results are useful for evaluating the slope distortion from the group delay and guiding improvement in design of the channel.
The objective of this study was to delineate the characteristics and incidence of congenital heart disease (CHD) in patients with isolated microtia and to determine whether the prevalence of CHD among patients with isolated microtia increases with the severity of microtia.
Methods:
A total of 804 consecutive patients had a pre-operative colour Doppler echocardiographic examination. A retrospective study was performed with the clinical and imaging data from November, 2017 to January, 2019. The χ2 test was performed to analyse the interaction between isolated microtia and CHD.
Results:
With the colour Doppler echocardiographic examination’s data from 804 consecutive isolated microtia patients, we found CHD, including atrial septal defect, ventricular septal defect, tetralogy of Fallot, patent ductus arteriosus, and others, occurred in 52 of 804 patients (6.5%). Atrial septal defect prevalence in patients with isolated microtia was significantly higher than ventricular septal defect (24/804 versus 11/804, p < 0.05) and patent ductus arteriosus (24/804 versus 2/804, p < 0.001). Ventricular septal defect prevalence in patients with isolated microtia was significantly higher than patent ductus arteriosus (11/804 versus 2/804, p < 0.05). All four types of microtia (concha-type microtia, small concha-type microtia, lobule-type microtia, and anotia) had similar incidences of CHD with no difference in the incidences among these types (p > 0.05 respectively). Furthermore, there was no significant difference in the incidence of the atrial septal defect among the four subtypes (p > 0.05 respectively). Similarly, ventricular septal defect and patent ductus arteriosus also showed no differences (p > 0.05 respectively).
Conclusions:
The overall incidences of CHD and three most common CHD subtypes (atrial septal defect, ventricular septal defect, and patent ductus arteriosus) in patients with isolated microtia are higher than general population. The prevalence of CHD among patients with isolated microtia does not increase with the severity of microtia. According to our experience in this study, we suggest colour Doppler echocardiographic imaging should be performed for isolated microtia patients soon after birth if possible. Furthermore, for the plastic surgeon and anaesthesiologist, it is important to take pre-operative colour Doppler echocardiographic images which can help evaluate heart function to ensure the safety of the peri-operative period. Future studies when investigating CHDs associated with isolated microtia could focus on genetic and molecular mechanisms.
Studies have suggested an association between metabolic and cerebrocardiovascular diseases and major depressive disorder (MDD). However, the risk of metabolic and cerebrocardiovascular diseases in the unaffected siblings of patients with MDD remains uncertain. Using the Taiwan National Health Insurance Research Database, 22,438 unaffected siblings of patients with MDD and 89,752 age-/sex-matched controls were selected and followed up from 1996 to the end of 2011. Individuals who developed metabolic and cerebrocardiovascular diseases during the follow-up period were identified. Compared with the controls, the unaffected siblings of patients with MDD had a higher prevalence of metabolic diseases, such as hypertension (5.0% vs. 4.5%, p = 0.007), dyslipidemia (5.6% vs. 4.8%, p < 0.001), and obesity (1.7% vs. 1.5%, p = 0.028), and cerebrocardiovascular diseases, such as ischemic stroke (0.6% vs. 0.4%, p < 0.005) and ischemic heart disease (2.1% vs. 1.7%, p < 0.001). Logistic regression analyses revealed that the unaffected siblings of patients with MDD were more likely to develop hypertension, dyslipidemia, ischemic stroke, and ischemic heart diseases during the follow-up period than the controls. Our study revealed a familial coaggregation between MDD and metabolic and cerebrocardiovascular diseases. Additional studies are required to investigate the shared pathophysiology of MDD and metabolic and cerebrocardiovascular diseases.