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This article synthesises the results of a large international study on primary care (PC), the QUALICOPC study.
Since the Alma Ata Declaration, strengthening PC has been high on the policy agenda. PC is associated with positive health outcomes, but it is unclear how care processes and structures relate to patient experiences.
Survey data were collected during 2011–2013 from approximately 7000 PC physicians and 70 000 patients in 34, mainly European, countries. The data on the patients are linked to data on the PC physicians within each country and analysed using multilevel modelling.
Patients had more positive experiences when their PC physician provided a broader range of services. However, a broader range of services is also associated with higher rates of hospitalisations for uncontrolled diabetes, but rates of avoidable diabetes-related hospitalisations were lower in countries where patients had a continuous relationship with PC physicians. Additionally, patients with a long-term relationship with their PC physician were less likely to attend the emergency department. Capitation payment was associated with more positive patient experiences. Mono- and multidisciplinary co-location was related to improved processes in PC, but the experiences of patients visiting multidisciplinary practices were less positive. A stronger national PC structure and higher overall health care expenditures are related to more favourable patient experiences for continuity and comprehensiveness. The study also revealed inequities: patients with a migration background reported less positive experiences. People with lower incomes more often postponed PC visits for financial reasons. Comprehensive and accessible care processes are related to less postponement of care.
The study revealed room for improvement related to patient-reported experiences and highlighted the importance of core PC characteristics including a continuous doctor–patient relationship as well as a broad range of services offered by PC physicians.
Depression is a common, serious, but under-recognised problem in multiple sclerosis (MS). The primary objective of this study was to assess whether a rapid visual analogue screening tool for depression could operate as a quick and reliable screening method for depression, in patients with MS.
Patients attending a regional MS outpatient clinic completed the Emotional Thermometer 7 tool (ET7), the Hospital Anxiety and Depression Scale – Depression Subscale (HADS-D) and the Major Depression Inventory (MDI) to establish a Diagnostic and Statistical Manual, 4th edition (DSM-IV) diagnosis of Major Depression. Full ET7, briefer subset ET4 version and depression and distress thermometers alone were compared with HADS-D and MDI. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and receiver operating characteristic (ROC) curve were calculated to compare the performance of all the screening tools.
In total, 190 patients were included. ET4 performed well as a ‘rule-out’ screening step (sensitivity 0.91, specificity 0.72, NPV 0.98, PPV 0.32). ET4 performance was comparable to HADS-D (sensitivity 0.96, specificity 0.77, NPV 0.99, PPV 0.37) without need for clinician scoring. The briefer ET4 performed as well as the full ET7.
ET are quick, sensitive and useful screening tools for depression in this MS population, to be complemented by further questioning or more detailed psychiatric assessment where indicated. Given that ET4 and ET7 perform equally well, we recommend the use of ET4 as it is briefer. It has the potential to be widely implemented across busy neurology clinics to assist in depression screening in this under diagnosed group.
Atmospheric aerosol particles have been sampled near a Los Angeles freeway and analyzed by proton-induced X-ray emission, PIXE, as a sulfur baseline study in September 1974 before 1975-model auto mobiles, equipped with catalytic emission control devices, appeared in large numbers. The sampling plan was optimized a c cording to the requirements of X-ray analysis techniques, fluctuations in air flow across the freeway, and the time and particlesise resolution of the aerosol sampling equipment. During five selected two-hour intervals with cross wind conditions, particles were collected as a function of size by six cascade impactorsope rating simultaneously on three towers at 2 and 7 meters above road level 35 meters upwind and 35 meters downwind of the traffic lanes. Particles as a function of time were sampled continuously, for the 100-hour duration of the experiment, from the three 7-meter heights using time series streaker filter samplers with two-hour time resolution. Precise analyses of S, Cl, K, Ca, Fe, Br, and. Pb established relationships which permit estimates to be made of future increases in particulate sulfur as a consequence of increased sulfate emissions from catalytic automobiles.
The current mixed-methods study explored qualitative accounts of prior childhood experiences and current contextual factors around family meals across three quantitatively informed categories of family meal frequency patterns from adolescence to parenthood: (i) ‘maintainers’ of family meals across generations; (ii) ‘starters’ of family meals in the next generation; and (iii) ‘inconsistent’ family meal patterns across generations.
Quantitative survey data collected as part of the first (1998–1999) and fourth (2015–2016) waves of the longitudinal Project EAT (Eating and Activity in Adolescents and Young Adults) study and qualitative interviews conducted with a subset (n 40) of Project EAT parent participants in 2016–2017.
Surveys were completed in school (Wave 1) and online (Wave 4); qualitative interviews were completed in-person or over the telephone.
Parents of children of pre-school age (n 40) who had also completed Project EAT surveys at Wave 1 and Wave 4.
Findings revealed salient variation within each overarching theme around family meal influences (‘early childhood experiences’, ‘influence of partner’, ‘household skills’ and ‘family priorities’) across the three intergenerational family meal patterns, in which ‘maintainers’ had numerous influences that supported the practice of family meals; ‘starters’ experienced some supports and some challenges; and ‘inconsistents’ experienced many barriers to making family meals a regular practice.
Family meal interventions should address differences in cooking and planning skills, aim to reach all adults in the home, and seek to help parents who did not eat family meals as a child develop an understanding of how and why they might start this tradition with their family.
Child maltreatment has been associated with various cumulative risk factors. However, little is known about the extent to which genetic and environmental factors contribute to individual differences between parents in perpetrating child maltreatment. To estimate the relative contribution of genetic and environmental factors to perpetrating maltreatment we used a parent-based extended family design. Child-reported perpetrated maltreatment was available for 556 parents (283 women) from 63 families. To explore reporter effects (i.e., child perspective on maltreatment), child reports were compared to multi-informant reports. Based on polygenic model analyses, most of the variance related to the perpetration of physical abuse and emotional neglect was explained by common environmental factors (physical abuse: c2 = 59%, SE = 12%, p = .006; emotional neglect: c2 = 47%, SE = 8%, p < .001) whereas genetic factors did not significantly contribute to the model. For perpetrated emotional abuse, in contrast, genetic factors did significantly contribute to perpetrated emotional abuse (h2 = 33%, SE = 8%, p < .001), whereas common environment factors did not. Multi-informant reports led to similar estimates of genetic and common environmental effects on all measures except for emotional abuse, where a multi-informant approach yielded higher estimates of the common environmental effects. Overall, estimates of unique environment, including measurement error, were lower using multi-informant reports. In conclusion, our findings suggest that genetic pathways play a significant role in perpetrating emotional abuse, while physical abuse and emotional neglect are transmitted primarily through common environmental factors. These findings imply that interventions may need to target different mechanisms dependings on maltreatment type.
The Icelandic crust is characterized by low δ18O values that originate from pervasive high-temperature hydrothermal alteration by 18O-depleted meteoric waters. Igneous rocks in Iceland with δ18O values significantly higher than unaltered oceanic crust (~5.7‰) are therefore rare. Here we report on rhyolitic intra-caldera samples from a cluster of Neogene central volcanoes in Borgarfjörður Eystri, Northeast Iceland, that show whole-rock δ18O values between +2.9 and +17.6‰ (n = 6), placing them among the highest δ18O values thus far recorded for Iceland. Extra-caldera rhyolite samples from the region, in turn, show δ18O whole-rock values between +3.7 and +7.8‰ (n = 6), consistent with the range of previously reported Icelandic rhyolites. Feldspar in the intra-caldera samples (n = 4) show δ18O values between +4.9 and +18.7‰, whereas pyroxene (n = 4) shows overall low δ18O values of +4.0 to +4.2‰, consistent with regional rhyolite values. In combination with the evidence from mineralogy and rock H2O contents, the high whole-rock δ18O values of the intra-caldera rhyolites appear to be the result of pervasive isotopic exchange during subsolidus hydrothermal alteration with 18O-enriched water. This alteration conceivably occurred in a near-surface hot spring environment at the distal end of an intra-caldera hydrothermal system, and was probably fed by waters that had already undergone significant isotope exchange with the country rock. Alternatively, 18O-enriched alteration fluids may have been produced during evaporation and boiling of standing water in former caldera lakes, which then interacted with the intra-caldera rock suites. Irrespective of the exact exchange processes involved, a previously unrecognized and highly localized δ18O-enriched rock composition exists on Iceland and thus probably within the Icelandic crust too.
Major advances have recently been made in merging language and vision representations. Most tasks considered so far have confined themselves to the processing of objects and lexicalised relations amongst objects (content words). We know, however, that humans (even pre-school children) can abstract over raw multimodal data to perform certain types of higher level reasoning, expressed in natural language by function words. A case in point is given by their ability to learn quantifiers, i.e. expressions like few, some and all. From formal semantics and cognitive linguistics, we know that quantifiers are relations over sets which, as a simplification, we can see as proportions. For instance, in most fish are red, most encodes the proportion of fish which are red fish. In this paper, we study how well current neural network strategies model such relations. We propose a task where, given an image and a query expressed by an object–property pair, the system must return a quantifier expressing which proportions of the queried object have the queried property. Our contributions are twofold. First, we show that the best performance on this task involves coupling state-of-the-art attention mechanisms with a network architecture mirroring the logical structure assigned to quantifiers by classic linguistic formalisation. Second, we introduce a new balanced dataset of image scenarios associated with quantification queries, which we hope will foster further research in this area.
West Antarctic climate and surface mass balance (SMB) records are sparse. To fill this gap, regional atmospheric climate modelling is useful, providing that such models are employed at sufficiently high horizontal resolution and coupled with a snow model. Here we present the results of a high-resolution (5.5 km) regional atmospheric climate model (RACMO2) simulation of coastal West Antarctica for the period 1979–2015. We evaluate the results with available in situ weather observations, remote-sensing estimates of surface melt, and SMB estimates derived from radar and firn cores. Moreover, results are compared with those from a lower-resolution version, to assess the added value of the resolution. The high-resolution model resolves small-scale climate variability invoked by topography, such as the relatively warm conditions over ice-shelf grounding zones, and local wind speed accelerations. Surface melt and SMB are well reproduced by RACMO2. This dataset will prove useful for picking ice core locations, converting elevation changes to mass changes, for driving ocean, ice-sheet and coupled models, and for attributing changes in the West Antarctic Ice Sheet and shelves to changes in atmospheric forcing.
A narrow bridge of floating ice that connected the Wilkins Ice Shelf, Antarctica, to two confining islands eventually collapsed in early April 2009. In the month preceding the collapse, we observed deformation of the ice bridge by means of satellite imagery and from an in situ GPS station. TerraSAR-X images (acquired in stripmap mode) were used to compile a time series. The ice bridge bent most strongly in its narrowest part (westerly), while the northern end (near Charcot Island) shifted in a northeasterly direction. In the south, the ice bridge experienced compressive strain parallel to its long axis. GPS position data were acquired a little south of the narrowest part of the ice bridge from 19 January 2009. Analysis of these data showed both cyclic and monotonic components of motion. Meteorological data and re-analysis of the output of weather-prediction models indicated that easterly winds were responsible for the cyclic motion component. In particular, wind stress on the rough ice melange that occupied the area to the east exerted significant pressure on the ice bridge. The collapse of the ice bridge began with crack formation in the southern section parallel to the long axis of the ice bridge and led to shattering of the southern part. Ultimately, the narrowest part, only 900 m wide, ruptured. The formation of many small icebergs released energy of >125 ×106 J.
Multi-decade observing campaigns of the globular clusters 47 Tucanae and M15 have led to an outstanding number of discoveries. Here, we report on the latest results of the long-term observations of the pulsars in these two clusters. For most of the pulsars in 47 Tucanae we have measured, among other things, their higher-order spin period derivatives, which have in turn provided stringent constraints on the physical parameters of the cluster, such as its distance and gravitational potential. For M15, we have studied the relativistic spin precession effect in PSR B2127+11C. We have used full-Stokes observations to model the precession effect, and to constrain the system geometry. We find that the visible beam of the pulsar is swiftly moving away from our line of sight and may very soon become undetectable. On the other hand, we expect to see the opposite emission beam sometime between 2041 and 2053.
We review results obtained with the Focal Plane Crystal Spectrometer (FPCS) on the Einstein Observatory. Clear evidence is found for departures from ionization equilibrium in the interior of Puppis A. This comes from the observed weakness of the forbidden lines relative to the resonance lines for the He - like triplets of O VII and Ne IX. However, it is shown that this departure from equilibrium does not alter our conclusion, based on previous FPCS results, that O and Ne are overabundant relative to Fe. The spectrum of N132D shows strong O VIII emission and very weak Fe emission, suggesting an even greater O/Fe abundance enhancement than in Puppis A. In the Cygnus Loop, the O to Ne abundance ratio is approximately solar; we have no information about Fe. The O VII triplet shows clear evidence for departures from ionization equilibrium in the Cygnus Loop. The spectrum of Tycho's SNR contains lines from ionization stages of Fe XVII through Fe XXIII and XXIV, indicating that a wide range of ionization conditions are present. Cas A and Kepler's SNR show relatively less emission from the higher ionization stages. For Tycho, we measured the strength of the strong Si XIII lines, and we find that a many-fold overabundance of Si relative to Fe is required regardless of the equilibrium state of the emitting plasma (confirming the Solid State Spectrometer results). On a separate topic, the completed analysis of X-ray Doppler shifts in Cas A suggests that the emitting material is concentrated in a ring that is inclined to the line of sight and is expanding at ~5000 km s−1.
Radio-glaciological parameters from the Moore’s Bay region of the Ross Ice Shelf, Antarctica, have been measured. The thickness of the ice shelf in Moore’s Bay was measured from reflection times of radio-frequency pulses propagating vertically through the shelf and reflecting from the ocean, and is found to be 576 ± 8 m. Introducing a baseline of 543 ± 7m between radio transmitter and receiver allowed the computation of the basal reflection coefficient, R, separately from englacial loss. The depth-averaged attenuation length of the ice column, 〈L〉 is shown to depend linearly on frequency. The best fit (95% confidence level) is 〈L(ν)〉= (460±20) − (180±40)ν m (20 dB km−1), for the frequencies ν = [0.100–0.850] GHz, assuming no reflection loss. The mean electric-field reflection coefficient is (1.7 dB reflection loss) across [0.100–0.850] GHz, and is used to correct the attenuation length. Finally, the reflected power rotated into the orthogonal antenna polarization is <5% below 0.400 GHz, compatible with air propagation. The results imply that Moore’s Bay serves as an appropriate medium for the ARIANNA high-energy neutrino detector.
Our understanding of the complex relationship between schizophrenia symptomatology and etiological factors can be improved by studying brain-based correlates of schizophrenia. Research showed that impairments in value processing and executive functioning, which have been associated with prefrontal brain areas [particularly the medial orbitofrontal cortex (MOFC)], are linked to negative symptoms. Here we tested the hypothesis that MOFC thickness is associated with negative symptom severity.
This study included 1985 individuals with schizophrenia from 17 research groups around the world contributing to the ENIGMA Schizophrenia Working Group. Cortical thickness values were obtained from T1-weighted structural brain scans using FreeSurfer. A meta-analysis across sites was conducted over effect sizes from a model predicting cortical thickness by negative symptom score (harmonized Scale for the Assessment of Negative Symptoms or Positive and Negative Syndrome Scale scores).
Meta-analytical results showed that left, but not right, MOFC thickness was significantly associated with negative symptom severity (βstd = −0.075; p = 0.019) after accounting for age, gender, and site. This effect remained significant (p = 0.036) in a model including overall illness severity. Covarying for duration of illness, age of onset, antipsychotic medication or handedness weakened the association of negative symptoms with left MOFC thickness. As part of a secondary analysis including 10 other prefrontal regions further associations in the left lateral orbitofrontal gyrus and pars opercularis emerged.
Using an unusually large cohort and a meta-analytical approach, our findings point towards a link between prefrontal thinning and negative symptom severity in schizophrenia. This finding provides further insight into the relationship between structural brain abnormalities and negative symptoms in schizophrenia.
Early trauma is linked to higher symptom levels in bipolar and psychotic disorders, but the translating mechanisms are not well understood. This study examines whether the relationship between early emotional abuse and depressive symptoms is mediated by metacognitive beliefs about thoughts being uncontrollable/dangerous, and whether this pathway extends to influence positive symptoms.
Patients (N = 261) with psychotic or bipolar disorders were assessed for early trauma experiences, metacognitive beliefs, and current depression/anxiety and positive symptoms. Mediation path analyses using ordinary least-squares regressions tested if the effect of early emotional abuse on depression/anxiety was mediated by metacognitive beliefs, and if the effect of early emotional abuse on positive symptoms was mediated by metacognitive beliefs and depression/anxiety.
Metacognitive beliefs about thoughts being uncontrollable/dangerous significantly mediated the relationship between early emotional abuse and depression/anxiety. Metacognitive beliefs and depression/anxiety significantly mediated the relationship between early emotional abuse and positive symptoms. The models explained a moderate amount of the variance in symptoms (R2 = 0.21–0.29).
Our results indicate that early emotional abuse is relevant to depression/anxiety and positive symptoms in bipolar and psychotic disorders, and suggest that metacognitive beliefs could play a role in an affective pathway to psychosis. Metacognitive beliefs could be relevant treatment targets with regards to depression/anxiety and positive symptoms in bipolar and psychotic disorders.
The Antarctic mosaic project is a joint National Oceanic and Atmospheric Administration/United States Geological Survey (NOAA/USGS) project to produce a photomosaic map at 1:5 000 000 scale. The mosaic will be made as a collage of rectified images from the polar-orbiting NOAA-6 satellite. The near-infrared wavelength band of 0.725 to 1.10 μm, with a spatial resolution of 1.1 km, will be used. The NOAA-6 data are obtained from the McMurdo station receiving facility and from the archive of recorded data. Examples of imagery from both sources are presented. The operational plan including the processing flow chart, rectification process, progress to date, and problems to be faced are discussed. Applications of the mosaic are discussed as well as possible NOAA-6 applications to Antarctic investigators.
The observation of 8B solar Neutrinos in the Kamiokande-II detector is presented. Based on 450 days of data in the time period of January 1987 through May 1988, the measured flux obtained with Ee ≥ 9.3 MeV was 0.46 ± 0.13 (stat) ± 0.08 (sys) of the value predicted by the standard solar model. The detector and analysis methods were improved since June 1988 and the background level has been decreased by a factor of about three since then.
The topic of this paper really falls somewhere between this session on active galaxies and the session on clusters. What I will report is really a cluster phenomenon but one which depends on the presence of a dominant, massive galaxy in the cluster. Specifically, we have detected several X-ray emission lines from the vicinity of M87 in the Virgo Cluster and NGC 1275 in Perseus. The lines are indicative of material which is cooler than the bulk of the intracluster gas. This material is most likely accreting onto the central galaxy with the accretion rate controlled by the rate of radiative cooling.
The observations I am reporting were made with the Focal Plane Crystal Spectrometer (FPCS)on the Einstein Observatory. The instrument is a Bragg crystal spectrometer which has a resolving power (E/ΔE) of 50 to 500 over the energy range of 0.2 to 3 keV. It operates much like an optical scanner in that it has a narrow passband which is swept over some restricted spectral range containing an emission line. Detailed descriptions are given elsewhere (Canizares et al. 1977, 1979, Giacconi et al. 1979).
In recent years, a revolution in astronomical position measurements has been taking place with the advent of modern space techniques. These new techniques, which supplement the traditional astrometric measurements, include laser ranging to the moon and artificial satellites, very-long-baseline interferometry (VLBI) of galactic and extra-galactic radio sources and spacecraft, radio tracking of satellites, and radar-ranging and spacecraft tracking during planetary encounters. Impressive accuracies have been achieved and further improvements are forthcoming. Each technique can be expected to establish its own reference frame which is derived from observations of a particular class of objects. The celestial and terrestrial coordinate systems are related through adopted constants and definitions. Contemporary astronomy has led to the development of three principal celestial coordinate systems: the optical frame (FK4/FK5) based on positions of galactic stars; the planetary/lunar ephemeris frame based on the major celestial bodies of the solar system; and the radio frame constructed from observations of extragalactic radio sources (quasars). Each frame is rotated with respect to others; furthermore, the optical frame offset is time variable. It is important that all frames be interconnected and unified. The optical frame is being connected to the radio frame by VLBI observations of radio emitting stars. The radio frame is being tied to the ephemeris frame in several ways – one is via differential VLBI measurements between quasars and planet-orbiting spacecraft.