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Electroconvulsive therapy (ECT) is a fast-acting intervention for major depressive disorder. Previous studies indicated neurotrophic effects following ECT that might contribute to changes in white matter brain structure. We investigated the influence of ECT in a non-randomized prospective study focusing on white matter changes over time.
Twenty-nine severely depressed patients receiving ECT in addition to inpatient treatment, 69 severely depressed patients with inpatient treatment (NON-ECT) and 52 healthy controls (HC) took part in a non-randomized prospective study. Participants were scanned twice, approximately 6 weeks apart, using diffusion tensor imaging, applying tract-based spatial statistics. Additional correlational analyses were conducted in the ECT subsample to investigate the effects of seizure duration and therapeutic response.
Mean diffusivity (MD) increased after ECT in the right hemisphere, which was an ECT-group-specific effect. Seizure duration was associated with decreased fractional anisotropy (FA) following ECT. Longitudinal changes in ECT were not associated with therapy response. However, within the ECT group only, baseline FA was positively and MD negatively associated with post-ECT symptomatology.
Our data suggest that ECT changes white matter integrity, possibly reflecting increased permeability of the blood–brain barrier, resulting in disturbed communication of fibers. Further, baseline diffusion metrics were associated with therapy response. Coherent fiber structure could be a prerequisite for a generalized seizure and inhibitory brain signaling necessary to successfully inhibit increased seizure activity.
We have explored the merits of using a Hgl2 spectrometer as a detector in x-ray diffraction systems instead of a proportional gas counter, or a scintillation counter. The full width at half maximum energy resolution of the HgI2 spectrometer used was about 1.1 keV for the CuKα line (8.1 keV), and about 1.5 keV for the MoKα line (17.4 keV), The energy resolution was utilised to eliminate x-ray fluorescence background from powder diffraction spectra. We demonstrate the suppression of Fe x-ray fluorescence in diffraction patterns of ErFe03 obtained with a Cu x-ray tube, and of Y x-ray fluorescence in diffraction patterns of Y2O3 obtained with a Mo x-ray tube. The peak height to background ratios were improved by about an order of magnitude in both cases.
As depression has a recurrent course, relapse and recurrence prevention is essential.
In our randomised controlled trial (registered with the Nederlands trial register, identifier: NTR1907), we found that adding preventive cognitive therapy (PCT) to maintenance antidepressants (PCT+AD) yielded substantial protective effects versus antidepressants only in individuals with recurrent depression. Antidepressants were not superior to PCT while tapering antidepressants (PCT/−AD). To inform decision-makers on treatment allocation, we present the corresponding cost-effectiveness, cost-utility and budget impact.
Data were analysed (n = 289) using a societal perspective with 24-months of follow-up, with depression-free days and quality-adjusted life years (QALYs) as health outcomes. Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were derived to provide information about cost-effectiveness. The budget impact was examined with a health economic simulation model.
Mean total costs over 24 months were €6814, €10 264 and €13 282 for AD+PCT, antidepressants only and PCT/−AD, respectively. Compared with antidepressants only, PCT+AD resulted in significant improvements in depression-free days but not QALYs. Health gains did not significantly favour antidepressants only versus PCT/−AD. High probabilities were found that PCT+AD versus antidepressants only and antidepressants only versus PCT/−AD were dominant with low willingness-to-pay thresholds. The budget impact analysis showed decreased societal costs for PCT+AD versus antidepressants only and for antidepressants only versus PCT/−AD.
Adding PCT to antidepressants is cost-effective over 24 months and PCT with guided tapering of antidepressants in long-term users might result in extra costs. Future studies examining costs and effects of antidepressants versus psychological interventions over a longer period may identify a break-even point where PCT/−AD will become cost-effective.
Declaration of interest
C.L.H.B. is co-editor of PLOS One and receives no honorarium for this role. She is also co-developer of the Dutch multidisciplinary clinical guideline for anxiety and depression, for which she receives no remuneration. She is a member of the scientific advisory board of the National Insure Institute, for which she receives an honorarium, although this role has no direct relation to this study. C.L.H.B. has presented keynote addresses at conferences, such as the European Psychiatry Association and the European Conference Association, for which she sometimes receives an honorarium. She has presented clinical training workshops, some including a fee. She receives royalties from her books and co-edited books and she developed preventive cognitive therapy on the basis of the cognitive model of A. T. Beck. W.A.N. has received grants from the Netherlands Organisation for Health Research and Development and the European Union and honoraria and speakers' fees from Lundbeck and Aristo Pharma, and has served as a consultant for Daleco Pharma.
Archaeological survey and excavations in the mangrove-estuary zone south of Izapa have generated an understanding of how the environment and human exploitation patterns changed during the Archaic and Formative periods. Archaic-period archaeological remains are not present, but the sedimentary record shows that Archaic people were clearing the coastal-plain forest for agricultural purposes. This activity augmented delivery of sediments to the littoral zone, which expanded the mangrove forest and created a productive environment that could be colonized by Early Formative villagers by around 1600 cal b.c. Population growth during the Early Formative created conditions that favored emergence of specialized pyro-industries, especially salt production, by around 1000 cal b.c. Production intensity increased thereafter, especially during the Late Formative period, coincident with the apogee of Izapa. Salt production became more episodic during the Terminal Formative period, when interior populations were declining to a nadir after cal a.d. 250.
Johan J Dempers, Department of Pathology, Faculty of Health Sciences, University of Stellenbosch, Tygerberg, South Africa,
Elsie H Burger, Department of Forensic Medicine, Forensic and Analytical Science Service, New South Wales Health Pathology, Sydney, Australia,
Lorraine Du Toit-Prinsloo, Department of Forensic Medicine, University of Pretoria, Pretoria, South Africa,
Janette Verster, Department of Pathology, Faculty of Health Sciences, University of Stellenbosch, Tygerberg, South Africa NSW Forensic Institute, NSW Government, Sydney, Australia
South Africa, at the southern tip of the African continent, is often referred to as “a world in one country” — a multicultural, biodiverse country with a vibrant economy. It is home to eight World Heritage Sites and seven different biomes. The country is divided into nine provinces, each with its own legislature, premier, and executive council. Eleven official languages are recognized (1).
The country covers some 1,219,602 km2 and is home to around 55.91 million people, of which close to 11% are under 4 years of age. The infant mortality rate is estimated at 33.7 per 1,000 live births (2016), a figure which has seen a steady decline from around 48.2 per 1,000 live births in 2002. Similarly, the under-5 mortality rate declined from 70.8 child deaths per 1,000 live births to 44.4 child deaths per 1,000 live births between 2002 and 2016 (2). Despite the decline in these rates over the years, South Africa is still faced with an immense challenge if it wishes to decrease the high death rate in infants. Investigation into unexpected deaths in children are complicated by multiple factors, however, including a significant variation in population density in different regions of the country, a lack of standardized national death investigation protocols, language and culture barriers, and a paucity of resources and funding for medico-legal death investigation and qualified forensic pathologists, especially in the rural regions of the country.
It is nearly impossible to understand the medico-legal death investigation process in South Africa without being mindful of the political history and development of the country, specifically the most recent 100 years or so. The South African political arena is most significantly marked by the process of segregation and the ideology of apartheid, which was consolidated after the 1948 general election, won by the National Party. Government regulated the job market, often with only the white minority being allowed skilled work opportunities. Legislation culminated in the Natives (Urban Areas) Act 1923, entrenching urban segregation. Pass laws controlled African mobility.
Electroconvulsive therapy (ECT) is one of the most effective treatments for severe depression. However, little is known regarding brain functional processes mediating ECT effects.
In a non-randomized prospective study, functional magnetic resonance imaging data during the automatic processing of subliminally presented emotional faces were obtained twice, about 6 weeks apart, in patients with major depressive disorder (MDD) before and after treatment with ECT (ECT, n = 24). Additionally, a control sample of MDD patients treated solely with pharmacotherapy (MED, n = 23) and a healthy control sample (HC, n = 22) were obtained.
Before therapy, both patient groups equally showed elevated amygdala reactivity to sad faces compared with HC. After treatment, a decrease in amygdala activity to negative stimuli was discerned in both patient samples indicating a normalization of amygdala function, suggesting mechanisms potentially unspecific for ECT. Moreover, a decrease in amygdala activity to sad faces was associated with symptomatic improvements in the ECT sample (rspearman = −0.48, p = 0.044), and by tendency also for the MED sample (rspearman = −0.38, p = 0.098). However, we did not find any significant association between pre-treatment amygdala function to emotional stimuli and individual symptom improvement, neither for the ECT sample, nor for the MED sample.
In sum, the present study provides first results regarding functional changes in emotion processing due to ECT treatment using a longitudinal design, thus validating and extending our knowledge gained from previous treatment studies. A limitation was that ECT patients received concurrent medication treatment.
The authors discuss results of long-term Dutch field projects in three regions in Italy and review case studies taken from these study areas in the light of indigenous developments in early Italian centralization and urbanization. By looking at regional developments in the domains of economy, religious and funerary practice as well as that of social relationships, they arrive at the conclusion that material culture was actively used in indigenous contexts. There is a consequent need for re-definition of centralization and urbanization, which in the Italian context are often seen as non-indigenous achievements. Comparative regional research, as suggested by the authors' case studies on the Sibaritide, the Brindisino and the Pontine region, will reveal both general trends concerning the concepts discussed and regional idiosyncrasies depending on regional traditions, histories and the regional landscape. To this end, a new project was launched, known as the Regional Pathways to Complexity project, that is introduced to the reader at the end of this paper.
We present our first results of a photometric monitoring project of the twin quasar 0957+561. This project aims mainly at the improvement of the determination of the time delay ΔT(A,B) for this gravitational lens, since the “time delay controversy on QSO 0957+561 (is) not yet decided” (Pelt et al. 1994). In addition, the quite large field of the CCD used allows also a long-term astrometric and photometric study of stars and galaxies in the field within a radius of about 10 arcminutes around the lens.
The Amsterdam glacial basin was a major sedimentary sink from late Saalian until late Eemian (Picea zone, E6) times. The basin’s exemplary record makes it a potential reference area for the last interglacial stage. The cored Amsterdam-Terminal borehole was drilled in 1997 to provide a record throughout the Eemian interglacial. Integrated facies analysis has resulted in a detailed reconstruction of the sedimentary history.
After the Saalian ice mass had disappeared from the area, a large, deep lake had come into being, fed by the Rhine river. At the end of the glacial, the lake became smaller because it was cut off from the river-water supply, and eventually only a number of shallow pools remained in the Amsterdam basin. During the early Eemian (Betula zone, El), a seepage lake existed at the site. The lake deepened under the influence of a steadily rising sea level and finally evolved into a silled lagoon (late Quercus zone, E3). Initially, the lagoon water had fairly stable stratification, but as the sea level continued to rise the sill lost its significance, the lagoon becoming well mixed by the middle of the Corylus/Taxus zone (E4b). The phase of free exchange with the open sea ended in the early Carpinus zone (E5), when barriers developed in the sill area causing the lagoon to become stratified again. During the Late Eemian (late E5), a more dynamic system developed. The sandy barriers that had obstructed exchange with the open sea were no longer effective, and a tidally-influenced coastal lagoon formed.
The Eemian sedimentary history shown in the Amsterdam-Terminal borehole is intimately connected with the sea-level history. Because the site includes both a high-resolution pollen signal and a record of sea-level change, it has potential for correlation on various scales. Palaeomagnetic results show that the sediments predate the Blake Event, which confirms that this reversal excursion is relatively young. The U/Th age of the uppermost part of the Eemian sequence is 118.2±6.3 ka.
The Utrecht Orbiting Ultraviolet Stellar Spectrophotometer S59 on board the ESRO TD-1A satellite has observed ultraviolet spectra of about 200 stars in the wavelength regions 2060–2160 Å. 2490–2590 Å and 2770–2870 Å with a resolution of 1.8 Å (cf. de Jager et al., 1974). The spectra are analyzed in order to find UV criteria for stellar classification. Particular attention has been given to Fe III lines since no strong lines of this ion occur in the visible part of the spectrum. As one of the most striking results, it is found that the feature at 2078 Å, which is mainly due to Fe III, is very sensitive to luminosity.
Current ultra-high-risk (UHR) criteria appear insufficient to predict imminent onset of first-episode psychosis, as a meta-analysis showed that about 20% of patients have a psychotic outcome after 2 years. Therefore, we aimed to develop a stage-dependent predictive model in UHR individuals who were seeking help for co-morbid disorders.
Baseline data on symptomatology, and environmental and psychological factors of 185 UHR patients (aged 14–35 years) participating in the Dutch Early Detection and Intervention Evaluation study were analysed with Cox proportional hazard analyses.
At 18 months, the overall transition rate was 17.3%. The final predictor model included five variables: observed blunted affect [hazard ratio (HR) 3.39, 95% confidence interval (CI) 1.56–7.35, p < 0.001], subjective complaints of impaired motor function (HR 5.88, 95% CI 1.21–6.10, p = 0.02), beliefs about social marginalization (HR 2.76, 95% CI 1.14–6.72, p = 0.03), decline in social functioning (HR 1.10, 95% CI 1.01–1.17, p = 0.03), and distress associated with suspiciousness (HR 1.02, 95% CI 1.00–1.03, p = 0.01). The positive predictive value of the model was 80.0%. The resulting prognostic index stratified the general risk into three risk classes with significantly different survival curves. In the highest risk class, transition to psychosis emerged on average ⩾8 months earlier than in the lowest risk class.
Predicting a first-episode psychosis in help-seeking UHR patients was improved using a stage-dependent prognostic model including negative psychotic symptoms (observed flattened affect, subjective impaired motor functioning), impaired social functioning and distress associated with suspiciousness. Treatment intensity may be stratified and personalized using the risk stratification.
We present preliminary results of models of terrestrial planet formation using on the one hand classical numerical integration of hundreds of small bodies on CPUs and on the other hand—for comparison—the results of our GPU code with thousands of small bodies which then merge to larger ones. To be able to determine the outcome of collision events we use our smooth particle hydrodynamics (SPH) code which tracks how water is lost during such events.
A cosmic ray detector, sensitive to γ-Rays with energies greater than 500 MeV is being flown on board the OGO-5 satellite. The spacecraft was launched into a highly eccentric orbit, apogee 145000 km, on March 4, 1968. γ-Ray observations are restricted to altitudes higher than 80000 km, thereby excluding interference from the radiation belts and reducing the influence from the earth albedo flux. A description of the instrument is published in the literature (Rogowski et al., 1969).
To characterise auditory involvement secondary to excessive craniotubular bone growth in individuals with sclerosteosis in South Africa.
This cross-sectional study assessed the auditory profile of 10 participants with sclerosteosis. An auditory test battery was used and results for each ear were recorded using descriptive and comparative analyses.
All participants presented with bilateral, mixed hearing losses. Of the 20 ears, hearing loss was moderate in 5 per cent (n = 1), severe in 55 per cent (n = 11) and profound in 40 per cent (n = 8). Air–bone gaps were smaller in older participants, although the difference was not statistically significant (p > 0.05). Computed tomography scans indicated pervasive abnormalities of the external auditory canal, tympanic membrane, middle-ear space, ossicles, oval window, round window and internal auditory canal. Narrowed internal auditory canals corresponded to poor speech discrimination, indicative of retrocochlear pathology and absent auditory brainstem response waves.
Progressive abnormal bone formation in sclerosteosis involves the middle ear, the round and oval windows of the cochlea, and the internal auditory canal. The condition compromises conductive, sensory and neural auditory pathways, which results in moderate to profound, mixed hearing loss.
High resolution Schottky barrier detectors for alpha particles have been fabricated on 20 μm n-type 4H-SiC epitaxial layers. Schottky barrier contact structure was accomplished by deposition of 10 nm nickel on the Si face of the epilayers. The detectors were characterized for structural, electrical, and spectroscopic properties. Scanning electron microscopy and Nomarski optical microscopy revealed a micropipe density lower than 1 cm-2. The current-voltage (I-V) characteristics of the device exhibited very low leakage current of the order of 6.5 pA at an operating bias of 90 V. C-V measurements revealed a typical effective doping concentrations of 2.4 × 1014 cm-3 in these epilayers. The detectors were evaluated for alpha particles detection using a 241Am source. An energy resolution of ∼0.98% for 5.48 MeV alpha particles was observed. The separate contribution of charge carrier drift and diffusion to the total charge collection efficiency has been calculated in these detectors following a drift-diffusion model. Detailed electronic noise analysis in terms of equivalent noise charge (ENC) was carried out to study the effect of various noise components that contribute to the total electronic noise in the detection system. Effect of shaping time, presence of source and bias on the ENC has been studied in details.
Cd0.9Zn0.1Te (CZT) single crystal has been grown using a tellurium solvent method. Two CZT crystals have been chosen from two different locations of the grown ingot. The two crystals were characterized using infrared transmission (IR) imaging and radiation detectors in planar geometry were fabricated on them. Current-voltage characteristics (I-V) revealed a resistivity of ∼8.6×1010 Ω−cm for detector A (6.9×6.9×4.8 mm3) and 6.7×1010 Ω−cm for detector B (11.5×11.7×2.6 mm3). IR imaging showed a lesser concentration of Te inclusions/precipitates in detector A. The transport properties viz., electron drift-mobility and electron mobility-lifetime product were measured using alpha spectroscopy in these detectors in a planar configuration. Detector A showed better charge transport properties compared to detector B. The superior transport properties of crystal A were reflected in the spectroscopic properties of the detectors. Gamma pulse height measurements using a 241Am isotope revealed an energy resolution of ∼5 % for detector A and ∼7 % for detector B. A digital spectrometer and a biparametric correction scheme was incorporated to recover the pulse height spectrum of high energy gamma rays (137Cs source) from the effect of poor hole movement.
The electronic properties of ThO2 single crystals were studied using x-ray photoemission spectroscopy (XPS). The XPS results show that the Th 4f core level is in an oxidation state that is consistent with that expected for Th in ThO2. The effective Debye temperature is estimated from the temperature dependent photoemission intensities of the Th 4f core level over the temperature range of 290 to 360 K. A Debye temperature of 468±32 K has been determined.
Hydrothermal synthesis of ThO2, UxTh1-xO2, and UOx at temperatures between 670°C and 700°C has been demonstrated. Synthesis at these temperatures is 50-80°C below prior growth studies and represents a new lower bound of successful growth. ThO2 single crystals of dimensions 6.49mm x 4.89mm x 3.89 mm and weighing 0.633g have been synthesized at average growth rates near 0.125mm/week. Single crystal UxTh1-xO2 crystals with mole fractions up to x≈0.30 have also been grown. The largest alloyed crystal with mole fraction x≈0.23 has dimensions of 2.97mm x 3.23mm x ∼3mm and recorded average growth rates near 0.2mm/week. Four structures were solved from X-ray diffraction data and their crystallographic data reported here. Rocking curve analysis determined a dislocation density of 1.2×109 cm-2.