To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Research exploring the longitudinal course of posttraumatic stress disorder (PTSD) symptoms has documented four modal trajectories (low, remitting, high, and delayed), with proportions varying across studies. Heterogeneity could be due to differences in trauma types and patient demographic characteristics.
This analysis pooled data from six longitudinal studies of adult survivors of civilian-related injuries admitted to general hospital emergency departments (EDs) in six countries (pooled N = 3083). Each study included at least three assessments of the clinician-administered PTSD scale in the first post-trauma year. Latent class growth analysis determined the proportion of participants exhibiting various PTSD symptom trajectories within and across the datasets. Multinomial logistic regression analyses examined demographic characteristics, type of event leading to the injury, and trauma history as predictors of trajectories differentiated by their initial severity and course.
Five trajectories were found across the datasets: Low (64.5%), Remitting (16.9%), Moderate (6.7%), High (6.5%), and Delayed (5.5%). Female gender, non-white race, prior interpersonal trauma, and assaultive injuries were associated with increased risk for initial PTSD reactions. Female gender and assaultive injuries were associated with risk for membership in the Delayed (v. Low) trajectory, and lower education, prior interpersonal trauma, and assaultive injuries with risk for membership in the High (v. Remitting) trajectory.
The results suggest that over 30% of civilian-related injury survivors admitted to EDs experience moderate-to-high levels of PTSD symptoms within the first post-trauma year, with those reporting assaultive violence at increased risk of both immediate and longer-term symptoms.
Determining infectious cross-transmission events in healthcare settings involves manual surveillance of case clusters by infection control personnel, followed by strain typing of clinical/environmental isolates suspected in said clusters. Recent advances in genomic sequencing and cloud computing now allow for the rapid molecular typing of infecting isolates.
To facilitate rapid recognition of transmission clusters, we aimed to assess infection control surveillance using whole-genome sequencing (WGS) of microbial pathogens to identify cross-transmission events for epidemiologic review.
Clinical isolates of Staphylococcus aureus, Enterococcus faecium, Pseudomonas aeruginosa, and Klebsiella pneumoniae were obtained prospectively at an academic medical center, from September 1, 2016, to September 30, 2017. Isolate genomes were sequenced, followed by single-nucleotide variant analysis; a cloud-computing platform was used for whole-genome sequence analysis and cluster identification.
Most strains of the 4 studied pathogens were unrelated, and 34 potential transmission clusters were present. The characteristics of the potential clusters were complex and likely not identifiable by traditional surveillance alone. Notably, only 1 cluster had been suspected by routine manual surveillance.
Our work supports the assertion that integration of genomic and clinical epidemiologic data can augment infection control surveillance for both the identification of cross-transmission events and the inclusion of missed and exclusion of misidentified outbreaks (ie, false alarms). The integration of clinical data is essential to prioritize suspect clusters for investigation, and for existing infections, a timely review of both the clinical and WGS results can hold promise to reduce HAIs. A richer understanding of cross-transmission events within healthcare settings will require the expansion of current surveillance approaches.
Breakthrough Listen is a 10-yr initiative to search for signatures of technologies created by extraterrestrial civilisations at radio and optical wavelengths. Here, we detail the digital data recording system deployed for Breakthrough Listen observations at the 64-m aperture CSIRO Parkes Telescope in New South Wales, Australia. The recording system currently implements two modes: a dual-polarisation, 1.125-GHz bandwidth mode for single-beam observations, and a 26-input, 308-MHz bandwidth mode for the 21-cm multibeam receiver. The system is also designed to support a 3-GHz single-beam mode for the forthcoming Parkes ultra-wideband feed. In this paper, we present details of the system architecture, provide an overview of hardware and software, and present initial performance results.
The six LIGO detections of merging black holes (BHs) allowed to infer slow spin values for the two pre-merging BHs. The three cases where the spins of the BHs can be determined in high-mass X-ray binaries (HMXBs) show that those BHs have high spin values. We discuss here scenarios explaining these differences in spin properties in these two classes of object.
. The nature and evolution of ultraluminous X-ray sources (ULXs) is an open problem in astrophysics. They challenge our current understanding of stellar compact objects and accretion physics. The recent discovery of pulsar ULXs further demonstrates the importance of this intriguing and rare class of objects.
In order to overcome the difficulties of directly studying the optical associations of ULXs, we generally resort in statistical studies of the stellar properties of their host galaxies. We present the largest such study based on the combination of Chandra archival data with the most complete galaxy catalog of the Local Universe. Incorporating robust distances and stellar population parameters based on associated multi-wavelength information, and we explore the association of ULXs with galaxies in the (star formation rate, stellar mass, metallicity) space.
We confirm the known correlation with morphology, star formation rate and stellar mass, while we find an excess of ULXs in dwarf galaxies, indicating dependence on age and metallicity.
We use deep Chandra and HST data to uniquely classify the X-ray binary (XRB) populations in M81 on the basis of their donor stars and local stellar populations (into early-type main sequence, yellow giant, supergiant, low-mass, and globular cluster). First, we find that more massive, redder, and denser globular clusters are more likely to be associated with XRBs. Second, we find that the high-mass XRBs (HMXBs) overall have a steeper X-ray luminosity function (XLF) than the canonical star-forming galaxy XLF, though there is some evidence of variations in the slopes of the sub-populations. On the other hand, the XLF of the prototypical starburst M82 is described by the canonical powerlaw (αcum ∼ 0.6) down to LX ∼ 1036 erg s−1. We attribute variations in XLF slopes to different mass transfer modes (Roche-lobe overflow versus wind-fed systems).
We analyse the vertical distribution of High Mass X-ray Binaries (HMXBs) in NGC 55, the nearest edge-on galaxy to the Milky Way. Our analysis reveals significant spatial offsets of HMXBs from the star forming regions, greater than those observed in the SMC and the LMC but similar with the Milky Way. The spatial offsets can be explained by a momentum kick the X-ray binaries receive during the formation of the compact object. The difference between the scale height of the vertical distribution of HMXBs and the vertical distribution of star-forming activity is 0.48±0.04 kpc. The centre-of-mass velocity of the distribution of HMXBs in NGC 55 is moving at a velocity of 52.4±11.4 km s−1, greater than the corresponding velocity of HMXBs in the SMC and LMC, but consistent with velocities of Milky Way HMXBs.
Projected changes to post-traumatic stress disorder (PTSD) diagnostic criteria in the upcoming International Classification of Diseases (ICD)-11 may affect the prevalence and severity of identified cases. This study examined differences in rates, severity, and overlap of diagnoses using ICD-10 and ICD-11 PTSD diagnostic criteria during consecutive assessments of recent survivors of traumatic events.
The study sample comprised 3863 survivors of traumatic events, evaluated in 11 longitudinal studies of PTSD. ICD-10 and ICD-11 diagnostic rules were applied to the Clinician-Administered PTSD Scale (CAPS) to derive ICD-10 and ICD-11 diagnoses at different time intervals between trauma occurrence and 15 months.
The ICD-11 criteria identified fewer cases than the ICD-10 across assessment intervals (range −47.09% to −57.14%). Over 97% of ICD-11 PTSD cases met concurrent ICD-10 PTSD criteria. PTSD symptom severity of individuals identified by the ICD-11 criteria (CAPS total scores) was 31.38–36.49% higher than those identified by ICD-10 criteria alone. The latter, however, had CAPS scores indicative of moderate PTSD. ICD-11 was associated with similar or higher rates of comorbid mood and anxiety disorders. Individuals identified by either ICD-10 or ICD-11 shortly after traumatic events had similar longitudinal course.
This study indicates that significantly fewer individuals would be diagnosed with PTSD using the proposed ICD-11 criteria. Though ICD-11 criteria identify more severe cases, those meeting ICD-10 but not ICD-11 criteria remain in the moderate range of PTSD symptoms. Use of ICD-11 criteria will have critical implications for case identification in clinical practice, national reporting, and research.
The local electrode atom probe (LEAP) has become the primary instrument used for atom probe tomography measurements. Recent advances in detector and laser design, together with updated hit detection algorithms, have been incorporated into the latest LEAP 5000 instrument, but the implications of these changes on measurements, particularly the size and chemistry of small clusters and elemental segregations, have not been explored. In this study, we compare data sets from a variety of materials with small-scale chemical heterogeneity using both a LEAP 3000 instrument with 37% detector efficiency and a 532-nm green laser and a new LEAP 5000 instrument with a manufacturer estimated increase to 52% detector efficiency, and a 355-nm ultraviolet laser. In general, it was found that the number of atoms within small clusters or surface segregation increased in the LEAP 5000, as would be expected by the reported increase in detector efficiency from the LEAP 3000 architecture, but subtle differences in chemistry were observed which are attributed to changes in the way multiple hit detection is calculated using the LEAP 5000.
This essay explores W. E. B. Du Bois’s evolving sense of disillusionment with the liberal paradigm in an effort to stimulate critical thinking about an American political culture consumed by both the fear and purported legitimacy of private competition. Du Bois always encouraged sustained critical appraisal of an American society torn between winners and losers, the favored and the damned. As his thinking developed into the 1930s, he focused more squarely upon the logic of capital accumulation, or the structural imperative to expand power in the service of private interest, and always in response to a suspicion or fear of the other—the competitor. I suggest that Du Bois’s claims about the racially biased character of the competitive society, as well as his argument, put forth in a series of speeches and writings on “Negro education,” that Black colleges ought to facilitate the critique of this society, may have some normative import today as widespread, often unreflective acquiescence to the principles of competitive liberalism seems poised to exacerbate and further legitimize racial and economic inequities.
The eastern Adriatic is a key area for understanding the mechanisms and effects of the spread of agriculture. This article presents an accelerator mass spectrometry (AMS) radiocarbon chronology for the introduction and subsequent development of farming villages on the eastern shore of the Adriatic (∼6000–1700 cal BC) and evaluates this in comparison with the established pottery chronology based on stylistic data from Pokrovnik (Drniš) on the Dalmatian coast of Croatia. Models for the spread of agriculture rely heavily on changing pottery styles to define cultural groups and trace geographic relationships. Based on AMS 14C dates presented here, Impressed Wares first appear in central Dalmatia by 6000 cal BC and persist until 5300 cal BC, well into what is generally termed the Middle Neolithic. Similarly, a typical Middle Neolithic ware, figulina, appeared earlier than anticipated. These findings stand in contrast to cave and rockshelter assemblages in the eastern Adriatic, but mirror assemblages from farming villages on the Italian Adriatic coast. This study argues that the similarities in ceramic assemblage composition and change through time may have less to do with direct contacts between areas, but more with the nature of ceramic production and consumption at village sites in general. These data shed light on the limitations of regional ceramic chronologies in the eastern Adriatic and highlight the necessity for systematic expansion of 14C chronologies to address the social, economic, and ecological relevance of early farming in the Adriatic for the spread of agriculture in Europe and the Mediterranean.
The primary objective of this study was to quantify the impact of a clinical practice intervention to promote the delivery of salbutamol by metered-dose inhaler (MDI) in a pediatric emergency department (PED). A secondary objective was to retrospectively document the components of the intervention.
PED inventory data for salbutamol inhalation solution (nebules), MDIs, and holding chambers were obtained from the pharmacy department. Patient data were obtained fromthe hospital's decision support unit. Interrupted time series analysis was used to evaluate trends in salbutamol inventory data, patient triage acuity, and hospital admissions from January 1, 2003, to May 31, 2010. Interviews and administrative documents were used to identify components of the intervention, which began in 2006.
There was a 1,215% increase in the proportion of salbutamol delivered as MDIs compared to total inhaled salbutamol (MDI plus nebulization solution) following the intervention (95% CI 1,032% to 1,396%, p < 0.001). Increases in salbutamol MDI use were associated with the implementation of an institution-specific asthma care map. A relative decrease of 32% in the hospital admission rate (absolute –7.25%: 95% CI –8.31 to –6.19, p < 0.001) was associated with the change in salbutamol MDI use and the use of the asthma care map.
A multifaceted intervention, designed and implemented by local PED clinical leaders, resulted in a pronounced change in salbutamol inhalation practice, with an associated decrease in admission rates. This intervention demonstrated many of the criteria for successful health system change. Findings from this research may be contextualized to inform change elsewhere.
A survey of the Milky Way disk and the Magellanic System at the wavelengths of the 21-cm atomic hydrogen (H i) line and three 18-cm lines of the OH molecule will be carried out with the Australian Square Kilometre Array Pathfinder telescope. The survey will study the distribution of H i emission and absorption with unprecedented angular and velocity resolution, as well as molecular line thermal emission, absorption, and maser lines. The area to be covered includes the Galactic plane (|b| < 10°) at all declinations south of δ = +40°, spanning longitudes 167° through 360°to 79° at b = 0°, plus the entire area of the Magellanic Stream and Clouds, a total of 13 020 deg2. The brightness temperature sensitivity will be very good, typically σT≃ 1 K at resolution 30 arcsec and 1 km s−1. The survey has a wide spectrum of scientific goals, from studies of galaxy evolution to star formation, with particular contributions to understanding stellar wind kinematics, the thermal phases of the interstellar medium, the interaction between gas in the disk and halo, and the dynamical and thermal states of gas at various positions along the Magellanic Stream.