Effects of antipsychotics on bone mineral density and prolactin levels in patients with schizophrenia: a 12-month prospective study

Objective: Effects of conventional and atypical antipsychotics on bone mineral density (BMD) and serum prolactin levels (PRL) were examined in patients with schizophrenia.Methods: One hundred and sixty-three first-episode inpatients with schizophrenia were recruited, to whom one of three conventional antipsychotics (perphenazine, sulpiride, and chlorpromazine) or one of three atypical antipsychotics (clozapine, quetiapine, and aripiprazole)was prescribed for 12 months as appropriate. BMD and PRL were tested before and after treatment. Same measures were conducted in 90 matched healthy controls.Results Baseline BMD of postero-anterior L1–L4 range from 1.04 ± 0.17 to 1.42 ± 1.23, and there was no significant difference between the patients group and healthy control group. However, post-treatment BMD values in patients (ranging from 1.02 ± 0.15 to 1.23 ± 0.10) were significantly lower than that in healthy controls (ranging from 1.15 ± 0.12 to 1.42 ± 1.36). The BMD values after conventional antipsychotics were significantly lower than that after atypical antipsychotics. The PRL level after conventional antipsychotics (53.05 ± 30.25 ng/ml) was significantly higher than that after atypical antipsychotics (32.81 ± 17.42 ng/ml). Conditioned relevance analysis revealed significant negative correlations between the PRL level and the BMD values after conventional antipsychotics.Conclusion The increase of PRL might be an important risk factor leading to a high prevalence of osteoporosis in patients with schizophrenia on long-term conventional antipsychotic medication.<br/

Possible origin of β\beta-relaxation in amorphous metal alloys from atomic-mass differences of the constituents

We employ an atomic-scale theory within the framework of nonaffine lattice dynamics to uncover the origin of the Johari-Goldstein (JG) $\beta$-relaxation in metallic glasses (MGs). Combining simulation and experimental data with our theoretical approach, we reveal that the large mass asymmetry between the elements in a La$_{60}$Ni$_{15}$Al$_{25}$ MG leads to a clear separation in the respective relaxation time scales, giving strong evidence that JG relaxation is controlled by the lightest atomic species present. Moreover, we show that only qualitative features of the vibrational density of states determine the overall observed mechanical response of the glass, paving the way for a possible unified theory of secondary relaxations in glasses

The role of health system governance in strengthening the rural health insurance system in China.

BACKGROUND: Systems of governance play a key role in the operation and performance of health systems. In the past six decades, China has made great advances in strengthening its health system, most notably in establishing a health insurance system that enables residents of rural areas to achieve access to essential services. Although there have been several studies of rural health insurance schemes, these have focused on coverage and service utilization, while much less attention has been given to the role of governance in designing and implementing these schemes. METHODS: Information from publications and policy documents relevant to the development of two rural health insurance policies in China was obtained, analysed, and synthesise. 92 documents on CMS (Cooperative Medical Scheme) or NCMS (New Rural Cooperative Medical Scheme) from four databases searched were included. Data extraction and synthesis of the information were guided by a framework that drew on that developed by the WHO to describe health system governance and leadership. RESULTS: We identified a series of governance practices that were supportive of progress, including the prioritisation by the central government of health system development and certain health policies within overall national development; strong government commitment combined with a hierarchal administrative system; clear policy goals coupled with the ability for local government to adopt policy measures that take account of local conditions; and the accumulation and use of the evidence generated from local practices. However these good practices were not seen in all governance domains. For example, poor collaboration between different government departments was shown to be a considerable challenge that undermined the operation of the insurance schemes. CONCLUSIONS: China's success in achieving scale up of CMS and NCMS has attracted considerable interest in many low and middle income countries (LMICs), especially with regard to the schemes' designs, coverage, and funding mechanisms. However, this study demonstrates that health systems governance may be critical to enable the development and operation of such schemes. Given that many LMICs are expanding health financing system to cover populations in rural areas or the informal sectors, we argue that strengthening specific practices in each governance domain could inform the adaptation of these schemes to other settings

Crux and long cycles in graphs

We introduce a notion of the \emph{crux} of a graph $G$, measuring the order of a smallest dense subgraph in $G$. This simple-looking notion leads to some generalisations of known results about cycles, offering an interesting paradigm of `replacing average degree by crux'. In particular, we prove that \emph{every} graph contains a cycle of length linear in its crux. Long proved that every subgraph of a hypercube $Q^m$ (resp. discrete torus $C_3^m$) with average degree $d$ contains a path of length $2^{d/2}$ (resp. $2^{d/4}$), and conjectured that there should be a path of length $2^{d}-1$ (resp. $3^{d/2}-1$). As a corollary of our result, together with isoperimetric inequalities, we close these exponential gaps giving asymptotically optimal bounds on long paths in hypercubes, discrete tori, and more generally Hamming graphs. We also consider random subgraphs of $C_4$-free graphs and hypercubes, proving near optimal bounds on lengths of long cycles

2-Eth­oxy­ethyl (Z)-2-cyano-3-[(N-phenyl­carbamo­yl)amino]­prop-2-enoate

The crystal structure of the title compound, C15H17N3O4, is stabilized by inter­molecular N—H⋯N hydrogen bonds. An intra­molecular N—H⋯O hydrogen bond also occurs