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Chronic pain and depression are common in older people, and creative activities may lower the perceived impact and distress related to the symptoms.
Aims
This study describes the co-development of a creative arts and crafts protocol for older people with chronic pain and depressive symptoms, and investigates its feasibility and potential effects.
Method
This study had two phases. In phase 1, a multidisciplinary expert panel (n = 10), consisting of professionals, patients and researchers, underwent iterative rounds to co-develop the protocol. In phase 2, a pilot study was conducted among 12 older adults (mean age 71.4 years). Mixed methods were used, including questionnaires at baseline, post-intervention and 3-month follow-up, assessing pain intensity and interference, depressive symptoms and quality of life; observational notes and focus groups. Descriptive and Wilcoxon signed-rank tests were applied to analyse quantitative data, and thematic analysis was used for qualitative data.
Results
Qualitative findings supported the programme’s feasibility. Participants reflected that the process was engaging and empowering and brought them a sense of achievement and recognition. The quantitative findings evidenced the programme’s potential effects in reducing depressive symptoms (Z = −2.60, P < 0.01) and improving mental health-related quality of life (Z = −2.67, P < 0.01) at 3-month follow-up.
Conclusions
Our results support the feasibility of a creative arts and crafts programme and provide preliminary evidence of its impact on reducing depressive symptoms and improving mental health-related quality of life. Given the promising results, a definitive trial is needed to reveal the effectiveness of creative activities in pain management.
We establish hyperweak boundedness of area functions, square functions, maximal operators, and Calderón–Zygmund operators on products of two stratified Lie groups.
Contrasting the well-described effects of early intervention (EI) services for youth-onset psychosis, the potential benefits of the intervention for adult-onset psychosis are uncertain. This paper aims to examine the effectiveness of EI on functioning and symptomatic improvement in adult-onset psychosis, and the optimal duration of the intervention.
Methods
360 psychosis patients aged 26–55 years were randomized to receive either standard care (SC, n = 120), or case management for two (2-year EI, n = 120) or 4 years (4-year EI, n = 120) in a 4-year rater-masked, parallel-group, superiority, randomized controlled trial of treatment effectiveness (Clinicaltrials.gov: NCT00919620). Primary (i.e. social and occupational functioning) and secondary outcomes (i.e. positive and negative symptoms, and quality of life) were assessed at baseline, 6-month, and yearly for 4 years.
Results
Compared with SC, patients with 4-year EI had better Role Functioning Scale (RFS) immediate [interaction estimate = 0.008, 95% confidence interval (CI) = 0.001–0.014, p = 0.02] and extended social network (interaction estimate = 0.011, 95% CI = 0.004–0.018, p = 0.003) scores. Specifically, these improvements were observed in the first 2 years. Compared with the 2-year EI group, the 4-year EI group had better RFS total (p = 0.01), immediate (p = 0.01), and extended social network (p = 0.05) scores at the fourth year. Meanwhile, the 4-year (p = 0.02) and 2-year EI (p = 0.004) group had less severe symptoms than the SC group at the first year.
Conclusions
Specialized EI treatment for psychosis patients aged 26–55 should be provided for at least the initial 2 years of illness. Further treatment up to 4 years confers little benefits in this age range over the course of the study.
Urinary Na excretion is a potential risk factor for CVD. However, the underlying biological mechanisms and effects of salt sensitivity are unclear. The purpose of this study was to characterise the relative contribution of biological factors to the Na–CVD association. A total of 2112 participants were enrolled in this study. Structured questionnaires and blood and urine samples were obtained. Twenty-four-hour Na excretion was estimated using a single overnight urine sample. Hypertension, the metabolic syndrome and overweight status were considered to indicate salt sensitivity. Cox proportional hazard models were used to investigate the effects of salt sensitivity on urinary Na excretion and CVD risk. The traditional mediation approach was used to calculate the proportion of mediation. The mean age (sd) of the 2112 participants was 54·5 (sd 12·2) years, and they were followed up for a mean of 14·1 (sd 8·1) years. Compared with those in the lowest quartile, the highest baseline urinary Na excretion (>4·2 g/24 h) was associated with a 43 % higher CVD risk (hazard ratio, 1·43; 95 % CI 1·02, 1·99). Participants with high urinary Na excretion, hypertension or the metabolic syndrome had a significantly high risk of CVD. The carotid intima-media thickness had the largest mediating effect (accounting for 35 % of the Na–CVD association), followed by systolic blood pressure (BP) (33 %), left ventricular mass (28 %) and diastolic BP (14 %). Higher urinary Na excretion increased the risk of CVD, which was explained largely by carotid media-thickness and systolic BP.
Little is known about long-term employment outcomes for patients with first-episode schizophrenia-spectrum (FES) disorders who received early intervention services.
Aims
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.
Method
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.
Results
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.
Conclusions
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.
Population-based colorectal cancer (CRC) screening programs that use a fecal immunochemical test (FIT) are often faced with a noncompliance issue and its subsequent waiting time (WT) for those FIT positives complying with confirmatory diagnosis. We aimed to identify factors associated with both of the correlated problems in the same model.
Methods
A total of 294,469 subjects, either with positive FIT test results or having a family history, collected from 2004 to 2013 were enrolled for analysis. We applied a hurdle Poisson regression model to accommodate the hurdle of compliance and also its related WT for undergoing colonoscopy while assessing factors responsible for the mixture of the two outcomes.
Results
The effect on compliance and WT varied with contextual factors, such as geographic areas, type of screening units, and level of urbanization. The hurdle score, representing the risk score in association with noncompliance, and the WT score, reflecting the rate of taking colonoscopy, were used to classify subjects into each of three groups representing the degree of compliance and the level of health awareness.
Conclusion
Our model was not only successfully applied to evaluating factors associated with the compliance and the WT distribution, but also developed into a useful assessment model for stratifying the risk and predicting whether and when screenees comply with the procedure of receiving confirmatory diagnosis given contextual factors and individual characteristics.
Using the peeling-induced splitting method, the effect of the irradiation of ultraviolet (UV) light on the formation of surface gratings on the surface of PMMA(Poly(Methyl Methacrylate))-based films is investigated at room temperature. The thickness of the PMMA-based films is in range of 236–534 nm, and the irradiation dose is in range of 0–5 J/cm2. Surface gratings are formed on the surface of the irradiated PMMA-based films. The spatial wave length is a linear function of the film thickness, independent of the UV doses used. The peeling-induced splitting process introduces compressive stress on the surface of the PMMA-based films, much larger than the corresponding surface energy. The magnitude of the apparent surface force increases with the increase of the film thickness. All the surface gratings formed have amplitudes approximately in the same range.
In this paper, we prove a Tb theorem on product spaces $\mathbb{R}$n × $\mathbb{R}$m, where b(x1, x2) = b1(x1)b2(x2), b1 and b2 are para-accretive functions on $\mathbb{R}$n and $\mathbb{R}$m, respectively.
In this paper we define a space$VM{{O}_{P}}$ associated with a family $P$ of parabolic sections and show that the dual of $VM{{O}_{P}}$ is the Hardy space $H_{P}^{1}$. As an application, we prove that almost everywhere convergence of a bounded sequence in $H_{P}^{1}$ implies weak$^{\star }$ convergence
Proper dry cow management is critical not only for subsequent milk production and fertility but also for mastitis control. A phenomenon of immunosuppression was commonly observed in transition cows, an example being the high susceptibility of the mammary gland during early the dry period to new infectious agents. Polymorphonuclear neutrophils (PMN) play important defence roles in the mammary gland of newly dried cows. One of the bactericidal mechanisms of PMN is through producing reactive oxygen species (ROS), which can be efficiently quantified by chemiluminescence (CL) assay. In the current study, the potential of intramammary application of a commercial Enterococcus faecium SF68 (SF68) product to enhance the local innate immunity of newly dried mammary glands was evaluated based on the CL assay. The preliminary experiments in vitro indicated virtual dose-responsiveness of ROS generation from three different cell preparations, bovine blood PMN, bovine blood PMN pre-conditioned with cow milk, and the post-diapedesis model somatic cells from cow milk, on their exposure to phorbol 12-myristate 13-acetate (PMA), viable SF68, and ultrasonicated SF68, but not dry-heated SF68. Because ultrasonication treatment was found to profoundly enhance the immunogenicity of SF68 in vitro, in the following animal trial, single infusion of either 5 or 10×107 original cfu of ultrasonicated SF68 was randomly applied to the front quarters and phosphate-bufferedsaline (PBS) applied to the rear quarters of each of the four experimental cows on the first day of milk stasis. The results showed that within the first post-infusion week, ultrasonicated SF68 induced a faster and greater (P<0·05) recruitment of PMN into mammary lumen with no apparent local or systemic inflammatory sign. Meanwhile, ultrasonicated SF68 also induced a greater (P<0·05) ROS production in response to PMA challenge by in situ somatic cells of mammary secretion. Taken together, ultrasonicated SF68 modulated ROS generation of bovine neutrophils, and would be a potential enhancer of udder innate immunity in drying-off dairy cows. More thorough work is warranted.
In this article, we establish a new atomic decomposition for $f\,\in \,L_{w}^{2}\,\bigcap \,H_{w}^{p}$, where the decomposition converges in $L_{w}^{2}$-norm rather than in the distribution sense. As applications of this decomposition, assuming that $T$ is a linear operator bounded on $L_{w}^{2}$ and $0\,<\,p\,\le \,1$, we obtain (i) if $T$ is uniformly bounded in $L_{w}^{p}$-norm for all $w-p$-atoms, then $T$ can be extended to be bounded from $H_{w}^{p}$ to $L_{w}^{2}$; (ii) if $T$ is uniformly bounded in $H_{w}^{p}$-norm for all $w-p$-atoms, then $T$ can be extended to be bounded on $H_{w}^{p}$; (iii) if $T$ is bounded on $H_{w}^{p}$, then $T$ can be extended to be bounded from $H_{w}^{p}$ to $L_{w}^{2}$.
Circulating levels of leptin and adiponectin are closely associated with obesity. However, it is not known whether there are common shared genes or environment exerting influences on the levels of leptin, adiponectin, and BMI. We aimed to assess the relative contribution of genes and environment to adiponectin, leptin, and BMI individually as well as simultaneously to the three measures. Our subjects included a total of 228 twin/sibling pairs aged 12 to 18 (130 monozygotic twins, 68 dizygotic twins and 30 sibling pairs) were recruited from the middle schools. Multivariate analyses were applied to twin/sibling data using structural equation modeling. The results showed that intraclass correlations for adiponectin, leptin and BMI were higher in the MZ twins than those in the DZ/SP group. The relative contribution of genes to adiponectin (39%) was comparable to those of shared environment (40%). In contrast, leptin and BMI were influenced mostly by genes (74% and 89%, respectively). The multivariate genetic analyses showed that a latent factor underlying the three measures was identified, with BMI being equivalent to this latent factor. The BMI-dependent genetic factor explains only 15% and 34% of variation of adiponectin and leptin, respectively. These data indicate a differential contribution of genetic factors for the variation of adiponectin, leptin and BMI. More importantly, only a small portion of the genetic influences on adiponectin and leptin was attributed to BMI. Our findings provided more insight into the complex regulation of adiponectin and leptin in obesity.
We investigated a cluster of postoperative febrile episodes and episodes of Acinetobacter baumannii bacteremia in obstetrics and gynecology wards after an electrical blackout and loss of the water supply. The use of patient-controlled analgesia was the only independent risk factor associated with postoperative fever, and A. baumannii isolates recovered from the blood of patients who had received patient-controlled analgesia were genetically related to an isolate recovered from the diluted morphine solution used for this procedure. After inappropriate preparation of the morphine solution was identified and stopped, the outbreak ended.
The efficiency of MEMS-based time-periodic micro chaotic mixers is experimentally and theoretically investigated in this study. A time-periodic flow perturbation was realized using digitally controlled solenoid valves to activate a source and sink alternately, acting together as a pair, with different driving frequencies. Working fluids with and without fluorescent dye were used in the micromixing experiments. The spatio-temporal variation of the mixing concentration during the mixing process was characterized at different Strouhal numbers, ranging from 0.03 to 0.74, using fluorescence microscopy. A simple kinematical model for the micromixer was used to demonstrate the presence of chaotic mixing. Specific stretching rate, Lyapunov exponent, and local bifurcation and Poincaré section analyses were used to identify the emergence of chaos. Two different numerical methods were employed to verify that the maximum Lyapunov exponent was positive in the proposed micromixer model. A simplified analytical analysis of the effect of Strouhal number is presented. Kolmogorov–Arnold–Mose (KAM) curves, which are mixing barriers, were also found in Poincaré sections. From a comparative study of the experimental results and theoretical analysis, a finite-time Lyapunov exponent (FTLE) was shown to be a more practical mixing index than the classical Lyapunov exponent because the time spent in mixing is the main concern in practical applications, such as bio-medical diagnosis. In addition, the FTLE takes into account both fluid stretching in terms of the stretching rate and fluid folding in terms of curvature.
The Ca intake and food sources of Chinese postmenopausal women are quite different from those of their Western counterparts. But, little information on Ca metabolism is available in Chinese populations. We determined true fractional calcium absorption (TFCA), true Ca absorption ( = TFCA × Ca intake, Va), urinary Ca excretion (Vu) and the difference between Va and Vu (Va − u), in response to three dietary Ca intake levels. Twenty-one healthy postmenopausal Chinese women aged 49–64 years were recruited for this randomized crossover trial from a general community, Guangzhou, China. Subjects were randomly assigned to receive 0, 500 and 1000 mg Ca/d for 5 weeks separated by 2-week washout periods. TFCA using Ca stable isotopes, total urinary Ca excretion and Ca intake were determined after 4 weeks of adaptation. Mean values for total Ca intake (Vi) of the three phases were 391 (sd 197), 880 (sd 130) and 1382 (sd 160) mg/d. On usual diet, TFCA, Vu, Va and Va − u were 0·57 (sd 0·12), 175 (sd 59) mg/d, 216 (sd 98) mg/d and 41 (sd 99) mg/d, respectively. With the supplementations of 500 and 1000 mg Ca/d, TFCA significantly decreased to 0·52 (sd 0·12) and 0·43 (sd 0·13) (P < 0·001); whereas urinary Ca (P = 0·003), Va and Va − u increased significantly (P < 0·001). Using a mixed-effects nonlinear regression model, it was estimated that Va − u was approaching a plateau when mean Ca intake reached 1300 mg/d. In conclusion, the present findings suggest postmenopausal Chinese women have high Ca absorption efficiency and a mean Ca intake of about 1300 mg/d is required to maximize the Va − u.
The motion of a DNA molecule in a solvent flow reflects the deformation of a nano/microscale flexible mass–spring structure by the forces exerted by the fluid molecules. The dynamics of individual molecules can reveal both fundamental properties of the DNA and basic understanding of the complex rheological properties of long-chain molecules. In this study, we report the dynamics of isolated DNA molecules under homogeneous extensional flow. Hydrodynamic focusing generates homogeneous extensional flow with uniform velocity in the transverse direction. The deformation of individual DNA molecules in the flow was visualized with video fluorescence microscopy. A coil–stretch transition was observed when the Deborah number (De) is larger than 0.8. With a sudden stopping of the flow, the DNA molecule relaxes and recoils. The longest relaxation time of T2 DNA was determined to be 0.63 s when scaling viscosity to 0.9 cP.
A fast and accurate method for detecting the collisions of convex polyhedra in a graphical simulation environment based on a newly developed method of distance estimate is presented. By the simultaneous use of the enclosing and the enclosed ellipsoids of convex polyhedra, potential collisions can be detected more accurate than those methods using only bounding volume for object representation, and more efficient than the polyhedral methods. An approach for computing the enclosed ellipsoid of a convex polyhedron by compressing, stretching and scaling operations on its best-fit enclosing ellipsoid is introduced. Graphical simulations of two case studies (moving polyhedral objects in three-dimensional space and multiple robot arms undergoing straight line motions) are conducted to demonstrate the accuracy of the proposed algorithm for collision detection.
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