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The rural-oriented tuition-waived medical education program in China, started in 2010, provides free medical education to students committed to serving in rural areas to address medical staff shortages. Despite its success in training and deploying graduates, retaining them post-obligation remains challenging. This study explores the mechanisms behind the turnover intentions of rural-oriented medical students in Western China, offering insights for their retention.
Methods:
Semi-structured interviews were conducted with 47 rural-oriented medical students and 30 health clinic directors in Nanning City. Interview data were analysed using grounded theory, and open, axial and selective coding was applied.
Results:
Through three levels of coding analysis, 34 tree nodes, 13 sub-categories and 3 main categories were identified from the interviews with rural-oriented medical students and health clinic directors. 3 main categories were Subjective Norms, Behavioural Attitudes, and Perceived Behavioural Control.
Conclusion:
A model of turnover intention among rural-oriented medical students was developed. This model can serve as a valuable reference for future policy optimization concerning China’s rural order-directed medical students.
Item replenishing is essential for item bank maintenance in cognitive diagnostic computerized adaptive testing (CD-CAT). In regular CAT, online calibration is commonly used to calibrate the new items continuously. However, until now no reference has publicly become available about online calibration for CD-CAT. Thus, this study investigates the possibility to extend some current strategies used in CAT to CD-CAT. Three representative online calibration methods were investigated: Method A (Stocking in Scale drift in on-line calibration. Research Rep. 88-28, 1988), marginal maximum likelihood estimate with one EM cycle (OEM) (Wainer & Mislevy In H. Wainer (ed.) Computerized adaptive testing: A primer, pp. 65–102, 1990) and marginal maximum likelihood estimate with multiple EM cycles (MEM) (Ban, Hanson, Wang, Yi, & Harris in J. Educ. Meas. 38:191–212, 2001). The objective of the current paper is to generalize these methods to the CD-CAT context under certain theoretical justifications, and the new methods are denoted as CD-Method A, CD-OEM and CD-MEM, respectively. Simulation studies are conducted to compare the performance of the three methods in terms of item-parameter recovery, and the results show that all three methods are able to recover item parameters accurately and CD-Method A performs best when the items have smaller slipping and guessing parameters. This research is a starting point of introducing online calibration in CD-CAT, and further studies are proposed for investigations such as different sample sizes, cognitive diagnostic models, and attribute-hierarchical structures.
Multidimensional-Method A (M-Method A) has been proposed as an efficient and effective online calibration method for multidimensional computerized adaptive testing (MCAT) (Chen & Xin, Paper presented at the 78th Meeting of the Psychometric Society, Arnhem, The Netherlands, 2013). However, a key assumption of M-Method A is that it treats person parameter estimates as their true values, thus this method might yield erroneous item calibration when person parameter estimates contain non-ignorable measurement errors. To improve the performance of M-Method A, this paper proposes a new MCAT online calibration method, namely, the full functional MLE-M-Method A (FFMLE-M-Method A). This new method combines the full functional MLE (Jones & Jin in Psychometrika 59:59–75, 1994; Stefanski & Carroll in Annals of Statistics 13:1335–1351, 1985) with the original M-Method A in an effort to correct for the estimation error of ability vector that might otherwise adversely affect the precision of item calibration. Two correction schemes are also proposed when implementing the new method. A simulation study was conducted to show that the new method generated more accurate item parameter estimation than the original M-Method A in almost all conditions.
This study revisits the parameter estimation issues in multidimensional item response theory more thoroughly and investigates some computation details that have seldom been addressed previously when implementing the expectation-maximization (EM) algorithm for finite mixtures (EM–FM). Two research questions are: Should we rescale after each EM cycle or after the final EM cycle? How to adapt the supplemented EM algorithm to the EM–FM framework to estimate standard errors (SEs) of all unknown parameters? Analytic details of the methods are provided, and a comprehensive simulation study is conducted to provide supporting evidence. Results reveal that rescaling after each EM cycle accelerates convergence without affecting the calibration accuracy. Moreover, the SEs of all model parameters, including item parameters and population mixing proportions, recover well when the sample size is relatively large (e.g., 2000).
In this article we present an exploratory tool for extracting systematic patterns from multivariate data. The technique, hierarchical segmentation (HS), can be used to group multivariate time series into segments with similar discrete-state recurrence patterns and it is not restricted by the stationarity assumption. We use a simulation study to describe the steps and properties of HS. We then use empirical data on daily affect from one couple to illustrate the use of HS for describing the affective dynamics of the dyad. First, we partition the data into three periods that represent different affective states and show different dynamics between both individuals’ affect. We then examine the synchrony between both individuals’ affective states and identify different patterns of coherence across the periods. Finally, we discuss the possibilities of using results from HS to construct confirmatory dynamic models with multiple change points or regime-specific dynamics.
Cognitive impairment, a major determinant of poor functioning in schizophrenia, had limited responses to existing antipsychotic drugs. The limited efficacy could be due to regional differences in the dysregulation of the dopamine system. This study investigated striatal and peripheral dopaminergic makers in schizophrenia and their relationship with cognitive impairment.
Methods
Thirty-three patients with schizophrenia and 36 age- and sex-matched healthy controls (HC) participated. We evaluated their cognitive performance, examined the availability of striatal dopamine transporter (DAT) using single-photon emission computed tomography with 99mTc-TRODAT, and measured plasma levels of dopaminergic precursors (phenylalanine and tyrosine) and three branched-chain amino acids (BCAA) that compete with precursors for brain uptake via ultra-performance liquid chromatography.
Results
Schizophrenia patients exhibited lower cognitive performance, decreased striatal DAT availability, and reduced levels of phenylalanine, tyrosine, leucine, and isoleucine, and the ratio of phenylalanine plus tyrosine to BCAA. Within the patient group, lower DAT availability in the left caudate nucleus (CN) or putamen was positively associated with attention deficits. Meanwhile, lower tyrosine levels and the ratio of phenylalanine plus tyrosine to BCAA were positively related to executive dysfunction. Among all participants, DAT availability in the right CN or putamen was positively related to memory function, and plasma phenylalanine level was positively associated with executive function.
Conclusions
This study supports the role of dopamine system abnormalities in cognitive impairment in schizophrenia. The distinct associations between different dopaminergic alterations and specific cognitive domain impairments suggest the potential need for multifaceted treatment approaches to target these impairments.
Various studies have highlighted the increased incidence and symptoms of depression and anxiety in paediatric cancer survivors (PCS). Yet no meta-analysis has focused on post-traumatic stress disorder (PTSD) or post-traumatic stress symptoms (PTSS) in PCS and their family nucleus.
Aims
To evaluate the overall risk of PTSD and severity of PTSS in PCS and their family nucleus. Secondary objectives include identifying potential risk factors of PTSD and high PTSS.
Method
We systematically searched PubMed, Embase and PsycINFO for studies comparing the risk of PTSD and PTSS severity among PCS, their family nucleus and non-cancer controls. PRISMA reporting guidelines were followed. Random effects meta-analyses and meta-regressions were conducted.
Results
From 1089 records, we included 21 studies. PCS have an increased risk of PTSD (risk ratio 2.36, 95% CI 1.37–4.06) and decreased PTSS severity (standardised mean difference −0.29, 95% CI −0.50 to −0.08). Subgroup analyses of other categorical study-level characteristics revealed that female PCS who were older at diagnosis and data collection had a significantly higher risk of PTSD. Meta-regression were insignificant. Family nucleus did not show a significantly increased risk of PTSD (risk ratio 1.13, 95% CI 0.59–5.00) and PTSS severity (standardised mean difference 0.53, 95% CI −0.00 to 1.06). Systematically reviewing studies on the family nucleus found that the majority reported a significantly increased risk of psychological trauma compared with the comparator. Lower education, income and social status were also risk factors.
Conclusions
Timely identification and interventions are imperative for policy makers and healthcare providers to prevent trauma from worsening in this population group.
Inconsistent results regarding the risk of relapse and better subjective outcomes of previous antipsychotic dose reduction trials in patients with remitted psychosis have not been verified using therapeutic drug monitoring (TDM). This study examined plasma drug concentrations of a dose-tapering trial which exhibited the potential of successful maintenance under lower antipsychotic dosages.
Methods
A 2-year open-label randomized prospective trial recruited remitted patients to undergo guided antipsychotic tapering. Blood samples were collected at baseline, annually, and after each dose reduction. Plasma aripiprazole/dehydroaripiprazole concentrations were determined using LC–MS/MS. The relationship between the dose and serum drug levels was examined using Spearman's correlation. Divided at 120 ng/mL, relapse rate, global function, quality of life, and psychopathology were compared between high- and low- drug level groups.
Results
A total of 126 blood samples were collected, after excluding13 samples due of non-adherence. The correlation coefficients between dosage and drug level were 0.853 (aripiprazole) and 0.864 (dehydroaripiprazole), and the dose and concentration plots were parallel along the tapering trajectories, except patients with non-adherence. The concentration-to-dose ratio of aripiprazole in this cohort, 17.79 ± 7.23 ng/mL/mg, was higher than that in Caucasian populations. No significant differences were observed in the clinical outcomes between the high- and low-level groups. Remarkably, 12 of 15 patients maintained remission at plasma aripiprazole concentrations of <120 ng/mL.
Conclusions
The lower-than-expected doses reached in our antipsychotic tapering trial were substantiated to provide adequate prophylactic effects by TDM results in a subset of patients treated with aripiprazole, even considering the differences in pharmacogenomics between ethnicities.
Individuals with schizophrenia face high mortality risks. The effects of lipid-modifying agents on this risk remain understudied.
Aim
This study was conducted to investigate the effects of lipid-modifying agents on mortality risk in people with schizophrenia.
Method
This nationwide cohort study collected the data of people with schizophrenia from Taiwan's National Health Insurance Research Database for the period between 1 January 2001 and 31 December 2019. Multivariable Cox proportional hazards regression with a time-dependent model was used to estimate the hazard ratio for mortality associated with each lipid-modifying agent.
Results
This study included 110 300 people with schizophrenia. Of them, 22 528 died (19 754 from natural causes and 1606 from suicide) during the study period, as confirmed using data from Taiwan's national mortality database. The use of lipid-modifying agents was associated with reduced risks of all-cause (adjusted hazard ratio [aHR]:0.37; P < 0.001) and natural (aHR:0.37; P < 0.001) mortality during a 5-year period. Among the lipid-modifying agents, statins and fibrates were associated with reduced risks of all-cause mortality (aHRs:0.37 and 0.39, respectively; P < 0.001 for both) and natural mortality (aHRs: 0.37 and 0.42, respectively; P < 0.001 for both). Notably, although our univariate analysis indicated an association between the use of lipid-modifying agents and a reduced risk of suicide mortality, the multivariate analysis revealed no significant association.
Conclusions
Lipid-modifying agents, particularly statins and fibrates, reduce the risk of mortality in people with schizophrenia. Appropriate use of lipid-modifying agents may bridge the mortality gap between these individuals and the general population.
Few previous studies have established Snaith–Hamilton Pleasure Scale (SHAPS) cut-off values using receiver operating characteristic curve analysis and applied these values to compare predictors of anhedonia between clinical and nonclinical groups.
Aims
To determine the optimal cut-off values for the SHAPS and use them to identify predictors of anhedonia in clinical and nonclinical groups in Taiwan.
Method
This cross-sectional and correlational study used convenience sampling to recruit 160 patients from three hospitals and 412 students from two universities in northern Taiwan. Data analysis included receiver operating characteristic curve, univariate and multivariate analyses.
Results
The optimal SHAPS cut-off values were 29.5 and 23.5 for the clinical and nonclinical groups, respectively. Moreover, two-stage analysis revealed that participants in the clinical group who perceived themselves as nondepressed, and participants in the nonclinical group who did not skip classes and whose fathers exhibited higher levels of care and protection were less likely to attain the cut-off values. Conversely, participants in the nonclinical group who reported lower academic satisfaction and were unwilling to seek help from family or friends were more likely to attain the cut-off values.
Conclusions
Our findings highlight the importance of optimal cut-off values in screening for depression risk within clinical and nonclinical groups. Accordingly, the development of comprehensive, individualised programmes to monitor variation trends in SHAPS scores and relevant predictors of anhedonia across different target populations is crucial.
Following the literature on entrepreneurial framing and identity change, we examined how Chinese shan-zhai phone entrepreneurs have drawn on their cultural resources to reframe their businesses to claim new identities and gain legitimacy over time. Through qualitative procedures, we found that a staged process of collective identity development underlies this entrepreneurial process, consisting of building (a) niche-market identity via pragmatic reframing, (b) socio-political identity via nationalistic reframing, and finally (c) professional identity via comprehensive reframing. There has also been a clear change in the sources of legitimacy from the indigenous market through the wider Chinese society to the more globally defined industry. Our central contribution is a processual model of identity change through cultural reframing specifically focused on how informal entrepreneurs grow into formalization and global competition.
As an important component of prehistoric subsistence, an understanding of bone-working is essential for interpreting the evolution of early complex societies, yet worked bones are rarely systematically collected in China. Here, the authors apply multiple analytical methods to worked bones from the Longshan site of Pingliangtai, in central China, showing that Neolithic bone-working in this area, with cervid as the main raw material, was mature but localised, household-based and self-sufficient. The introduction of cattle in the Late Neolithic precipitated a shift in bone-working traditions but it was only later, in the Bronze Age, that cattle bones were utilised in a specialised fashion and dedicated bone-working industries emerged in urban centres.
Seven accelerator mass spectrometry radiocarbon (AMS 14C) dates (7260±106∼7607±95 BP averaged 7444±103 BP) on a giant oyster shell, collected from an ancient shore of the Taipei Basin, are similar to the LSC (liquid scintillation counting) 14C age (7260±46 BP) of a grass sample inside the shell. The calibrated 14C ages of the C. gigas by Marine20 are 7490±240∼7805±230 cal BP (average 7660±96 cal BP), generally agreed with the calibrated LSC 14C ages of the grass and the oyster shell. Combined with other 14C ages of shoreline samples in the Taipei Basin, it is evident that sea level rose from 8600 to 7600 cal BP and reached a stand higher than modern sea level. During this marine transgression, the sedimentation rate along the shoreline was very high because 14C dating was not able to detect age differences for 4–5 m thick sediment sequences. Sixty-nine analyses of δ18O and δ13C from the oldest part of the shell exhibit clear seasonal cycles, with a 4-year period of growth in the 5.5-cm section. According to the δ18O values, the ancient oyster grew in a warmer-than-present shoreline environment, suggesting that the current absence of the giant oyster in Taiwan is not due to warming conditions.
Functional montmorillonite can be dispersed in polymer coatings and organic species and polymers can be intercalated into the interlayer space or grafted onto the surface of the functional montmorillonite. The addition of functional montmorillonite into polymer-based coatings can significantly improve anti-corrosion, refractory, super-hydrophobicity, antibacterial activity, and absorption of solar radiation by the resulting montmorillonite/polymer coatings. Montmorillonite can be functionalized for this purpose by ion exchange, intercalation, exfoliation, or combinations of these treatments. The rigid montmorillonite layers interspersed within the polymer matrix inhibit the penetration of corrosive substances, minimize the impact of high-temperature airflow, and thereby lead to strong resistance of the coating to corrosion and fire. The combination of polymers and dispersed montmorillonite nanolayers, which are modified by metal ions, metal oxides, and hydrophobic organic species, allows the resulting composite coating to have quite a rough surface and a much smaller surface free energy so that the montmorillonite/polymer coating possesses superhydrophobicity. The interlayer space of functional montmorillonite can also host or encapsulate antibacterial substances, phase-change materials, and solar energy-absorbing materials. Moreover, it can act as a template to make these guest species exist in a more stable and ordered state. Literature surveys suggest that future work on the functional montmorillonite/polymer coatings should be targeted at the manufacture of functional montmorillonite nanolayers by finding more suitable modifiers and tuning the dispersion and funtionalities of montmorillonite in the coatings.
In this work, the dynamics of two-dimensional rotating Janus drops in shear flow is studied numerically using a ternary-fluid diffuse interface method. The rotation of Janus drops is found to be closely related to their deformation. A new deformation parameter $D$ is proposed to assess the significance of the drop deformation. According to the maximum value of $D$ ($D_{max}$), the deformation of rotating Janus drops can be classified into linear deformation ($D_{max}\le 0.2$) and nonlinear deformation ($D_{max}> 0.2$). In particular, $D_{max}$ in the former depends linearly on the Reynolds and capillary numbers, which can be interpreted by a mass–spring model. Furthermore, the rotation period $t_R$ of a Janus drop is found to be more sensitive to the drop deformation than to the aspect ratio of the drop at equilibrium. By introducing a corrected shear rate and an aspect ratio of drop deformation, a rotation model for Janus drops is established based on Jeffery's theory for rigid particles, and it agrees well with our numerical results.
The COVID-19 pandemic has had a profound impact on the mental health of healthcare workers (HCWs). We aimed to identify the factors associated with depression among HCWs during the pandemic. We conducted literature search using eight electronic databases up to July 27 2022. Observational studies with more than 200 participants investigating correlates of depression in HCWs after COVID-19 outbreak were included. We used fixed- and random-effects models to pool odds ratios (ORs) across studies, and Cochran's chi-squared test and I2 statistics to assess study heterogeneity. Publication bias was evaluated by funnel plots. Thirty-five studies involving 44,362 HCWs met the inclusion criteria. Female (OR=1.50, 95% CI [1.23,1.84]), single (OR=1.36, 95% CI [1.21,1.54]), nurse (OR=1.69, 95% CI [1.28,2.25]), history of mental diseases (OR=2.53, 95% CI [1.78,3.58]), frontline (OR=1.79, 95% CI [1.38,2.32]), health anxiety due to COVID-19 (OR=1.88, 95% CI [1.29,2.76]), working in isolation wards (OR=1.98, 95% CI [1.38,2.84]), and insufficient personal protective equipment (OR=1.49, 95% CI [1.33,1.67]) were associated with increased risk of depression. Instead, HCWs with a positive professional prospect (OR=0.34, 95% CI [0.24,0.49]) were less likely to be depressed. This meta-analysis provides up-to-date evidence on the factors linked to depression among HCWs during the COVID-19 pandemic. Given the persistent threats posed by COVID-19, early screening is crucial for the intervention and prevention of depression in HCWs.
This paper presents a comprehensive study of flow-induced vibrations of a D-section prism with various angles of attack $\alpha$ ($= 0^{\circ }\unicode{x2013}180^{\circ }$) and reduced velocity $U^*$ (= 2–20) via direct numerical simulations at a Reynolds number ${Re} = 100$. The prism is allowed to vibrate in both streamwise and transverse directions. Based on the characteristics of vibration amplitudes and frequencies, the responses are classified into nine different regimes: typical VIV regime ($\alpha = 0^{\circ }\unicode{x2013}30^{\circ }$), hysteretic VIV regime ($\alpha = 35^{\circ }\unicode{x2013}45^{\circ }$), extended VIV regime ($\alpha = 50^{\circ }\unicode{x2013}55^{\circ }$), first transition response regime ($\alpha = 60^{\circ }\unicode{x2013}65^{\circ }$), dual galloping regime ($\alpha = 70^{\circ }$), combined VIV and galloping regime ($\alpha = 75^{\circ }\unicode{x2013}80^{\circ }$), narrowed VIV regime ($\alpha = 85^{\circ }\unicode{x2013}145^{\circ }$), second transition response regime ($\alpha = 150^{\circ }\unicode{x2013}160^{\circ }$) and transverse-only galloping regime (${\alpha = 165^{\circ }\unicode{x2013}180^{\circ }}$). In the typical and narrowed VIV regimes, the vibration frequencies linearly increase with increasing $U^*$. In the hysteretic and extended VIV regimes, the vibration amplitudes are large in a wider range of $U^*$ as a result of the closeness of the vortex shedding frequency to the natural frequency of the prism because of the shear layer reattachment and separation point movement. In the two galloping regimes, the transverse amplitude keeps increasing with $U^*$ while the streamwise amplitude stays small or monotonically increases with increasing $U^*$. In the combined VIV and galloping regime, the vibration amplitude is relatively small in the VIV region while drastically increasing with increasing $U^*$ in the galloping region. In the transition response regimes, the vibration frequencies are galloping-like but the divergent amplitude cannot persist at high $U^*$. Furthermore, a wake mode map in the examined parametric space is offered. Particular attention is paid to physical mechanisms for hysteresis, dual galloping and flow intermittency. Finally, we probe the dependence of the responses on Reynolds numbers, mass ratios and degrees of freedom, and analyse the roles of the shear layer reattachment and separation point movement in the appearance of multiple responses.
Rodents and shrews are major reservoirs of various pathogens that are related to zoonotic infectious diseases. The purpose of this study was to investigate co-infections of zoonotic pathogens in rodents and shrews trapped in four provinces of China. We sampled different rodent and shrew communities within and around human settlements in four provinces of China and characterised several important zoonotic viral, bacterial, and parasitic pathogens by PCR methods and phylogenetic analysis. A total of 864 rodents and shrews belonging to 24 and 13 species from RODENTIA and EULIPOTYPHLA orders were captured, respectively. For viral pathogens, two species of hantavirus (Hantaan orthohantavirus and Caobang orthohantavirus) were identified in 3.47% of rodents and shrews. The overall prevalence of Bartonella spp., Anaplasmataceae, Babesia spp., Leptospira spp., Spotted fever group Rickettsiae, Borrelia spp., and Coxiella burnetii were 31.25%, 8.91%, 4.17%, 3.94%, 3.59%, 3.47%, and 0.58%, respectively. Furthermore, the highest co-infection status of three pathogens was observed among Bartonella spp., Leptospira spp., and Anaplasmataceae with a co-infection rate of 0.46%. Our results suggested that species distribution and co-infections of zoonotic pathogens were prevalent in rodents and shrews, highlighting the necessity of active surveillance for zoonotic pathogens in wild mammals in wider regions.