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Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.
Methods
T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).
Results
PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).
Conclusions
PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.
Sperlingite, (H2O)K(Mn2+Fe3+)(Al2Ti)(PO4)4[O(OH)][(H2O)9(OH)]⋅4H2O, is a new monoclinic member of the paulkerrite group, from the Hagendorf-Süd pegmatite, Oberpfalz, Bavaria, Germany. It was found in corrosion pits of altered zwieselite, in association with columbite, hopeite, leucophosphite, mitridatite, scholzite, orange–brown zincoberaunite sprays and tiny green crystals of zincolibethenite. Sperlingite forms colourless prisms with pyramidal terminations, which are predominantly only 5 to 20 μm in size, rarely to 60 μm and frequently are multiply intergrown and are overgrown with smaller crystals. The crystals are flattened on {010} and slightly elongated along [100] with forms {010}, {001} and {111}. Twinning occurs by rotation about c. The calculated density is 2.40 g⋅cm–3. Optically, sperlingite crystals are biaxial (+), α = 1.600(est), β = 1.615(5), γ = 1.635(5) (white light) and 2V (calc.) = 82.7°. The optical orientation is X = b, Y = c and Z = a. Neither dispersion nor pleochroism were observed. The empirical formula from electron microprobe analyses and structure refinement is A1[(H2O)0.96K0.04]Σ1.00A2(K0.52□0.48)Σ1.00M1(Mn2+0.60Mg0.33Zn0.29Fe3+0.77)Σ1.99M2+M3(Al1.05Ti4+1.33Fe3+0.62)Σ3.00(PO4)4X[F0.19(OH)0.94O0.87]Σ2.00[(H2O)9.23(OH)0.77]Σ10.00⋅3.96H2O. Sperlingite has monoclinic symmetry with space group P21/c and unit-cell parameters a = 10.428(2) Å, b = 20.281(4) Å, c = 12.223(2) Å, β = 90.10(3)°, V = 2585.0(8) Å3 and Z = 4. The crystal structure was refined using synchrotron single-crystal data to wRobs = 0.058 for 5608 reflections with I > 3σ(I). Sperlingite is the first paulkerrite-group mineral to have co-dominant divalent and trivalent cations at the M1 sites; All other reported members have Mn2+ or Mg dominant at M1. Local charge balance for Fe3+ at M1 is achieved by H2O → OH– at H2O coordinated to M1.
This constructivist grounded theory study aimed to (1) explore patients’ experiences of and roles in interprofessional collaborative practice for chronic conditions in primary care and (2) consider the relevance and alignment of an existing theoretical framework on patients’ roles and based on the experiences of patient advocates.
Background:
High-quality management of chronic conditions requires an interprofessional collaborative practice model of care considering an individual’s mental, physical, and social health situation. Patients’ experiences of this model in the primary care setting are relatively unknown.
Methods:
A constructivist grounded theory approach was taken. Interview data were collected from primary care patients with chronic conditions across Australia in August 2020 – February 2022. Interviews were recorded, transcribed verbatim, and thematically analysed by (1) initial line-by-line coding, (2) focused coding, (3) memo writing, (4) categorisation, and (5) theme and sub-theme development. Themes and sub-themes were mapped against an existing theoretical framework to expand and confirm the results from a previous study with a similar research aim.
Findings:
Twenty adults with chronic conditions spanning physical disability, diabetes, heart disease, cancer, autoimmune, and mental health conditions participated. Two themes were developed: (1) Adapting to Change with two sub-themes describing how patients adapt to interprofessional team care and (2) Shifting across the spectrum of roles, with five sub-themes outlining the roles patients enact while receiving care. The findings suggest that patients’ roles are highly variable and fluid in interprofessional collaborative practice, and further work is recommended to develop a resource to support greater patient engagement in interprofessional collaborative practice.
OBJECTIVES/GOALS: To examine the individual and combined association between preoperative sleep disturbance (SD) and depression and 12-month disability, back pain, and leg pain after lumbar spine surgery (LSS). METHODS/STUDY POPULATION: We analyzed prospectively collected multi-center registry data from 700 patients undergoing LSS (mean age=60.9 years, 37% female, 89% white). Preoperative SD and depression were assessed with PROMIS measures. Established thresholds defined patients with moderate/severe symptoms. Disability (Oswestry Disability Index) and back and leg pain (Numeric Rating Scales) were assessed preoperatively and at 12 months. We conducted separate regressions to examine the influence of SD and depression on each outcome. Regressions examined each factor with and without accounting for the other and in combination as a 4-level variable. Covariates included age, sex, race, education, insurance, body mass index, smoking status, preoperative opioid use, fusion status, revision status, and preoperative outcome score. RESULTS/ANTICIPATED RESULTS: One hundred thirteen (17%) patients reported moderate/severe SD alone, 70 (10%) reported moderate/severe depression alone, and 57 (8%) reported both moderate/severe SD and depression. In independent models, preoperative SD and depression were significantly associated with 12-month outcomes (all p’s<0.05). After accounting for depression, preoperative SD was only associated with disability, while preoperative depression adjusting for SD remained associated with all outcomes (all p’s<0.05). Patients reporting both moderate/severe SD and moderate/severe depression had 12.6 points higher disability (95%CI=7.4 to 17.8) and 1.5 points higher back (95%CI=0.8 to 2.3) and leg pain (95%CI=0.7 to 2.3) compared to patients with no/mild SD and no/mild depression. DISCUSSION/SIGNIFICANCE: Preoperative SD and depression are independent predictors of 12-month disability and pain when considered in isolation. The combination of SD and depression impacts postoperative outcomes considerably. The high-risk group of patients with moderate/severe SD and depression could benefit from targeted treatment strategies.
References to the European Convention on Human Rights by Israeli courts – the European Convention on Human Rights and the European Court of Human Rights as sources of comparative law – comparative law as technique of legitimation – content analysis of use by domestic courts of European Court of Human Rights jurisprudence – European Court of Human Rights jurisprudence and deference to state
This paper introduces type P web supercategories. They are defined as diagrammatic monoidal ${\mathbb {k}}$-linear supercategories via generators and relations. We study the structure of these categories and provide diagrammatic bases for their morphism spaces. We also prove these supercategories provide combinatorial models for the monoidal supercategory generated by the symmetric powers of the natural module and their duals for the Lie superalgebra of type P.
Children with CHD are at risk for neurodevelopmental delays, and length of hospitalisation is a predictor of poorer long-term outcomes. Multiple aspects of hospitalisation impact neurodevelopment, including sleep interruptions, limited holding, and reduced developmental stimulation. We aimed to address modifiable factors by creating and implementing an interdisciplinary inpatient neurodevelopmental care programme in our Heart Institute.
Methods:
In this quality improvement study, we developed an empirically supported approach to neurodevelopmental care across the continuum of hospitalisation for patients with CHD using three plan-do-study-act cycles. With input from multi-level stakeholders including parents/caregivers, we co-designed interventions that comprised the Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) programme. These included medical/nursing orders for developmental care practices, developmental kits for patients, bedside developmental plans, caregiver education and support, developmental care rounds, and a specialised volunteer programme. We obtained data from the electronic health record for patients aged 0–2 years admitted for at least 7 days to track implementation.
Results:
There were 619 admissions in 18 months. Utilisation of CINCO interventions increased over time, particularly for the medical/nursing orders and caregiver handouts. The volunteer programme launch was delayed but grew rapidly and within six months, provided over 500 hours of developmental interaction with patients.
Conclusions:
We created and implemented a low-cost programme that systematised and expanded upon existing neurodevelopmental care practices in the cardiac inpatient units. Feasibility was demonstrated through increasing implementation rates over time. Key takeaways include the importance of multi-level stakeholder buy-in and embedding processes in existing clinical workflows.
This article revises the spatial and temporal boundaries of the Casas Grandes tradition associated with northwest Chihuahua, Mexico, based on new data collected in neighboring northeastern Sonora. The Casas Grandes tradition attained its greatest extent during the Medio period (AD 1200–1450/1500) followed by a dramatic demographic and political collapse. Hunter-gatherer groups subsequently occupied most of northwest Chihuahua. Data from the Fronteras Valley, Sonora, presents an alternative scenario, with a clear pattern of cultural continuity from the eleventh century to the colonial period in which sedentary farmers occupied the same landscapes and occasionally the same villages. These observations contribute to our understanding of the spread and subsequent demise of the Casas Grandes tradition in hinterland regions. For the Fronteras Valley, we infer that immigrant groups originally introduced Casas Grandes traditions and that uneven participation in a suite of shared religious beliefs and practices was common to all the hinterlands.
Schizophrenia is a chronic psychiatric illness with periods of remission and relapse. Patients vary in the frequency and severity of relapse, time until relapse and time in remission. Discontinuation of antipsychotic medication is by far the most important reason for relapse. A possible method to optimize medication adherence is to treat patients with long-term, depot medication rather than oral medication.
Objectives
Primary objective is to compare all cause discontinuation rates in patients with schizophrenia randomized to either one of the two depot medications (aripiprazole depot or paliperidone palmitate) with patients randomized to either one of the two oral formulations of the same medication (aripiprazole or paliperidone) over an 19 month follow-up period.
Methods
Pragmatic, randomized, open label, multicenter, multinational comparative trial consisting of a 19 month treatment period. Patients aged 18 years or older, having experienced the first psychosis 1-7 years ago, currently meeting DSM-IV-R criteria for schizophrenia. Patients are randomized 1:1:1:1 to paliperidone palmitate, aripiprazole depot, oral aripiprazole or oral paliperidone. The primary outcome is all cause discontinuation.
Results
In the Intent to Treat sample (n=511), no difference was found in time to ACD between the combined oral and combined depot treatment arms, nor between the four individual treatment arms.
Conclusions
Even though the scientific evidence comparing oral and depot medication has been inconsistent, most studies were conducted in rigorous clinical settings, which may have biased those results. In contract, given the pragmatic, open label design of the current trial, the results may be more representative of common daily practice.
This article is a clinical guide which discusses the “state-of-the-art” usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion—this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy—while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward “bridging” methods that may be used to transition simply and safely from other antidepressants to MAOIs.
The Square Kilometre Array (SKA) will be the largest radio astronomy observatory ever built, providing unprecedented sensitivity over a very broad frequency band from 50 MHz to 15.3 GHz. The SKA’s low frequency component (SKA-Low), which will observe in the 50–350 MHz band, will be built at the Murchison Radio-astronomy Observatory (MRO) in Western Australia. It will consist of 512 stations each composed of 256 dual-polarised antennas, and the sensitivity of an individual station is pivotal to the performance of the entire SKA-Low telescope. The answer to the question in the title is, it depends. The sensitivity of a low frequency array, such as an SKA-Low station, depends strongly on the pointing direction of the digitally formed station beam and the local sidereal time (LST), and is different for the two orthogonal polarisations of the antennas. The accurate prediction of the SKA-Low sensitivity in an arbitrary direction in the sky is crucial for future observation planning. Here, we present a sensitivity calculator for the SKA-Low radio telescope, using a database of pre-computed sensitivity values for two realisations of an SKA-Low station architecture. One realisation uses the log-periodic antennas selected for SKA-Low. The second uses a known benchmark, in the form of the bowtie dipoles of the Murchison Widefield Array. Prototype stations of both types were deployed at the MRO in 2019, and since then have been collecting commissioning and verification data. These data were used to measure the sensitivity of the stations at several frequencies and over at least 24 h intervals, and were compared to the predictions described in this paper. The sensitivity values stored in the SQLite database were pre-computed for the X, Y, and Stokes I polarisations in 10 MHz frequency steps, $\scriptsize{1/2}$ hour LST intervals, and $5^\circ$ resolution in pointing directions. The database allows users to quickly and easily estimate the sensitivity of SKA-Low for arbitrary observing parameters (your favourite object) using interactive web-based or command line interfaces. The sensitivity can be calculated using publicly available web interface (http://sensitivity.skalow.link) or a command line python package (https://github.com/marcinsokolowski/station_beam), which can also be used to calculate the sensitivity for arbitrary pointing directions, frequencies, and times without interpolations.
Increasing the scale of renewable integration is a key component of China’s decarbonization strategy. While the immediate challenge is to reduce renewable curtailment and increase its penetration, mitigating climate change in the long term will require a transition from an electricity system dominated by coal to one that consists primarily of renewables. This chapter summarizes the current governance structure and policies for renewable energy development and integration in China. It identifies two key considerations for China to transition towards large-scale penetration of renewables: geographic mismatch between renewable resources and demand centers, and concerns associated with integrating high penetration of intermittent renewable energy resources. Responding to these considerations, this chapter discusses four foundational elements that China needs to put in place in the near term to plan for the longer-term transition: flexible conventional generators, an appropriately large and more integrated transmission network, storage technology development, and demand-side flexibility/responsiveness.
Rapid economic growth in China has predominantly relied on coal-fired electricity and coal use in industry, generating an increasing range of economic, environmental, and health costs. While many policies aim to restrict – and reverse – coal’s growth, the transition from coal to low-carbon alternatives is neither automatic nor just around the corner. Entrenched technological systems, political interests, and historical factors serve to maintain coal’s dominance. For China to prepare for deep decarbonization by mid-century, it must proactively convert coal from a barrier to a bridge – productively repurposing and valuing coal assets for flexible operation, addressing the difficult coal-based district heating infrastructure in the north – develop alternative fuels and feedstocks for industry and households, and mitigate the immense socioeconomic consequences of this transition on governments, firms, and workers.
The experiment was carried out in three crop cycles as plant cane, first ratoon, and second ratoon at five locations on Florida muck soils (histosols) to evaluate the genotypes, test locations, and identify the superior and stable sugarcane genotypes. There were 13 sugarcane genotypes along with three commercial cultivars as checks included in this study. Five locations were considered as environments to analyze genotype-by-environment interaction (GEI) in 13 genotypes in three crop cycles. The sugarcane genotypes were planted in a randomized complete block design with six replications at each location. Performance was measured by the traits of sucrose yield tons per hectare (SY) and commercial recoverable sugar (CRS) in kilograms of sugar per ton of cane. The data were subjected to genotype main effects and genotype × environment interaction (GGE) analyses. The results showed significant effects for genotype (G), locations (E), and G × E (genotype × environment interaction) with respect to both traits. The GGE biplot analysis showed that the sugarcane genotype CP 12-1417 was high yielding and stable in terms of sucrose yield. The most discriminating and non-representative locations were Knight Farm (KN) for both SY and CRS. For sucrose yield only, the most discriminating and non-representative locations were Knight Farm (KN), Duda and Sons, Inc. USSC, Area 5 (A5), and Okeelanta (OK).
How is international human rights law (IHRL) made “everyday” outside of treaty negotiations? Leading socio-legal accounts emphasize transnational civil society activism as a driver of norm change but insufficiently consider power dynamics and the legal-institutional environment. This article sheds light on these dimensions of IHRL by reconstructing how domestic violence came to be included in the prohibition of torture in five international and regional human rights institutions. Through process tracing based on interviews and a vast amount of documentation, the study reveals everyday lawmaking in IHRL as a complex, incremental process in which a wide range of actors negotiate legal outcomes. The political implications of this process are ambiguous as it enables participation while creating hidden sites of power. In addition to challenging existing models of international norm change, this study offers an in-depth empirical exploration of a key development in the international prohibition of torture and demonstrates the benefits of process tracing as a socio-legal methodology.
We present the first Southern-Hemisphere all-sky imager and radio-transient monitoring system implemented on two prototype stations of the low-frequency component of the Square Kilometre Array (SKA-Low). Since its deployment, the system has been used for real-time monitoring of the recorded commissioning data. Additionally, a transient searching algorithm has been executed on the resulting all-sky images. It uses a difference imaging technique to enable identification of a wide variety of transient classes, ranging from human-made radio-frequency interference to genuine astrophysical events. Observations at the frequency 159.375 MHz and higher in a single coarse channel ($\approx$0.926 MHz) were made with 2 s time resolution, and multiple nights were analysed generating thousands of images. Despite having modest sensitivity ($\sim$ few Jy beam–1), using a single coarse channel and 2-s imaging, the system was able to detect multiple bright transients from PSR B0950+08, proving that it can be used to detect bright transients of an astrophysical origin. The unusual, extreme activity of the pulsar PSR B0950+08 (maximum flux density $\sim$155 Jy beam–1) was initially detected in a ‘blind’ search in the 2020 April 10/11 data and later assigned to this specific pulsar. The limitations of our data, however, prevent us from making firm conclusions of the effect being due to a combination of refractive and diffractive scintillation or intrinsic emission mechanisms. The system can routinely collect data over many days without interruptions; the large amount of recorded data at 159.375 and 229.6875 MHz allowed us to determine a preliminary transient surface density upper limit of $1.32 \times 10^{-9} \text{deg}^{-2}$ for a timescale and limiting flux density of 2 s and 42 Jy, respectively. In the future, we plan to extend the observing bandwidth to tens of MHz and improve time resolution to tens of milliseconds in order to increase the sensitivity and enable detections of fast radio bursts below 300 MHz.
After detailing the tensions created by the lawsuit in US–Paraguayan relations, this chapter reveals that in the late 1970s and early 1980s the commercial Paraguayan press used the case to challenge the Stroessner regime. Where the US courts emphasized the responsibility of a cruel individual torturer, the Paraguayan commercial press insisted that the case also implicated the police and the judicial system; the defendant was presented as an ordinary, not demonized, individual; and the victims were construed as agents. Documents from the Paraguayan police’s secret police archive further reveal that high-ranking officials perceived the commercial press coverage of the case as threatening. The chapter offers overlapping explanations for the divergence between the representations of the case produced by US courts and the press in Paraguay, and draws particular attention to the opportunities created by features of tort litigation as well as processes of local reinterpretation.
The conclusion draws together the book’s findings and arguments, and elaborates on their historical and normative–legal implications today. It calls for a history of human rights that explores the multiple social and narrative practices through which the human rights discourse has been deployed and sometimes transformed; in other words, it calls for an unabashedly interdisciplinary legal–historical–ethnographic approach to human rights.