The Implementation of China's Mental Health Law-Defined Risk Criteria for Involuntary Admission: A National Cross-Sectional Study of Involuntarily Hospitalized Patients

Objective: Involuntary admission is one of the most controversial issues in psychiatry in China. This study aimed to examine the implementation of the new risk criteria for involuntary admission, as defined by the new Mental Health Law (MHL), in major psychiatric hospitals; and to explore factors associated with the implementation.Method: We selected 32 psychiatric hospitals in 29 provincial capital cities in mainland China. We included all involuntarily admitted psychiatric inpatients who were discharged from December 25 to 27, 2017. Patients' demographic and clinical data and reasons for admission were retrieved. Hospitals' information was also collected. Multilevel logistic regression was applied to explore factors associated with the implementation.Results: We collected valid data from 814 inpatients. Rates of risk criteria implementation ranged from 7.9 to 88.5% in these hospitals. Only 369 inpatients (45.3%) met the MHL-defined risk criteria. Overall, between 62.2 and 78.5% of the variance in risk criteria implementation was at the patient level, and between 21.5 and 37.8% of the variance was at the hospital level. Patients with higher Global Assessment of Functioning (GAF) scores at admission were less likely to meet the risk criteria (OR 1.02, 95% CI 1.01–1.03). No statistically significant association was found between risk criteria implementation and other patient level or hospital level factors.Conclusion: Our findings show the implementation rate of the MHL's risk criteria overall was low, with only 45.3% of involuntary admissions meeting the MHL-defined criteria. This suggests that some patients' civil rights might have been violated

Psychiatry Residents in China: Socio-Demographic Characteristics, Career Satisfaction, and Related Factors

Objective: To study the socio-demographic characteristics, the working environment, and the level of career satisfaction among psychiatry residents in China.Method: This was a part of a large-scale, nation-wide online survey of hospitals, healthcare professionals, and patients. Data, including socio-demographics, work hours, income, job satisfaction, and intention to quit were collected anonymously. Respondents also completed the Minnesota Satisfaction Questionnaire (MSQ).Results: One thousand sixty residents nested in 32 psychiatric hospitals in 29 provinces in China completed the survey. Respondents were predominantly female (69.0%), worked an average of 47.8 ± 11.6 h per week, and 28.97% had experienced medical disputes in the previous year. The top three reported reasons for dissatisfaction were low pay (50.1%), contentious doctor-patient relationships (17.6%), and high workload (10.8%). An intention to quit their current job was reported by 18.7% of residents. The overall mean MSQ score was 73.8 ± 13.8, with significant differences across post-graduate training years and regions. A multilevel regression analysis found that a higher MSQ score was significantly associated with fewer years in residency, shorter work hours, higher monthly pay, having medical liability insurance, and feeling satisfied with the level of doctor-nurse cooperation, their hospitals' medical disputes prevention/management, and the healthcare workers' social environment.Conclusion: Psychiatry residents in China are predominantly female and well-educated. They are only moderately satisfied with their career. Poor salaries, contentious doctor-patient relationships and high workload are among their top complaints and may explain why a considerable proportion are intending to leave their current residency. More support from the government regarding residents' salaries, workload and working environment may help improve their job satisfaction and retention, ensuring that China will have a pool of well-trained and engaged psychiatrists for the future

Alcohol misuse, health-related behaviors, and burnout among clinical therapists in China during the early Covid-19 pandemic: A Nationwide survey

ObjectivesThis study aimed to assess the extent of alcohol use and misuse among clinical therapists working in psychiatric hospitals in China during the early COVID-19 Pandemic, and to identify associated factors.MethodsAn anonymous nationwide survey was conducted in 41 tertiary psychiatric hospitals. We collected demographic data as well as alcohol use using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and burnout using the Maslach Burnout Inventory Human Services Survey.ResultsIn total, 396 clinical therapists completed the survey, representing 89.0% of all potential participants we targeted. The mean age of participants was 33.8 years old, and more than three-quarters (77.5%) were female. Nearly two-fifths (39.1%) self-reported as current alcohol users. The overall prevalence of alcohol misuse was 6.6%. Nearly one-fifth (19.9%) reported symptoms of burnout with high emotional exhaustion in 46 (11.6%), and high depersonalization in 61 (15.4%). Multiple logistic regression showed alcohol use was associated with male gender (OR = 4.392; 95% CI =2.443–7.894), single marital status (OR = 1.652; 95% CI =0.970–2.814), smoking habit (OR = 3.847; 95%CI =1.160–12.758) and regular exercise (OR = 2.719; 95%CI =1.490–4.963). Alcohol misuse was associated with male gender (OR = 3.367; 95% CI =1.174–9.655), a lower education level (OR = 3.788; 95%CI =1.009–14.224), smoking habit (OR = 4.626; 95%CI =1.277–16.754) and high burnout (depersonalization, OR = 4.848; 95%CI =1.433–16.406).ConclusionDuring the COVID-19 pandemic, clinical therapists’ alcohol consumption did not increase significantly. Male gender, cigarette smoking, and burnout are associated with an increased risk of alcohol misuse among clinical therapists. Targeted intervention is needed when developing strategies to reduce alcohol misuse and improve clinical therapists’ wellness and mental health

Prevalence and associated factors of depression, anxiety and stress among clinical therapists in China in the context of early COVID-19 pandemic

ObjectivesTo study the socio-demographic characteristics and the prevalence of depression, anxiety, and stress among clinical therapists in China during the early Coronavirus disease 2019 (COVID-19) pandemic and to identify associated factors.MethodThis cross-sectional study was part of a multicenter, nationally representative survey conducted through WeChat from January 2021 to March 2021. Data, including socio-demographics, health-related behaviors, and information on whether they participated in the frontline work of treating COVID-19, were collected anonymously. Respondents also completed the Depression Anxiety Stress Scales-21 (DASS-21).ResultsIn total, 396 clinical therapists in the selected hospitals completed the questionnaires, with a response rate of 89.0%. Respondents were predominantly female (77.3%). About 6.6% of the participants were current tobacco users, and 20.7% had participated in the frontline work of treating COVID-19. Overall, 22.0%, 17.9%, and 8.8% of participants were classified as having clinically meaningful depression, anxiety, and stress, respectively, based on DASS-21 scores. Multiple logistic regression in Model 1 and Model 2 showed that depression, anxiety, and stress were associated with regular physical activity and frequent insomnia (all, p < 0.05). In anxiety model 2, the associated factors for anxiety during the pandemic were identified as education (master’s degree or more, OR=0.520; 95% CI=0.283-0.955), marital status (single, OR=2.064; 95% CI=1.022-4.168), tobacco use (OR=4.265; 95% CI=1.352-13.454), regular physical activity (OR=0.357; 95% CI=0.192-0.663), frequent insomnia (OR=6.298; 95% CI =2.522-15.729), and participation in the frontline work of treating COVID-19 (OR=3.179; 95% CI=1.697-5.954). The COVID-19 epidemic did not significantly increase the depression and stress levels among clinical therapists, but it did significantly increase anxiety levels.ConclusionDuring the COVID-19 pandemic, depression, anxiety and stress were relatively common among clinical therapists in China. Regular physical activity and good sleep were important protective factors against emotional problems. Therefore, encouraging regular physical activity and actively addressing clinical therapists’ sleep problems is beneficial to improving the ability to cope with negative emotions. The COVID-19 epidemic significantly increased anxiety, and awareness and interventions should be recommended to reduce anxiety among clinical therapists during the COVID-19 pandemic

Exploring Variability of Trichodesmium Photophysiology Using Multi-Excitation Wavelength Fast Repetition Rate Fluorometry

Fast repetition rate fluorometry (FRRf) allows for rapid non-destructive assessment of phytoplankton photophysiology in situ yet has rarely been applied to Trichodesmium. This gap reflects long-standing concerns that Trichodesmium (and other cyanobacteria) contain pigments that are less effective at absorbing blue light which is often used as the sole excitation source in FRR fluorometers—potentially leading to underestimation of key fluorescence parameters. In this study, we use a multi-excitation FRR fluorometer (equipped with blue, green, and orange LEDs) to investigate photophysiological variability in Trichodesmium assemblages from two sites. Using a multi-LED measurement protocol (447+519+634 nm combined), we assessed maximum photochemical efficiency (Fv/Fm), functional absorption cross section of PSII (σPSII), and electron transport rates (ETRs) for Trichodesmium assemblages in both the Northwest Pacific (NWP) and North Indian Ocean in the vicinity of Sri Lanka (NIO-SL). Evaluating fluorometer performance, we showed that use of a multi-LED measuring protocol yields a significant increase of Fv/Fm for Trichodesmium compared to blue-only excitation. We found distinct photophysiological differences for Trichodesmium at both locations with higher average Fv/Fm as well as lower σPSII and non-photochemical quenching (NPQNSV) observed in the NWP compared to the NIO-SL (Kruskal–Wallis t-test df = 1, p < 0.05). Fluorescence light response curves (FLCs) further revealed differences in ETR response with a lower initial slope (αETR) and higher maximum electron turnover rate ((Formula presented.)) observed for Trichodesmium in the NWP compared to the NIO-SL, translating to a higher averaged light saturation EK (= (Formula presented.) /αETR) for cells at this location. Spatial variations in physiological parameters were both observed between and within regions, likely linked to nutrient supply and physiological stress. Finally, we applied an algorithm to estimate primary productivity of Trichodesmium using FRRf-derived fluorescence parameters, yielding an estimated carbon-fixation rate ranging from 7.8 to 21.1 mgC mg Chl-a–1 h–1 across this dataset. Overall, our findings demonstrate that capacity of multi-excitation FRRf to advance the application of Chl-a fluorescence techniques in phytoplankton assemblages dominated by cyanobacteria and reveals novel insight into environmental regulation of photoacclimation in natural Trichodesmium population

Influences of the Thomson Effect on the Performance of a Thermoelectric Generator-Driven Thermoelectric Heat Pump Combined Device

A thermodynamic model of a thermoelectric generator-driven thermoelectric heat pump (TEG-TEH) combined device is established considering the Thomson effect and the temperature dependence of the thermoelectric properties based on non-equilibrium thermodynamics. Energy analysis and exergy analysis are performed. New expressions for heating load, maximum working temperature difference, coefficient of performance (COP), and exergy efficiency are obtained. The performance is analyzed and optimized using numerical calculations. The general performance, optimal performance, optimum variables, optimal performance ranges, and optimum variable ranges are obtained. The results show that the Thomson effect decreases the general performance and optimal performance, and narrows the optimal operating ranges and optimum variable ranges. Considering the Thomson effect, more thermoelectric elements should be allocated to the thermoelectric generator when designing the devices. The optimum design variables for the maximum exergy efficiency are different from those for the maximum COP. The results can provide more scientific guidelines for designing TEG-TEH devices

Molecular dynamics studies on the NMR structures of rabbit prion protein wild type and mutants: surface electrostatic charge distributions

Prion diseases are invariably fatal and highly infectious neurodegenerative diseases that affect a wide variety of mammalian species such as sheep and goats, cattle, deer and elk, and humans. But for rabbits, studies have shown that they have a low susceptibility to be infected by prion diseases. This paper does molecular dynamics (MD) studies of rabbit NMR structures (of the wild type and its two mutants of two surface residues), in order to understand the specific mechanism of rabbit prion proteins (RaPrPC). Protein surface electrostatic charge distributions are specially focused to analyze the MD trajectories. This paper can conclude that surface electrostatic charge distributions indeed contribute to the structural stability of wild-type RaPrPC; this may be useful for the medicinal treatment of prion diseases

Adaptive Estimation and Cooperative Guidance for Active Aircraft Defense in Stochastic Scenario

The active aircraft defense problem is investigated for the stochastic scenario wherein a defending missile (or a defender) is employed to protect a target aircraft from an attacking missile whose pursuit guidance strategy is unknown. For the purpose of identifying the guidance strategy, the static multiple model estimator (sMME) based on the square-root cubature Kalman filter is proposed, and each model represents a potential attacking missile guidance strategy. Furthermore, an estimation enhancement approach is provided by using pseudo-measurement. For each model in the sMME, the model-matched cooperative guidance laws for the target and defender are derived by formulating the active defense problem as a constrained linear quadratic problem, where an accurate defensive interception and the minimum evasion miss distance are both considered. The proposed adaptive cooperative guidance laws are the result of mixing the model-matched optimal cooperative guidance laws in the criterion of maximum a posteriori probability in the framework of the sMME. By adopting the adaptive cooperative guidance laws, the target can facilitate the defender&#8217;s interception with the attacking missile with less control effort. Also, simulation results show that the proposed guidance laws increase the probability of successful target protection in the stochastic scenario compared with other defensive guidance laws

Influences of the Thomson Effect on the Performance of a Thermoelectric Generator-Driven Thermoelectric Heat Pump Combined Device

A thermodynamic model of a thermoelectric generator-driven thermoelectric heat pump (TEG-TEH) combined device is established considering the Thomson effect and the temperature dependence of the thermoelectric properties based on non-equilibrium thermodynamics. Energy analysis and exergy analysis are performed. New expressions for heating load, maximum working temperature difference, coefficient of performance (COP), and exergy efficiency are obtained. The performance is analyzed and optimized using numerical calculations. The general performance, optimal performance, optimum variables, optimal performance ranges, and optimum variable ranges are obtained. The results show that the Thomson effect decreases the general performance and optimal performance, and narrows the optimal operating ranges and optimum variable ranges. Considering the Thomson effect, more thermoelectric elements should be allocated to the thermoelectric generator when designing the devices. The optimum design variables for the maximum exergy efficiency are different from those for the maximum COP. The results can provide more scientific guidelines for designing TEG-TEH devices