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Multimorbidity, especially physical–mental multimorbidity, is an emerging global health challenge. However, the characteristics and patterns of physical–mental multimorbidity based on the diagnosis of mental disorders in Chinese adults remain unclear.
Methods
A cross-sectional study was conducted from November 2004 to April 2005 among 13,358 adults (ages 18–65years) residing in Liaoning Province, China, to evaluate the occurrence of physical–mental multimorbidity. Mental disorders were assessed using the Composite International Diagnostic Interview (version 1.0) with reference to the Diagnostic and Statistical Manual of Mental Disorders (3rd Edition Revised), while physical diseases were self-reported. Physical–mental multimorbidity was assessed based on a list of 16 physical and mental morbidities with prevalence ≥1% and was defined as the presence of one mental disorder and one physical disease. The chi-square test was used to calculate differences in the prevalence and comorbidity of different diseases between the sexes. A matrix heat map was generated of the absolute number of comorbidities for each disease. To identify complex associations and potential disease clustering patterns, a network analysis was performed, constructing a network to explore the relationships within and between various mental disorders and physical diseases.
Results
Physical–mental multimorbidity was confirmed in 3.7% (498) of the participants, with a higher prevalence among women (4.2%, 282) than men (3.3%, 216). The top three diseases with the highest comorbidity rate and average number of comorbidities were dysphoric mood (86.3%; 2.86), social anxiety disorder (77.8%; 2.78) and major depressive disorder (77.1%; 2.53). A physical–mental multimorbidity network was visually divided into mental and physical domains. Additionally, four distinct multimorbidity patterns were identified: ‘Affective-addiction’, ‘Anxiety’, ‘Cardiometabolic’ and ‘Gastro-musculoskeletal-respiratory’, with the digestive-respiratory-musculoskeletal pattern being the most common among the total sample. The affective-addiction pattern was more prevalent in men and rural populations. The cardiometabolic pattern was more common in urban populations.
Conclusions
The physical–mental multimorbidity network structure and the four patterns identified in this study align with previous research, though we observed notable differences in the proportion of these patterns. These variations highlight the importance of tailored interventions that address specific multimorbidity patterns while maintaining broader applicability to diverse populations.
Based on a 4f system, a 0° reflector and a single laser diode side-pump amplifier, a new amplifier is designed to compensate the spherical aberration of the amplified laser generated by a single laser diode side-pump amplifier and enhance the power of the amplified laser. Furthermore, the role of the 4f system in the passive spherical aberration compensation and its effect on the amplified laser are discussed in detail. The results indicate that the amplification efficiency is enhanced by incorporating a 4f system in a double-pass amplifier and placing a 0° reflector only at the focal point of the single-pass amplified laser. This method also effectively uses the heat from the gain medium (neodymium-doped yttrium aluminium garnet) of the amplifier to compensate the spherical aberration of the amplified laser.
We developed a real-world evidence (RWE) based Markov model to project the 10-year cost of care for patients with depression from the public payer’s perspective to inform early policy and resource planning in Hong Kong.
Methods
The model considered treatment-resistant depression (TRD) and development of comorbidities along the disease course. The outcomes included costs for all-cause and psychiatric care. From our territory-wide electronic medical records, we identified 25,190 patients with newly diagnosed depression during the period from 2014 to 2016, with follow-up until December 2020 for real-world time-to-event patterns. Costs and time varying transition inputs were derived using negative binomial and parametric survival modeling. The model is available as a closed cohort, which studies a fixed cohort of incident patients, or an open cohort that introduces new patients every year. Utilities values and the number of incident cases per year were derived from published sources.
Results
There were 9,217 new patients with depression in 2023. Our closed cohort model projected that the cumulative cost of all-cause and psychiatric care for these patients would reach USD309 million and USD58 million by 2032, respectively. In our open cohort model, 55,849 to 57,896 active prevalent cases would cost more than USD322 million and USD61 million annually in all-cause and psychiatric care, respectively. Although less than 20 percent of patients would develop TRD or its associated comorbidities, they contribute 31 to 54 percent of the costs. The key cost drivers were the number of annual incident cases and the probability of developing TRD and associated comorbidities and of becoming a low-intensity service user. These factors are relevant to early disease stages.
Conclusions
A small proportion of patients with depression develop TRD, but they contribute to a high proportion of the care costs. Our projection also demonstrates the application of RWE to model the long-term costs of care, which can aid policymakers in anticipating foreseeable burden and undertaking budget planning to prepare for future care needs.
A high-energy pulsed vacuum ultraviolet (VUV) solid-state laser at 177 nm with high peak power by the sixth harmonic of a neodymium-doped yttrium aluminum garnet (Nd:YAG) amplifier in a KBe2BO3F2 prism-coupled device was demonstrated. The ultraviolet (UV) pump laser is a 352 ps pulsed, spatial top-hat super-Gaussian beam at 355 nm. A high energy of a 7.12 mJ VUV laser at 177 nm is obtained with a pulse width of 255 ps, indicating a peak power of 28 MW, and the conversion efficiency is 9.42% from 355 to 177 nm. The measured results fitted well with the theoretical prediction. It is the highest pulse energy and highest peak power ever reported in the VUV range for any solid-state lasers. The high-energy, high-peak-power, and high-spatial-uniformity VUV laser is of great interest for ultra-fine machining and particle-size measurements using UV in-line Fraunhofer holography diagnostics.
A recent study published in Oryx proposed that the extinct Javan tiger Panthera tigris sondaica may still survive on the Island of Java, Indonesia, based on mitochondrial DNA analysis of a single hair sample collected from a location where a tiger was reportedly encountered. However, upon reanalysing the genetic data presented in that study, we conclude that there is little support for this claim. The sequences of the putative tiger hair and Javan tiger museum specimens generated are not from tiger cytoplasmic mitochondrial DNA but more likely the nuclear pseudogene copies of mitochondrial DNA. In addition, the number of mismatches between the two Javan tiger sequences is unusually high for homologous sequences that are both from tigers, suggesting potential issues with data reliability. The paper provides insufficient details on quality control measures, making it impossible to rule out the possibility that errors were introduced during the analysis. Consequently, it is inappropriate to use the sequences presented in that study to infer the existence of the Javan tiger.
In this paper, curved detonation equations with gradients for the pre-wave and post-wave are constructed followed by analysis, verification and applications. The study focuses on shock induced chemical reaction such as detonation, with the energy effect for the main attention. Equations consider both planar and transverse curvature to accommodate both planar and axisymmetric flow problems. Influence coefficients are derived and used to analyse the effect of energy and curvature on the post-wave gradient. Good agreement with the simulation results demonstrates that the equations presented in this paper can calculate various post-wave gradients accurately. After verification, the equations can be applied to applications, including not only solution and analysis but also in the inverse design. First, the method can be applied with polar analysis to provide a new perspective and higher order parameters for the study of detonation. Second, the equations can be used for the capture of detonation waves, where both planar and axisymmetric examples show better performance. Furthermore, the equations can be used in the inverse design of detonation waves in combination with the method of characteristics, which is one of the unique benefits of the present equations.
Accurately converting satellite instantaneous evapotranspiration (λETi) over time to daily evapotranspiration (λETd) is crucial for estimating regional evapotranspiration from remote sensing satellites, which plays an important role in effective water resource management. In this study, four upscaling methods based on the principle of energy balance, including the evaporative fraction method (Eva-f method), revised evaporative fraction method (R-Eva-f method), crop coefficient method (Kc-ET0 method) and direct canopy resistance method (Direct-rc method), were validated based on the measured data of the Bowen ratio energy balance system (BREB) in maize fields in northwestern (NW) and northeastern (NE) China (semi-arid and semi-humid continental climate regions) from 2021 to 2023. Results indicated that Eva-f and R-Eva-f methods were superior to Kc-ET0 and Direct-rc methods in both climatic regions and performed better between 10:00 and 11:00, with mean absolute errors (MAE) and coefficient of efficiency (ɛ) reaching <10 W/m2 and > 0.91, respectively. Comprehensive evaluation of the optimal upscaling time using global performance indicators (GPI) showed that the Eva-f method had the highest GPI of 0.59 at 12:00 for the NW, while the R-Eva-f method had the highest GPI of 1.18 at 11:00 for the NE. As a result, the Eva-f approach is recommended as the best way for upscaling evapotranspiration in NW, with 12:00 being the ideal upscaling time. The R-Eva-f method is the optimum upscaling method for the Northeast area, with an ideal upscaling time of 11:00. The comprehensive results of this study could be useful for converting λETi to λETd.
Control over the legislative messaging agenda has important political, electoral and policy consequences. Existing models of congressional agenda-setting suggest that national polarization drives the agenda. At the same time, models of home style and formal models of leadership hypothesize that legislators shift their messaging as they balance coordination and information problems. We say the coordination problem dominates when conditions incentivize legislators to agree on the same message rather than fail to reach consensus. Conversely, the information problem is said to dominate in circumstances where legislators prefer to say nothing at all rather than reach consensus on the wrong political message. Formal theories predict that when coordination problems are pressing, legislative members follow the policy positions of party leaders. When their party’s information problem is acute, party members instead rely on the wisdom of the caucus to set the party’s agenda. To test these theories, we analyze the Twitter accounts of U.S. House members with a Joint Sentiment Topic model, generating a new understanding of House leadership power. Our analyses reveal complex leader-follower relationships. Party leaders possess the power to substantially affect the propensity of rank-and-file members to discuss topics, especially when the coordination problem dominates; these effects are pronounced even when coordination problems are pressing. That said, when the underlying politics are unclear, rank-and-file members exert influence on the discussion of a topic because the information problem is more acute. At the same time and for these uncertain topics, leadership influence decreases, consistent with theory. We show these results are robust to the underlying dynamics of contemporary political discussion and context, including leading explanations for party leadership power, such as national polarization.
Artificial sweeteners are generally used and recommended to alternate added sugar for health promotion. However, the health effects of artificial sweeteners remain unclear. In this study, we included 6371 participants from the National Health and Nutrition Examination Survey with artificial sweetener intake records. Logistic regression and Cox regression were applied to explore the associations between artificial sweeteners and risks of cardiometabolic disorders and mortality. Mendelian randomisation was performed to verify the causal associations. We observed that participants with higher consumption of artificial sweeteners were more likely to be female and older and have above medium socio-economic status. After multivariable adjustment, frequent consumers presented the OR (95 % CI) for hypertension (1·52 (1·29, 1·80)), hypercholesterolaemia (1·28 (1·10, 1·50)), diabetes (3·74 (3·06, 4·57)), obesity (1·52 (1·29, 1·80)), congestive heart failure (1·89 (1·35, 2·62)) and heart attack (1·51 (1·10, 2·04)). Mendelian randomisation confirmed the increased risks of hypertension and type 2 diabetes. Moreover, an increased risk of diabetic mortality was identified in participants who had artificial sweeteners ≥ 1 daily (HR = 2·62 (1·46, 4·69), P = 0·001). Higher consumption of artificial sweeteners is associated with increased risks of cardiometabolic disorders and diabetic mortality. These results suggest that using artificial sweeteners as sugar substitutes may not be beneficial.
Species of epiphytic microbiota are closely associated with the fermentation performance of natural forage silage. This study aimed to evaluate the dynamic microbial communities, fermentation parameters, and aerobic stability of Napier grass silage from the same variety and growth period but harvested from three different regions (NGP1, NGP2, and NGP3). After 60 days of ensiling, triplicate silos were opened for sampling and testing aerobic stability. The epiphytic microbiota with higher relative abundances in fresh Napier grass (NGP1, NGP2, and NGP3) were Weissella, Enterobacter, and Lactococcus, respectively. After 60 days of ensiling, NGP3 exhibited higher fermentation quality, indicated by higher lactic acid (LA) concentration and lower pH than that of NGP1 and NGP2. The NH3–N content of all treatments was lower than 100 g/kg total nitrogen. Compared with NGP1 and NGP2 silage, NGP3 silage exhibited a sharp rise in pH and LA consumption during air exposure. After 7 days of air exposure, NGP3 had higher ethanol concentrations and pH. Ruminiclostridium_5, Pediococcus, and Lactobacillus predominated in NGP1, NGP2, and NGP3 silages, respectively, whereas Candida and Monascus predominated in air-exposed NGP3 silage. The bacterial co-occurrence networks from fresh samples to ensiling and air exposure became more complex; however, NGP3 had a higher negative correlation with co-occurrence after air exposure. Different regions had significant effects on the fermentation patterns, bacterial communities, and aerobic stability of Napier grass silage. This was mainly due to variable epiphytic microbiota. Higher fermentation quality of Napier grass silage may also result in accelerated spoilage due to air exposure. Candida and Monascus were primarily responsible for the lower dry matter recovery and higher ethanol contents and air exposure spoilage of Napier grass silage.
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.
Chinese nurses working with immense stress may have issues with burnout during COVID-19 regular prevention and control. There were a few studies investigating status of burnout and associated factors among Chinese nurses. However, the relationships remained unclear.
Objectives
To investigate status and associated factors of nurses’ burnout during COVID-19 regular prevention and control.
Methods
784 nurses completed questionnaires including demographics, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Insomnia Severity Index, Impact of Event Scale-revised, Perceived Social Support Scale, Connor–Davidson Resilience Scale, General Self-efficacy Scale and Maslach Burnout Inventory.
Results
310 (39.5%), 393 (50.1%) and 576 (73.5%) of respondents were at high risk of emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA). The risk of EE, DP and reduced PA were moderate, high and high. Nurses with intermediate and senior professional rank and title and worked >40 h every week had lower scores in EE. Those worked in low-risk department reported lower scores in PA. Anxiety, post-traumatic stress disorder (PTSD), self-efficacy and social support were influencing factors of EE and DP, while social support and resilience were associated factors of PA.
Conclusion
Chinese nurses’ burnout during COVID-19 regular prevention and control was serious. Professional rank and title, working unit, weekly working hours, anxiety, PTSD, self-efficacy, social support and resilience were associated factors of burnout.
This paper investigates the effect of curvature on curved detonation and its reflections. Specifically, the study focuses on two aspects: the effect of curvature on the postwave parameters and their gradients, and the stabilization of Mach reflection. Relationships are established between the curvature and the gradients of the postwave parameters, thus providing a basis for examining detonation reflections and obtaining a comprehensive understanding of curved detonation. In particular, these relationships offer a valuable analytical tool to predict the postwave gradients, as well as providing a fresh perspective to understand the transformation from Mach reflection to regular reflection in curved detonation. The validity of these relationships is confirmed by comparison with simulation results. Two mechanisms by which curvature influences the stationarity of Mach reflection are identified. An increase in wave angle and interference between wave systems leading to the generation and integration of subsonic zones are the reasons for the non-stationarity of the Mach reflection in curved detonation. Besides, the effect mechanisms of choked flow which is considered to be the root cause are analysed in detail. On the basis of a theoretical model, the development of a quantitative criterion for the stability of detonation reflection is proposed, and its validity is confirmed by simulations. This criterion is used in a comprehensive investigation of the primary factors affecting the stability of detonation wave reflections, providing insights that will be of great value for the further development of detonation engines.
Tuberculosis (TB) infection prevention and control (IPC) in healthcare facilities is key to reducing transmission risk. A framework for systematically improving TB IPC through training and mentorship was implemented in 9 healthcare facilities in China from 2017 to 2019.
Methods:
Facilities conducted standardized TB IPC assessments at baseline and quarterly thereafter for 18 months. Facility-based performance was assessed using quantifiable indicators for IPC core components and administrative, environmental, and respiratory protection controls, and as a composite of all control types We calculated the percentage changes in scores over time and differences by IPC control type and facility characteristics.
Results:
Scores for IPC core components increased by 72% during follow-up when averaged across facilities. The percentage changes for administrative, environmental, and respiratory protection controls were 39%, 46%, and 30%, respectively. Composite scores were 45% higher after the intervention. Overall, scores increased most during the first 6 months. There was no association between IPC implementation and provincial economic development or volume of TB services.
Conclusions:
TB IPC policies and practices showed most improvement early during implementation and did not differ consistently by facility characteristics. The training component of the project helped increase the capacity of healthcare professionals to manage TB transmission risks. Lessons learned here will inform national TB IPC guidance.
The Righi–Leduc heat flux generated by the self-generated magnetic field in the ablative Rayleigh–Taylor instability driven by a laser irradiating thin targets is studied through two-dimensional extended-magnetohydrodynamic simulations. The perturbation structure gets into a low magnetization state though the peak strength of the self-generated magnetic field could reach hundreds of teslas. The Righi–Leduc effect plays an essential impact both in the linear and nonlinear stages, and it deflects the total heat flux towards the spike base. Compared to the case without the self-generated magnetic field included, less heat flux is concentrated at the spike tip, finally mitigating the ablative stabilization and leading to an increase in the velocity of the spike tip. It is shown that the linear growth rate is increased by about 10% and the amplitude during the nonlinear stage is increased by even more than 10% due to the feedback of the magnetic field, respectively. Our results reveal the importance of Righi–Leduc heat flux to the growth of the instability and promote deep understanding of the instability evolution together with the self-generated magnetic field, especially during the acceleration stage in inertial confinement fusion.
The production and industrial use of asbestos cement and other asbestos-containing materials have been restricted in most countries because of the potential detrimental effects on human health and the environment. Chrysotile is the most common form of asbestos and investigations into how to recycle this serpentine phyllosilicate mineral have attracted extensive attention. Chrysotile asbestos tailings can be transformed thermally, at high temperature, by in situ carbothermal reduction (CR). The CR method aims to maximize use of the chrysotile available and uses high temperatures and carbon to change the mineral form and structure of the chrysotile asbestos tailings. When chrysotile asbestos is employed as the raw material and coke (carbon) powder is used as the reducing agent for CR transformation, stable, high-temperature composites consisting of forsterite, stishovite, and silicon carbide are formed. Forsterite (Mg2SiO4) was the most abundant crystalline phase formed in samples heat treated below 1500ºC. At 1600ºC, forsterite was exhausted through decomposition and β-SiC formed by reduction of stishovite. A larger proportion of β-SiC was generated as the carbon content was increased. This research revealed that both temperature and carbon addition play key roles in the transformation of chrysotile asbestos tailings.
A rhamnolipid-layered double hydroxide (RL-LDH) nanocomposite, derived from the rhamnolipid (RL) biosurfactant, was synthesized through a delamination/reassembling process. The adsorption characteristics of Cu(II) on RL-LDH were investigated in detail and the results indicated the potential of using RL-LDH as an environmentally friendly adsorbent to remove Cu(II). The fabricated RL-LDH nanocomposite was characterized using powder X-ray diffraction, Fourier-transform infrared spectroscopy, scanning electron microscopy, transmission electron microscopy, elemental chemical composition, and specific surface area analyses. Batch adsorption experiments were conducted to study the influence of various factors, such as contact time, initial Cu(II) concentration, temperature, initial solution pH, and electrolyte concentration on Cu(II) adsorption by the RL-LDH nanocomposite. The RL-LDH nanocomposite had a low surface area of 11.71 m2 g−1, which suggests that surface adsorption would not be important in Cu(II) adsorption. The Cu(II) adsorption data fitted the Freundlich model well at pH 5.5, whereas the adsorption kinetics were accurately described by a pseudo-second-order kinetics model. Chemical binding, that is, the formation of a RL-Cu(II) complex in the LDH interlayer, was assumed to be the rate-limiting step in the adsorption process. Thermodynamic parameters that included Gibbs free energy, enthalpy, and entropy changes were also calculated. The adsorption was found to be a spontaneous and exothermic chemisorption process. Furthermore, the adsorption properties of RL-LDH for Cu(II) were compared to Cu(II) adsorption using other adsorbents.
The lift generation mechanism of leading-edge vortex (LEV) in the case of a pitching and plunging plate is studied using an experimental approach and the improved discrete vortex method in this research. A formation condition of the secondary structure is introduced into the traditional discrete vortex method to compensate for the shortcomings in the simulation of the viscous effect between LEV and plate. The simulation of the secondary structure helps the improved method perform better in flow-field reconstruction and lift prediction. Accordingly, the lift generation mechanism of the LEV and influence of the secondary structure are studied. The lift contribution of the vortex structure is isolated and linearly decomposed into two parts according to sources of flow field: the quasi-potential flow part and the vortex-induced flow part. The vortex lift is defined as the lift contribution of the vortex structure in vortex-induced flow, which gives a new insight into the production of lift of the LEV. The lift generation mechanism through the discrete vortex method is verified and extended in viscous flow through experimental measurement. In addition, a vortex lift indicator based on the reverse flow of the LEV is proposed to examine the change of vortex lift in experimental measurement. The flow mechanism for the decline of vortex lift for different maximum effective angles of attack is revealed based on the vortex lift indicator. Furthermore, for the LEV-dominating flow, the indicator can also be applied in estimating the maximum value and corresponding critical time of overall lift in experiments.
The discharged capillary plasma channel has been extensively studied as a high-gradient particle acceleration and transmission medium. A novel measurement method of plasma channel density profiles has been employed, where the role of plasma channels guiding the advantages of lasers has shown strong appeal. Here, we have studied the high-order transverse plasma density profile distribution using a channel-guided laser, and made detailed measurements of its evolution under various parameters. The paraxial wave equation in a plasma channel with high-order density profile components is analyzed, and the approximate propagation process based on the Gaussian profile laser is obtained on this basis, which agrees well with the simulation under phase conditions. In the experiments, by measuring the integrated transverse laser intensities at the outlet of the channels, the radial quartic density profiles of the plasma channels have been obtained. By precisely synchronizing the detection laser pulses and the plasma channels at various moments, the reconstructed density profile shows an evolution from the radial quartic profile to the quasi-parabolic profile, and the high-order component is indicated as an exponential decline tendency over time. Factors affecting the evolution rate were investigated by varying the incentive source and capillary parameters. It can be found that the discharge voltages and currents are positive factors quickening the evolution, while the electron-ion heating, capillary radii and pressures are negative ones. One plausible explanation is that quartic profile contributions may be linked to plasma heating. This work helps one to understand the mechanisms of the formation, the evolutions of the guiding channel electron-density profiles and their dependences on the external controllable parameters. It provides support and reflection for physical research on discharged capillary plasma and optimizing plasma channels in various applications.