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To use a Machine Learning (ML) approach to compare Neuropsychiatric Symptoms (NPS) in participants of a longitudinal study who developed dementia and those who did not.
Mann-Whitney U and ML analysis. Nine ML algorithms were evaluated using a 10-fold stratified validation procedure. Performance metrics (accuracy, recall, F-1 score, and Cohen’s kappa) were computed for each algorithm, and graphic metrics (ROC and precision-recall curves) and features analysis were computed for the best-performing algorithm.
Primary care health centers.
128 participants: 78 cognitively unimpaired and 50 with MCI.
Diagnosis at baseline, months from the baseline assessment until the 3rd follow-up or development of dementia, gender, age, Charlson Comorbidity Index, Neuropsychiatric Inventory-Questionnaire (NPI-Q) individual items, NPI-Q total severity, and total stress score and Geriatric Depression Scale-15 items (GDS-15) total score.
30 participants developed dementia, while 98 did not. Most of the participants who developed dementia were diagnosed at baseline with amnestic multidomain MCI. The Random Forest Plot model provided the metrics that best predicted conversion to dementia (e.g. accuracy=.88, F1=.67, and Cohen’s kappa=.63). The algorithm indicated the importance of the metrics, in the following (decreasing) order: months from first assessment, age, the diagnostic group at baseline, total NPI-Q severity score, total NPI-Q stress score, and GDS-15 total score.
ML is a valuable technique for detecting the risk of conversion to dementia in MCI patients. Some NPS proxies, including NPI-Q total severity score, NPI-Q total stress score, and GDS-15 total score, were deemed as the most important variables for predicting conversion, adding further support to the hypothesis that some NPS are associated with a higher risk of dementia in MCI.
Uncontrolled pain in advanced cancer is a common problem and has significant impact on individuals’ quality of life and use of healthcare resources. Interventions to help manage pain at the end of life are available, but there is limited economic evidence to support their wider implementation. We conducted a case study economic evaluation of two pain self-management interventions (PainCheck and Tackling Cancer Pain Toolkit [TCPT]) compared with usual care.
We generated a decision-analytic model to facilitate the evaluation. This modelled the survival of individuals at the end of life as they moved through pain severity categories. Intervention effectiveness was based on published meta-analyses results. The evaluation was conducted from the perspective of the U.K. health service provider and reported cost per quality-adjusted life-year (QALY).
PainCheck and TCPT were cheaper (respective incremental costs -GBP148 [-EUR168.53] and -GBP474 [-EUR539.74]) and more effective (respective incremental QALYs of 0.010 and 0.013) than usual care. There was a 65 percent and 99.5 percent chance of cost-effectiveness for PainCheck and TCPT, respectively. Results were relatively robust to sensitivity analyses. The most important driver of cost-effectiveness was level of pain reduction (intervention effectiveness). Although cost savings were modest per patient, these were considerable when accounting for the number of potential intervention beneficiaries.
Educational and monitoring/feedback interventions have the potential to be cost-effective. Economic evaluations based on estimates of effectiveness from published meta-analyses and using a decision modeling approach can support commissioning decisions and implementation of pain management strategies.
Jumping to conclusions (JTC), which is the proneness to require less information before forming beliefs or making a decision, has been related to formation and maintenance of delusions. Using data from the National Institute of Health Research Biomedical Research Centre Genetics and Psychosis (GAP) case–control study of first-episode psychosis (FEP), we set out to test whether the presence of JTC would predict poor clinical outcome at 4 years.
One-hundred and twenty-three FEP patients were assessed with the Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF) and the probabilistic reasoning ‘Beads’ Task at the time of recruitment. The sample was split into two groups based on the presence of JTC bias. Follow-up data over an average of 4 years were obtained concerning clinical course and outcomes (remission, intervention of police, use of involuntary treatment – the Mental Health Act (MHA) – and inpatient days).
FEP who presented JTC at baseline were more likely during the follow-up period to be detained under the MHA [adjusted OR 15.62, 95% confidence interval (CI) 2.92–83.54, p = 0.001], require intervention by the police (adjusted OR 14.95, 95% CI 2.68–83.34, p = 0.002) and have longer admissions (adjusted IRR = 5.03, 95% CI 1.91–13.24, p = 0.001). These associations were not accounted for by socio-demographic variables, IQ and symptom dimensions.
JTC in FEP is associated with poorer outcome as indicated and defined by more compulsion police intervention and longer periods of admission. Our findings raise the question of whether the implementation of specific interventions to reduce JTC, such as Metacognition Training, may be a useful addition in early psychosis intervention programmes.
To compare the epidemiology, clinical characteristics, and mortality of patients with bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) versus ESBL-producing Klebsiella pneumoniae (ESBL-KP) and to examine the differences in clinical characteristics and outcome between BSIs caused by isolates with CTX-M versus other ESBL genotypes
As part of the INCREMENT project, 33 tertiary hospitals in 12 countries retrospectively collected data on adult patients diagnosed with ESBL-EC BSI or ESBL-KP BSI between 2004 and 2013. Risk factors for ESBL-EC versus ESBL-KP BSI and for 30-day mortality were examined by bivariate analysis followed by multivariable logistic regression.
The study included 909 patients: 687 with ESBL-EC BSI and 222 with ESBL-KP BSI. ESBL genotype by polymerase chain reaction amplification of 286 isolates was available. ESBL-KP BSI was associated with intensive care unit admission, cardiovascular and neurological comorbidities, length of stay to bacteremia >14 days from admission, and a nonurinary source. Overall, 30-day mortality was significantly higher in patients with ESBL-KP BSI than ESBL-EC BSI (33.7% vs 17.4%; odds ratio, 1.64; P=.016). CTX-M was the most prevalent ESBL subtype identified (218 of 286 polymerase chain reaction-tested isolates, 76%). No differences in clinical characteristics or in mortality between CTX-M and non–CTX-M ESBLs were detected.
Clinical characteristics and risk of mortality differ significantly between ESBL-EC and ESBL-KP BSI. Therefore, all ESBL-producing Enterobacteriaceae should not be considered a homogeneous group. No differences in outcomes between genotypes were detected.
Herbicide resistance, and in particular multiple-herbicide resistance, poses an ever-increasing threat to food security. A biotype of junglerice [Echinochloa colona (L.) Link] with resistance to four herbicides, imazamox, fenoxaprop-P-ethyl, quinclorac, and propanil, each representing a different mechanism of action, was identified in Sunflower County, MS. Dose responses were performed on the resistant biotype and a biotype sensitive to all four herbicides to determine the level of resistance. Application of a cytochrome P450 inhibitor, malathion, with the herbicides imazamox and quinclorac resulted in increased susceptibility in the resistant biotype. Differential gene expression analysis of resistant and sensitive plants revealed that 170 transcripts were upregulated in resistant plants relative to sensitive plants and 160 transcripts were upregulated in sensitive plants. In addition, 507 transcripts were only expressed in resistant plants and 562 only in sensitive plants. A subset of these transcripts were investigated further using quantitative PCR (qPCR) to compare gene expression in resistant plants with expression in additional sensitive biotypes. The qPCR analysis identified two transcripts, a kinase and a glutathione S-transferase that were significantly upregulated in resistant plants compared with the sensitive plants. A third transcript, encoding an F-box protein, was downregulated in the resistant plants relative to the sensitive plants. As no cytochrome P450s were differentially expressed between the resistant and sensitive plants, a single-nucleotide polymorphism analysis was performed, revealing several nonsynonymous point mutations of interest. These candidate genes will require further study to elucidate the resistance mechanisms present in the resistant biotype.
This article demonstrates that José Pérez Ocaña's political performances open up the possibility of questioning the narrative of the transition to democracy in Spain as one resulting from political consensus. Using sources available in documentaries and in the archives of the counterculture, the essay studies Ocaña as a political subject of the transition. Among his public acts, the essay considers his street performances, his sexually explicit performance in the Canet Rock music festival and in International Anarchist Days in 1977, and his problematic participation in gay pride parades in Barcelona. In his public appearances, Ocaña eroded the distinction between public and private while asserting his right to appear. Despite his prominence in countercultural realms, gay activists and anarchist organizations rejected him. I argue that Ocaña opted to disidentify with all labels as he confronted both gender norms and the countercultural public sphere.
Using a 72-atom supercell we report ab initio calculations of the electronic and vibrational densities of states for the bismuth (111) bilayers (bismuthene) with periodic boundary conditions and a vacuum of 5 Å, 10 Å and 20 Å. We find that the electronic density of states shows a metallic character at the Fermi level and that the vibrational density of states manifests the expected gap due to the layers. Our results indicate that a vacuum down to 5 Å does not affect the electronic and vibrational structures noticeably. A comparison of present results with those obtained for the Wyckoff structure is displayed. Assuming that the Cooper pairing potential is similar for all phases and structures of bismuth, an estimate of the superconducting transition temperature gives 2.61 K for the bismuth bilayers.
Objectives: The aim of this study was to determine the presence and severity of potential cultural and language bias in widely used cognitive and other assessment instruments, using structural MRI measures of neurodegeneration as biomarkers of disease stage and severity. Methods: Hispanic (n=75) and White non-Hispanic (WNH) (n=90) subjects were classified as cognitively normal (CN), amnestic mild cognitive impairment (aMCI) and mild dementia. Performance on the culture-fair and educationally fair Fuld Object Memory Evaluation (FOME) and Clinical Dementia Rating Scale (CDR) between Hispanics and WNHs was equivalent, in each diagnostic group. Volumetric and visually rated measures of the hippocampus entorhinal cortex, and inferior lateral ventricles (ILV) were measured on structural MRI scans for all subjects. A series of analyses of covariance, controlling for age, depression, and education, were conducted to compare the level of neurodegeneration on these MRI measures between Hispanics and WNHs in each diagnostic group. Results: Among both Hispanics and WNH groups there was a progressive decrease in volume of the hippocampus and entorhinal cortex, and an increase in volume of the ILV (indicating increasing atrophy in the regions surrounding the ILV) from CN to aMCI to mild dementia. For equivalent levels of performance on the FOME and CDR, WNHs had greater levels of neurodegeneration than did Hispanic subjects. Conclusions: Atrophy in medial temporal regions was found to be greater among WNH than Hispanic diagnostic groups, despite the lack of statistical differences in cognitive performance between these two ethnic groups. Presumably, unmeasured factors result in better cognitive performance among WNH than Hispanics for a given level of neurodegeneration. (JINS, 2018, 24, 176–187)
A remarkable stela from Montoro, southern Spain, is unique in its morphology, epigraphic traits and landscape context. A programme of chemical characterisation, digital imaging, and geo-lithological and epigraphic analyses were conducted to determine its age and significance, and the results were integrated with data from archaeological investigations of the surrounding area. This multi-faceted approach allowed the stela to be interpreted within the context of early interactions between literate Mediterranean societies of the Late Bronze Age and Iron Age and non-literate Iberian societies. A key outcome of this research is a wider understanding of the complex patterns in the use and perception of early scripts.
X-ray fluorescence (XRF) has been employed as one of several orthogonal means of screening materials to prevent counterfeit and adulterated products from entering the product stream. We document the use of principal component analysis (PCA) of XRF data on compositionally similar and dissimilar stainless steels for the purpose of testing the feasibility of employing XRF spectra to parse and bin these alloys as the same or significantly different alloy materials. The results indicate that XRF spectra can separate and assign alloys via PCA, but that important corrections for detector drift and scaling must be performed in order to achieve valid results.
Bismuth displays puzzling superconducting properties. In its crystalline equilibrium phase, it does not seem to superconduct at accessible low temperatures. However, in the amorphous phase it displays superconductivity at ∼ 6 K. Under pressure bismuth has been found to superconduct at Tcs that go from 3.9 K to 8.5 K depending on the phase obtained. So the question is: what electronic or vibrational changes occur that explains this radical transformation in the conducting behavior of this material? In a recent publication we argue that changes in the density of electronic and vibrational states may account for the behavior observed in the amorphous phase with respect to the crystal. We have now undertaken an ab initio computational study of the effects of pressure alone maintaining the original crystalline structure and compressing our supercell computationally. From the results obtained we infer that if the crystal structure remains the same (except for the contraction), no superconductivity will appear.
The discrepancy between abundances computed using optical recombination lines (ORLs) and collisionally excited lines (CELs) is a major, unresolved problem with significant implications for the determination of chemical abundances throughout the Universe. In planetary nebulae (PNe), the most common explanation for the discrepancy is that two different gas phases coexist: a hot component with standard metallicity, and a much colder plasma enhanced in heavy elements. This dual nature is not predicted by mass loss theories, and direct observational support for it is still weak. In this work, we present our recent findings that demonstrate that the largest abundance discrepancies are associated with close binary central stars. OSIRIS-GTC tunable filter imaging of the faint O ii ORLs and MUSE-VLT deep 2D spectrophotometry confirm that O ii ORL emission is more centrally concentrated than that of [Oiii] CELs and, therefore, that the abundance discrepancy may be closely linked to binary evolution.
The northern regions of the Iberian Peninsula have traditionally been excluded in international debates on Iron Age urbanisation. However, the hillforts and oppida of the Cantabrian area show considerable similarities to the situation found in wide parts of Temperate Europe during the 1st millennium bc. One of the most important centres is the oppidum of Monte Bernorio, which was occupied between the Late Bronze Age and the Roman Conquest. This paper offers a first overview of the archaeological fieldwork carried out over the last decade, which has revealed the existence of an extremely complex and extensive system of multivallate fortifications enclosing an area of about 90 ha. Therefore, it is one of the largest Iron Age fortified sites of the whole of the Iberian Peninsula. The material culture recovered at the settlement – including large amounts of pottery, animal remains, metal objects, and glass beads – testifies both local production and long-distance networks. Moreover, the recovery of a tessera hospitalis with written text constitutes a prime example of the existence of legally sanctioned ‘citizenship rights’ among the pre-Roman communities of the Cantabrian area. Finally, recent discoveries at the oppidum itself and at the nearby Roman military camp of El Castillejo indicate a siege and conquest by the Roman army in the course of the Cantabrian Wars led by Emperor Augustus in the 20s BC. The evidence points towards the existence of one of the major battlefields of Rome’s imperial expansion in the West.
Potassium titanyl phosphate crystals in both x-cut and z-cut were irradiated with 185 MeV Au ions. The morphology of the resulting ion tracks was investigated using small angle x-ray scattering (SAXS), transmission electron microscopy (TEM), and atomic force microscopy (AFM). SAXS measurements indicate the presence of cylindrical ion tracks with abrupt boundaries and a density contrast of 1 ± 0.5% compared to the surrounding matrix, consistent with amorphous tracks. The track radius depends on the crystalline orientation, with 6.0 ± 0.1 nm measured for ion tracks along the x-axis and 6.3 ± 0.1 nm for those along the z-axis. TEM images in both cross-section and plan-view show amorphous ion tracks with radii comparable to those determined from SAXS analysis. The protruding hillocks covering the sample surface detected by AFM are consistent with a lower density of the amorphous material within the ion tracks compared to the surrounding matrix. Simulations using an inelastic thermal-spike model indicate that differences in the thermal conductivity along the z- and x-axis can partially explain the different track radii along these directions.
Twelve accelerator mass spectrometry (AMS) radiocarbon dates from the shell-matrix site of Canímar Abajo (Matanzas, Cuba) are reported. Eleven were obtained directly from human bone collagen in burials and one was obtained from charcoal recovered from a burial context. The site stratigraphy presents two episodes of burial activity separated by a shell midden layer. The AMS dates fall into two compact clusters that correlate remarkably well with the stratigraphy. The older burial dates to between 1380–800 cal BC (2σ) and the younger one to between cal AD 360–950 (2σ). The AMS dates are compared to eight conventional 14C dates previously obtained on shell and charcoal. One of the conventional dates on charcoal (5480–5380 cal BC; 2σ) has been reported as the oldest 14C date in the Caribbean region; its context and reliability are clarified. The suite of AMS dates provides one of the most reliable chronometric dating of a cultural context during this timeframe in Cuba. The correlation of 14C and stratigraphy establishes a solid chronology for investigating the important economic and ritual features of Canímar Abajo.
We have carried out an ALMA Cycle 2 survey of 15 confirmed or candidate low-mass (<0.2M⊙) members of the TW Hya Association (TWA) with the goal of detecting line emission from CO molecular gas and continuum emission from cold dust. Our targets have spectral types of M4-L0 and hence represent the extreme low end of the TWA's mass function. The survey has yielded a detection of 12CO(2–1) emission around TWA 34. This newly discovered ~10 Myr-old molecular gas disk lies just ~50pc from Earth.