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Iraq and Afghanistan Veterans with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) history have high rates of performance validity test (PVT) failure. The study aimed to determine whether those with scores in the invalid versus valid range on PVTs show similar benefit from psychotherapy and if psychotherapy improves PVT performance.
Veterans (N = 100) with PTSD, mild-to-moderate TBI history, and cognitive complaints underwent neuropsychological testing at baseline, post-treatment, and 3-month post-treatment. Veterans were randomly assigned to cognitive processing therapy (CPT) or a novel hybrid intervention integrating CPT with TBI psychoeducation and cognitive rehabilitation strategies from Cognitive Symptom Management and Rehabilitation Therapy (CogSMART). Performance below standard cutoffs on any PVT trial across three different PVT measures was considered invalid (PVT-Fail), whereas performance above cutoffs on all measures was considered valid (PVT-Pass).
Although both PVT groups exhibited clinically significant improvement in PTSD symptoms, the PVT-Pass group demonstrated greater symptom reduction than the PVT-Fail group. Measures of post-concussive and depressive symptoms improved to a similar degree across groups. Treatment condition did not moderate these results. Rate of valid test performance increased from baseline to follow-up across conditions, with a stronger effect in the SMART-CPT compared to CPT condition.
Both PVT groups experienced improved psychological symptoms following treatment. Veterans who failed PVTs at baseline demonstrated better test engagement following treatment, resulting in higher rates of valid PVTs at follow-up. Veterans with invalid PVTs should be enrolled in trauma-focused treatment and may benefit from neuropsychological assessment after, rather than before, treatment.
Pulsed coherent extreme ultraviolet (EUV) radiation is a potential alternative to pulsed near-ultraviolet (NUV) wavelengths for atom probe tomography. EUV radiation has the benefit of high absorption within the first few nm of the sample surface for elements across the entire periodic table. In addition, EUV radiation may also offer athermal field ion emission pathways through direct photoionization or core-hole Auger decay processes, which are not possible with the (much lower) photon energies used in conventional NUV laser-pulsed atom probe. We report preliminary results from what we believe to be the world’s first EUV radiation-pulsed atom probe microscope. The instrument consists of a femtosecond-pulsed, coherent EUV radiation source interfaced to a local electrode atom probe tomograph by means of a vacuum manifold beamline. EUV photon-assisted field ion emission (of substrate atoms) has been demonstrated on various insulating, semiconducting, and metallic specimens. Select examples are shown.
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.
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.
A large number of hydrodynamic pulsation models are converged in the first overtone, and their mean properties compared with observations of RRc stars in six globular clusters. The two observed quantities, period and Fourier parameter ϕ31, lead, via the models, to inferred values for mean mass, luminosity and temperature of the RRc sample in each cluster. We find a narrow range in intracluster RRc luminosity and temperature, but a wider range in mass. At the same time, the intercluster spread is wide in all three parameters. A full discussion of our techniques and results will be given elsewhere (Simon and Clement, in preparation).
In late 1912 British domestic social politics were dominated by the noisy dispute between David Lloyd George and the British Medical Association over the details of the national health insurance act. Led by the B.M.A., doctors bitterly opposed the insurance scheme and threatened to boycott panel medical service. The profession's inept political maneuvers and the skillful gamemanship of Lloyd George have been well documented by Bentley Gilbert, as well as Alfred Cox and William Braithwaite, two participants in the controversy. Yet, the story of the medical profession's relationship with the insurance act remains unfinished. Almost nothing is known about what followed the political collapse of the B.M.A. after medical benefit became a reality in January 1913. The post-January period, however, was nearly as tumultuous as 1912, and certainly more important to the efficient working of the insurance act which was for the next thirty-five years to provide health care to Britain's laboring poor. This essay will examine the conditions and politics of medical practice during the initial year of national health insurance in Britain.
The level scheme and electromagnetic properties of 148Pm have been studied using 149Sm(d, 3He) and 148Nd(p, nγ) reactions. Combining these measurements with estimates for E2/M1 decay branching ratios leads to the tentative conclusion that 148Pmg,m are in thermal equilibrium during the s-process. The branch at 148Pm then leads to an inferred s-process neutron density of 3 × 108 cm−3.
Forecast accuracy is typically measured in terms of a given loss function. However, as a consequence of the use of misspecified models in multiple model comparisons, relative forecast rankings are loss function dependent. In order to address this issue, a novel criterion for forecast evaluation that utilizes the entire distribution of forecast errors is introduced. In particular, we introduce the concepts of general-loss (GL) forecast superiority and convex-loss (CL) forecast superiority; and we develop tests for GL (CL) superiority that are based on an out-of-sample generalization of the tests introduced by Linton, Maasoumi, and Whang (2005, Review of Economic Studies 72, 735–765). Our test statistics are characterized by nonstandard limiting distributions, under the null, necessitating the use of resampling procedures to obtain critical values. Additionally, the tests are consistent and have nontrivial local power, under a sequence of local alternatives. The above theory is developed for the stationary case, as well as for the case of heterogeneity that is induced by distributional change over time. Monte Carlo simulations suggest that the tests perform reasonably well in finite samples, and an application in which we examine exchange rate data indicates that our tests can help identify superior forecasting models, regardless of loss function.
Prenatal maternal obesity has been linked to adverse childhood neuropsychiatric outcomes, including increased symptoms of attention deficit hyperactivity disorder (ADHD), internalizing and externalizing problems, affective disorders and neurodevelopmental problems but few studies have studied neuropsychiatric outcomes among offspring born to very severely obese women or assessed potential familial confounding by maternal psychological distress.
We evaluated neuropsychiatric symptoms in 112 children aged 3–5 years whose mothers had participated in a longitudinal study of obesity in pregnancy (50 very severe obesity, BMI ⩾40 kg/m2, obese class III and 62 lean, BMI 18.5–25 kg/m2). The mothers completed the Conners’ Hyperactivity Scale, Early Symptomatic Syndrome Eliciting Neurodevelopmental Clinical Examination Questionnaire (ESSENCE-Q), Child's Sleep Habits Questionnaire (CSHQ), Strengths and Difficulties Questionnaire (SDQ), and Child Behavior Checklist (CBCL) to assess child neuropsychiatric symptoms. Covariates included child's sex, age, birthweight, gestational age, socioeconomic deprivation levels, maternal age, parity, smoking status during pregnancy, gestational diabetes and maternal concurrent symptoms of anxiety and depression assessed using State Anxiety of Spielberger State-Trait Anxiety Index (STAI) and General Health Questionnaire (GHQ), respectively.
Children exposed to prenatal maternal very severe obesity had significantly higher scores in the Conners’ Hyperactivity Scale; ESSENCE-Q; total sleep problems in CSHQ; hyperactivity, conduct problems and total difficulties scales of the SDQ; higher externalizing and total problems, anxious/depressed, aggressive behaviour and other problem syndrome scores and higher DSM-oriented affective, anxiety and ADHD problems in CBCL. Prenatal maternal very severe obesity remained a significant predictor of child neuropsychiatric problems across multiple scales independent of demographic factors, prenatal factors and maternal concurrent symptoms of anxiety and depression.
Prenatal maternal very severe obesity is a strong predictor of increased neuropsychiatric problems in early childhood.
It is well known that 14C dating of fossil bone with seriously depleted protein levels, or bone that has been consolidated with preservatives, can produce erroneous results. In the tropics, warm and moist soil conditions lead to constant reworking of organic matter and add to the danger of bone contamination. Because of this, 14C dating of preservative-impregnated bone from such areas has rarely been successful. We report here a set of AMS dates on both unconsolidated animal bone and polyvinyl acetate/polyvinyl alcohol (PVA/PV-OH) impregnated human burials from the Maya site of Cuello, Belize. The steps needed to purify the samples are described, together with details on the use of qualitative infra-red (IR) spectra as a means of assessing sample purity.
In this review we present the ISO imaging of nebulae around Luminous Blue Variables. Three LBVs have been imaged with ISO: HR Car, AG Car and the LBV candidate G79.29+0.46. The ISOCAM instrument did not resolve the nebula around HR Car. However some nebular emission lines are seen in the spectral energy distribution of this source. A proper deconvolution of the images may resolve the nebula. For AG Car and G79.29+0.46 the nebula is clearly resolved. The structure and intensity distribution of the nebular emission is dependent on the wavelength, indicating a separation between the ionised matter and the dust in the nebulae. Some model calculations are presented for the G79.29+0.46 nebula.
AG Car is one of the few Luminous Blue Variables (LBV’s) in our galaxy. The star is a photometric variable which had a recent outburst in 1981 (Whitelock et al., 1983; Wolf and Stahl, 1982) and is surrounded by a resolved ring nebula (Thackeray, 1950; Paresce, 1989). These properties indicate that AG Car is a typical LBV. However, at its canonical distance of 2-2.5 kpc, derived from its assumed membership of the Car OBI or OB2 association, AG Car has a bolometric luminosity of Mbol ⋍ −8.5 to −9.0 and is located significantly below the Humphreys-Davidson limit, and also below the upperlimit for red supergiants (RSG). This implies that AG Car might have been a RSG and that the ring might be due to the interaction of the RSG wind and the LBV wind.
We present spectra obtained with the Infared Space Observatory (ISO) of the dust shells surrounding several Luminous Blue Variables (LBVs), both in our galaxy and in the LMC. The 20-45 μm spectra of R71, AG Car and Wra 751 show prominent emission features from crystalline silicates. The composition of the crystalline silicates in LBV dust shells is compared to that found in other types of objects, such as (post)-AGB stars and red supergiants (RSG). Both Wra 751 and AG Car have a high ratio of pyroxenes to olivines. This suggests that the grains in both stars experienced very similar processing, but that this processing has lead to a higher abundance of pyroxenes compared to RSG. The dust composition of the three LBVs discussed here suggests dust formation in a cool outflow not unlike those of RSG.