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We describe the High-Precision Polarimetric Instrument-2 (HIPPI-2) a highly versatile stellar polarimeter developed at the University of New South Wales. Two copies of HIPPI-2 have been built and used on the 60-cm telescope at Western Sydney University’s (WSU) Penrith Observatory, the 8.1-m Gemini North Telescope at Mauna Kea and extensively on the 3.9-m Anglo-Australian Telescope (AAT). The precision of polarimetry, measured from repeat observations of bright stars in the SDSS g′band, is better than 3.5 ppm (parts per million) on the 3.9-m AAT and better than 11 ppm on the 60-cm WSU telescope. The precision is better at redder wavelengths and poorer in the blue. On the Gemini North 8-m telescope, the performance is limited by a very large and strongly wavelength-dependent TP that reached 1000’s of ppm at blue wavelengths and is much larger than we have seen on any other telescope.
In the present study, we aimed to compare anthropometric indicators as predictors of mortality in a community-based setting.
We conducted a population-based longitudinal study nested in a cluster-randomized trial. We assessed weight, height and mid-upper arm circumference (MUAC) on children 12 months after the trial began and used the trial’s annual census and monitoring visits to assess mortality over 2 years.
Children aged 6–60 months during the study.
Of 1023 children included in the study at baseline, height-for-age Z-score, weight-for-age Z-score, weight-for-height Z-score and MUAC classified 777 (76·0 %), 630 (61·6 %), 131 (12·9 %) and eighty (7·8 %) children as moderately to severely malnourished, respectively. Over the 2-year study period, fifty-eight children (5·7 %) died. MUAC had the greatest AUC (0·68, 95 % CI 0·61, 0·75) and had the strongest association with mortality in this sample (hazard ratio = 2·21, 95 % CI 1·26, 3·89, P = 0·006).
MUAC appears to be a better predictor of mortality than other anthropometric indicators in this community-based, high-malnutrition setting in Niger.
We review the various functional cognitive disorders (FCDs) – complaints about memory function or another cognitive process in the absence of relevant neuropathology. These are increasingly coming to the attention of psychiatrists and neurologists and FCD encompasses some newly recognised conditions in addition to classic types such as pseudodementia and psychogenic amnesia. The clinical features, neuropsychological findings and treatment are presented and discussed.
After reading this article you will be able to:
• describe clinical features of FCD and how it differs from neurodegenerative causes of cognitive impairment
• be able to subclassify cases of FCD using the proposed nosology
• understand how to discuss the diagnosis with the patient and explain how the symptoms arise.
New approaches are needed to safely reduce emergency admissions to hospital by targeting interventions effectively in primary care. A predictive risk stratification tool (PRISM) identifies each registered patient's risk of an emergency admission in the following year, allowing practitioners to identify and manage those at higher risk. We evaluated the introduction of PRISM in primary care in one area of the United Kingdom, assessing its impact on emergency admissions and other service use.
We conducted a randomized stepped wedge trial with cluster-defined control and intervention phases, and participant-level anonymized linked outcomes. PRISM was implemented in eleven primary care practice clusters (total thirty-two practices) over a year from March 2013. We analyzed routine linked data outcomes for 18 months.
We included outcomes for 230,099 registered patients, assigned to ranked risk groups.
Overall, the rate of emergency admissions was higher in the intervention phase than in the control phase: adjusted difference in number of emergency admissions per participant per year at risk, delta = .011 (95 percent Confidence Interval, CI .010, .013). Patients in the intervention phase spent more days in hospital per year: adjusted delta = .029 (95 percent CI .026, .031). Both effects were consistent across risk groups.
Primary care activity increased in the intervention phase overall delta = .011 (95 percent CI .007, .014), except for the two highest risk groups which showed a decrease in the number of days with recorded activity.
Introduction of a predictive risk model in primary care was associated with increased emergency episodes across the general practice population and at each risk level, in contrast to the intended purpose of the model. Future evaluation work could assess the impact of targeting of different services to patients across different levels of risk, rather than the current policy focus on those at highest risk.
Emergency admissions to hospital are a major financial burden on health services. In one area of the United Kingdom (UK), we evaluated a predictive risk stratification tool (PRISM) designed to support primary care practitioners to identify and manage patients at high risk of admission. We assessed the costs of implementing PRISM and its impact on health services costs. At the same time as the study, but independent of it, an incentive payment (‘QOF’) was introduced to encourage primary care practitioners to identify high risk patients and manage their care.
We conducted a randomized stepped wedge trial in thirty-two practices, with cluster-defined control and intervention phases, and participant-level anonymized linked outcomes. We analysed routine linked data on patient outcomes for 18 months (February 2013 – September 2014). We assigned standard unit costs in pound sterling to the resources utilized by each patient. Cost differences between the two study phases were used in conjunction with differences in the primary outcome (emergency admissions) to undertake a cost-effectiveness analysis.
We included outcomes for 230,099 registered patients. We estimated a PRISM implementation cost of GBP0.12 per patient per year.
Costs of emergency department attendances, outpatient visits, emergency and elective admissions to hospital, and general practice activity were higher per patient per year in the intervention phase than control phase (adjusted δ = GBP76, 95 percent Confidence Interval, CI GBP46, GBP106), an effect that was consistent and generally increased with risk level.
Despite low reported use of PRISM, it was associated with increased healthcare expenditure. This effect was unexpected and in the opposite direction to that intended. We cannot disentangle the effects of introducing the PRISM tool from those of imposing the QOF targets; however, since across the UK predictive risk stratification tools for emergency admissions have been introduced alongside incentives to focus on patients at risk, we believe that our findings are generalizable.
A predictive risk stratification tool (PRISM) to estimate a patient's risk of an emergency hospital admission in the following year was trialled in general practice in an area of the United Kingdom. PRISM's introduction coincided with a new incentive payment (‘QOF’) in the regional contract for family doctors to identify and manage the care of people at high risk of emergency hospital admission.
Alongside the trial, we carried out a complementary qualitative study of processes of change associated with PRISM's implementation. We aimed to describe how PRISM was understood, communicated, adopted, and used by practitioners, managers, local commissioners and policy makers. We gathered data through focus groups, interviews and questionnaires at three time points (baseline, mid-trial and end-trial). We analyzed data thematically, informed by Normalisation Process Theory (1).
All groups showed high awareness of PRISM, but raised concerns about whether it could identify patients not yet known, and about whether there were sufficient community-based services to respond to care needs identified. All practices reported using PRISM to fulfil their QOF targets, but after the QOF reporting period ended, only two practices continued to use it. Family doctors said PRISM changed their awareness of patients and focused them on targeting the highest-risk patients, though they were uncertain about the potential for positive impact on this group.
Though external factors supported its uptake in the short term, with a focus on the highest risk patients, PRISM did not become a sustained part of normal practice for primary care practitioners.
We present spectropolarimetric observations of the type Ia supernova 1992A obtained 2 weeks and 7 weeks after maximum light. No significant polarisation was detected across any of the spectral features.
We present spectropolarimetric observations of the eclipsing cataclysmic variable 1H1752+08. Modelling of the line intensity and polarisation spectra of 1H1752+08 shows that the magnetic field structure of the white dwarf is off-centre and the mean photospheric field strength is about 7 MG, the lowest measured in a cataclysmic variable (CV). We argue that 1H1752+08 is most probably a low-field AM Herculis system.
The very low background observed from Antarctica in a window from about 2·25 to 2·45 μm can be exploited as a way of making deep near-IR surveys over wide areas of sky. Imaging surveys using the entire window can cover large areas of sky to limits of around K = 20, and can be used to study galaxy evolution and to search for high-redshift quasars, dust-obscured quasars and brown dwarfs. It is also possible to make spectroscopic surveys in this window. The window includes molecular hydrogen emission and CO absorption in galactic sources, and can also be used to search for emission lines such as Hα in high-redshift star-forming galaxies.
The use of artificial neural networks (ANNs) as a classifier of digital spectra is investigated. Using both simulated and real data, it is shown that neural networks can be trained to discriminate between the spectra of different classes of active galactic nucleus (AGN) with realistic sample sizes and signal-to-noise ratios. By working in the Fourier domain, neural nets can classify objects without knowledge of their redshifts.
We present near-infrared spectroscopic observations over the wavelength range 0·9 to 2·5 μm of the AM Herculis system BL Hyi. During these observations, broad and resolvable cyclotron emission harmonics were visible near 1·25, 1·60 and 2·20 μm. We have interpreted these features as arising from a cyclotron emission region located near the white dwarf’s polar cap of magnetic field strength Bp = 23 MG.
Spectropolarimetric observations of SN 1987A obtained with the AAT are presented and discussed. The foreground interstellar polarization is estimated to have a value of 0.8% at position angle 40°. In the early stages polarization features on the absorption troughs of the P-Cygni profiles are observed. At later stages the polarization is dominated by the effects of electron scattering. After correction for the effects of interstellar polarization the position angle of the electron scattering polarization is 110°. The spectrum of the polarized radiation shows broad redshifted features corresponding to the emission lines which can be understood as the consequence of electron scattering in an expanding atmosphere. The position angle observed is consistent with the elongation of the supernova image seen by speckle inteferometry.
The processes of accretion onto the white dwarf in a cataclysmic variable are reviewed. These systems provide the most easily observable examples of accretion disks, and enable the structure of the accretion region to be studied in detail. The properties of column accretion onto magnetic cataclysmic variables are also described.
Above all else, Madison's political thought and practice forces us to confront the problem of constitutional imperfection. Because no constitution can address every political problem, and because those who live under constitutions will find ways to make them compatible with their deepest ambitions, constitutions are necessarily imperfect. As a result, the philosophically inclined will want to understand whether their constitution recommends a doctrine of how to treat constitutional imperfection. With respect to this problem in the context of the U.S. Constitution, scholarship on the political thought and development of the early republic has uncovered three great traditions associated with the three most dominant political thinkers of the period: Hamilton, Jefferson, and Madison.
This evidence presented in this book, however, complicates our understanding of these traditions by showing where Madison departs from Madisonian constitutionalism. In place of Publius Madison, who argued for veneration of the Constitution and seemed to rely on elite representatives to “refine and enlarge” the public view, this book has presented a fuller Madison by considering in him in several of the contexts of his long career. This wider perspective reveals that Madison did not always see veneration of the Constitution as an unqualified good. Rather, at times, Madison worried that veneration would stand in the way of necessary reform. This wider perspective also further confirms that Madison's opinions about the Senate remained complicated by the deal with the small states, and it reveals that this deal – both its terms and its consequences – gave Madison additional reasons to doubt the possibility of true deliberation by legislative elites, both during times of founding and during times of normal politics. On a related point, this book also shows that Madison turned to the democratic logic of the argument for “responsibility” even before he was forced by his break with Hamilton to organize the opposition to Washington's administration. Further, in using responsibility to connect the president to a national majority, Madison was likely limiting the damage he believed resulted from the equality of states in the Senate, but he also laid the intellectual groundwork for Jefferson's Revolution of 1800.
This book presents a provocative account of James Madison's political thought by focusing on Madison's lifelong encounter with the enduring problem of constitutional imperfection. In particular, it emphasizes Madison's alliance with Thomas Jefferson, liberating it from those long-standing accounts of Madisonian constitutionalism that emphasize deliberation by elites and constitutional veneration. Contrary to much of the scholarship, this book shows that Madison was aware of the limits of the inventions of political science and held a far more subtle understanding of the possibility of constitutional government than has been recognized. By repositioning Madison as closer to Jefferson and the Revolution of 1800, this book offers a reinterpretation of one of the central figures of the early republic.
This book's cover includes a photograph of James Madison's letter to John G. Jackson, written in 1821. In that letter, clearly revised with care, Madison made an extraordinary confession to Jackson. He confessed that some of the delegates to the Federal Convention of 1787 had been overly influenced by Shays’ Rebellion in Massachusetts. By overestimating the importance of that rebellion, these delegates imparted a “higher toned system than was perhaps warranted.”
This confession should surprise readers who are familiar with Madison's political thought and with the history of the early republic. It is not surprising because an important American Founder said it. After all, Madison's friend and lifelong accomplice made that point over and over again as soon as the text of the new Constitution reached him in France. To Madison, Thomas Jefferson wrote, “The late rebellion in Massachusetts has given more alarm than I think it should have done.” Jefferson was more descriptive to William S. Smith: “Our Convention has been too much impressed by the insurrection of Massachusetts: and in the spur of the moment they are setting up a kite to keep the hen-yard in order.” It is surprising because, according to our accepted understandings of Madison, Shays’ Rebellion represents the critical difference between him and Jefferson.
In what follows, I argue for a new reading of Madison, and this new reading emphasizes the alliance between Madison and Jefferson. In this, I have followed the path blazed by Lance Banning. I do not, however, agree with all of Banning's conclusions. Most importantly, I do not share Banning's central assumption that, for Madison, republicanism presupposed a particular variety of federalism. I think Banning's otherwise definitive account is distorted on that point, and readers will see that I am not all that interested in determining the extent to which Madison was a nationalist.
“How devoutly it is to be wished, then, that the public opinion of the United States should be enlightened; that it should attach itself to their governments as delineated in the great charters, derived not from the usurped power of kings, but from the legitimate authority of the people; and that it should guarantee, with a holy zeal, these political scriptures from every attempt to add to or diminish from them.”
– James Madison
Even if Madison failed in giving the United States the constitution he thought best, he succeeded in terms of getting a better constitution proposed, ratified, inaugurated, and then safely amended. This was a tremendous accomplishment, and it required that Madison refuse to compromise on the essential features of what a constitution is, but it also required that he compromise on others that were essential to getting any constitution at all. This forced him to encounter not only the enduring and necessary imperfection of any constitution but also the unnecessary and contingent imperfections of the constitution that he got. During his first year in Congress, Madison was able to dominate the politics that emerged at the intersection of these two kinds of imperfections, at least with respect to the debate on the removal power and the Bill of Rights. But he was not so successful in the succeeding debates, and he lost on key policy questions such as the assumption of war debts, the national bank, and U.S. neutrality in relations with France and England.
Rather than accepting these losses as the necessary consequence of deliberation, or as settled by the compromise and consensus required to survive the separation of powers, Madison instead chose the extra-constitutional path of organized opposition. This choice was not inevitable, and it was perhaps the most critical event of the decade. It was a choice that probably cannot be understood without placing it in the context of Thomas Jefferson, whose return from France somehow happened at about the same moment of Madison's turn to parties.