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Psychotropic medications are sometimes used off-label and inappropriately. This may cause harm to adolescents with intellectual disability. However, few studies have analysed off-label or inappropriate prescribing to this group.
To examine the appropriateness of psychotropic prescribing to adolescents with intellectual disability living in the community in south-east Queensland, Australia.
Off-label medication use was determined based on whether the recorded medical condition treated was approved by the Australian Therapeutic Goods Administration. Clinical appropriateness of medication use was determined based on published guidelines and clinical opinion of two authors who specialise in developmental disability medicine (J.N.T. and D.H.).
We followed 429 adolescents for a median of 4.2 years. A total of 107 participants (24.9%) were prescribed psychotropic medications on at least one occasion. Of these, 88 (82.2%) were prescribed their medication off-label or inappropriately at least once. Off-label or inappropriate use were most commonly associated with challenging behaviours.
Off-label or inappropriate use of psychotropic medications was common, especially for the management of challenging behaviours. Clinical decision-making accounts for individual patient factors and is made based on clinical experience as well as scientific evidence, whereas label indications are developed for regulatory purposes and, although appropriate at a population level, cannot encompass the foregoing considerations. Education for clinicians and other staff caring for people with intellectual disability, and a patient-centred approach to prescribing with involvement of families should encourage appropriate prescribing. The effect of the National Disability Insurance Scheme on the appropriateness of psychotropic medication prescribing should be investigated.
The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers.
In this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes.
From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country.
A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries.
This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.
Peri-orbital surgical emphysema is a rare complication that can occur after lacrimal surgery. It has only been described in isolated cases, following external dacryocystorhinostomy (n = 2) and Lester Jones tube insertion (n = 1).
A retrospective, non-comparative case series was conducted of patients who developed surgical emphysema following endoscopic dacryocystorhinostomy.
A total of 356 endoscopic dacryocystorhinostomy cases (primary, n = 316; revision, n = 40) were performed over a six-year period. Seven cases of post-operative surgical emphysema were identified, all of which were preceded by uncontrolled sneezing, nose-blowing or coughing within the first week of surgery. The occurrence of surgical emphysema post-endoscopic dacryocystorhinostomy in our centre was 7 in 356, or 2 per cent, over six years.
This is the first study to report the occurrence of surgical emphysema post-endoscopic dacryocystorhinostomy. Clinicians may wish to suggest patients stifle the aforementioned triggers within the first week to reduce the potential for surgical emphysema.
This study estimates the incubation period of COVID-19 among locally transmitted cases, and its association with age to better inform public health measures in containing COVID-19. Epidemiological data of all PCR-confirmed COVID-19 cases from all restructured hospitals in Singapore were collected between 23 January 2020 and 2 April 2020. Activity mapping and detailed epidemiological investigation were conducted by trained personnel. Positive cases without clear exposure to another positive case were excluded from the analysis. One hundred and sixty-four cases (15.6% of patients) met the inclusion criteria during the defined period. The crude median incubation period was 5 days (range 1–12 days) and median age was 42 years (range 5–79 years). The median incubation period among those 70 years and older was significantly longer than those younger than 70 years (8 vis-à-vis 5 days, P = 0.040). Incubation period was negatively correlated with day of illness in both groups. These findings support current policies of 14-day quarantine periods for close contacts of confirmed cases and 28 days for monitoring infections in known clusters. An elderly person who may have a longer incubation period than a younger counterpart may benefit from earlier and proactive testing, especially after exposure to a positive case.
While the overall prevalence of autism is 1.7% in the United States of America, research has demonstrated a two- to five-fold increase in CHD. The Cardiac Neurodevelopmental Outcome Collaborative recommends screening for autism from infancy through adolescence. This study investigated the frequency of autism concerns at a single Cardiac Neurodevelopmental Program and examined current clinical practice as a way to improve quality of care.
Materials and methods:
Patients (n = 134; mean age = 9.0 years) included children with high-risk CHD who completed a neurodevelopmental evaluation following a formalised referral to the Cardiac Neurodevelopmental Program between 2018 and 2019. Retrospective chart review included parent report on the Behaviour Assessment System for Children-3 and Adaptive Behaviour Assessment System-3. Descriptive and correlation analyses were completed.
In this sample, 11.2% presented with autism-related concerns at referral, 2 were diagnosed with autism, 9 were referred to an autism specialist (6 confirmed diagnosis; 3 not completed). Thus, at least 5.9% of the sample were diagnosed with autism following thorough clinical evaluation. Analyses showed atypicality, along with deficient adaptability, leisure, social, and communication skills. Frequency of early intervention, school supports, and relation with comorbidities are reported.
Prior to assessment recommendations by the Cardiac Neurodevelopmental Outcome Collaborative, autism screening may not be completed systematically in clinical care for CHD. The current sample demonstrates a high frequency of autism in the typically referred clinical sample. Commonly used parent-report measures may reveal concerns but will not help diagnosis. Systematic use of an autism screener is essential.
The species of Gagnepainia K.Schum. and Hemiorchis Kurz are revised throughout their ranges. These genera are shown with evidence from morphological and molecular studies to be distinct, although closely related to each other. Two species of Gagnepainia and three of Hemiorchis are recognised. A key to the genera of Globbeae and keys to the species of Gagnepainia and Hemiorchis are given, all names are typified and descriptions are provided. Conservation assessments of all taxa are proposed.
Big data provides high volume of data to inform product customisation. Understanding which data is relevant remains a challenge. A method is proposed to identify relevant data to inform data-driven customisation. A case study regarding customisation of orthoses was conducted. Verbal protocol analysis was employed to extract time spent on major fabrication phases. Data related to patients, therapists and fabrication time was analysed. Results showed that the number of stabilised joints, experience of therapists and whether the design is for in- or out-patient are key factors for customisation.
In this paper, the generation of relativistic electron mirrors (REM) and the reflection of an ultra-short laser off the mirrors are discussed, applying two-dimension particle-in-cell simulations. REMs with ultra-high acceleration and expanding velocity can be produced from a solid nanofoil illuminated normally by an ultra-intense femtosecond laser pulse with a sharp rising edge. Chirped attosecond pulse can be produced through the reflection of a counter-propagating probe laser off the accelerating REM. In the electron moving frame, the plasma frequency of the REM keeps decreasing due to its rapid expansion. The laser frequency, on the contrary, keeps increasing due to the acceleration of REM and the relativistic Doppler shift from the lab frame to the electron moving frame. Within an ultra-short time interval, the two frequencies will be equal in the electron moving frame, which leads to the resonance between laser and REM. The reflected radiation near this interval and corresponding spectra will be amplified due to the resonance. Through adjusting the arriving time of the probe laser, a certain part of the reflected field could be selectively amplified or depressed, leading to the selective adjustment of the corresponding spectra.
Electromagnetic scattering from the sea surface is of great significance in radar detection, target recognition, ocean remote sensing, etc. By introducing the action spectrum, the modified spatio-temporal variation wave spectrum is used to establish a nonlinear sea surface with currents in this paper. Traditional capillary wave modification facet scattering model (CWMFSM) can only calculate the backscattering from the wind-driven sea surface. By using the new spatio-temporal variation wave spectrum to modify the scattering amplitude of every facet, the new CWMFSM can be used to calculate the nonlinear sea surface scattering with surface currents. Therefore, the model simultaneously considers the modulation of sea surface wind and currents to the radar back echo. The dependence of backscattering coefficient from nonlinear sea surface on the incident angle and the polarization are discussed. The results verify that the nonlinear model is more consistent with the measurement data. This paper also investigates the Doppler spectrum characteristics of the sea with currents. It is found that the effect of wave–current interaction on Doppler spectra is weaker than that of wave–wave interaction. The SAR images of nonlinear sea surfaces are also simulated and different bands, polarizations, and baseline length effects on sea current detection performance of along-track interference SAR are analyzed.
To determine the prevalence of depression and quality of life in patients with epilepsy, and its associated risk factors.
This was a cross sectional study where 120 patients with epilepsy and 60 controls who were the patients’ sibling, were recruited. Socio-demographic data (age, sex, race, marital status, education level and employment status) and clinical variables (age at onset, duration and type of seizure, seizure recency, type of antiepileptic drug used, family history of epilepsy and depression) were recorded. Both patients and the control subjects were given the “Hospital Anxiety and Depression Scale” and “Mini International Neuropsychiatric Interview” to screen and diagnose for depression respectively. The Quality of Life Inventory of Epilepsy (QOLIE-31) was used to assess quality of life.
The prevalence of depression in patients with epilepsy was higher than in controls (9.2% as compared to 3.3%), though it was not statistically significant. There were also no significant differences between the depressed and non depressed patients in terms of socio-demographic and clinical variables. However, patients with younger onset of epilepsy were more likely to report depressive symptoms on HADS (p = 0.02). Patients with epilepsy who were depressed also had poorer quality life as compared to those without depression: p< 0.001.
Patients with epilepsy had higher rates of depression as compared to controls. Furthermore they had significantly poorer quality of life as compared to those without depression. Therefore, epileptic patients should be regularly screened for depression to prevent unnecessary suffering and poorer quality of life.
The motivation of the patient may affect response to treatment and prognosis.
The objective of this study was to compare the various types of application of patients in terms of their motivation and sociodemographic variables.
To demonstrate that patients who apply for treatment themselves have greater motivation and less depression and anxiety.
Patients who applied or were referred for treatment of addiction to the Elazig Hospital for Mental Disorders were included in this study. Patients diagnosed according to DSM-IV criteria, giving written informed consent and who did not have severe comorbid psychopathology were enrolled. Beck Depression and Anxiety Scales, and Motivation for Treatment Scale (MfT) were used in evaluation. p was set at 0.05.
Forty five male patients with a mean age of 37.9 (S.D. 11.2) were enrolled in the study. The mean scores for Beck Depression and Anxiety Scales and the Motivation for Treatment Scale were 27.7 (S.D. 12.8), 25.2 (S.D. 15.2) and 67.4 (S.D. 11.4); respectively. When the socio-demographic and clinical variables of the patients who applied voluntarily and those who were referred for treatment involuntarily were compared by Mann-Whitney U test, only the total score on the Motivation for Treatment Scale as well as those of its subscales for seeking help and being ready for treatment differed betwen groups (p: 0.01, 0.05 and 0.01; respectively).
Types of application for treatment may affect levels of motivation in patients for treatment. Techniques for motivational interview may especially be important for patients applying involuntarily.
The onset of eating pathology has commonly been attributed to media influences. However, most of these studies have not included an experimental design and have mainly concentrated on Caucasian samples, with limited research on non-Western populations.
To assess whether exposure to either objectifying female media images or neutral images (e.g. chairs) had an impact on eating pathology and self-objectification and whether this effect was different for Australian and Asian females.
A total sample of 301 female participants [Caucasian Australians (n= 97); Asians grown up in Australia (n = 70), Asians currently residing in Australia (n = 60) and Chinese living in Hong Kong (n = 74)] were exposed to a slideshow of either objectifying women (n=147) or neutral (n=154) images. Variables associated with the objectification framework and eating pathology were assessed through self-report.
State self-objectification was higher in individuals who were exposed to the objectifying media images, regardless of ethnicity (p >0.01). Caucasians had significantly higher BMI and greater body surveillance compared to the Chinese population (p>0.01), and more trait self-objectification and body surveillance compared to Asians residing in Australia (p>0.05). Similarly, Asians who grew up in Australia demonstrated higher trait self-objectification compared to Asians residing in Australia (p>0.05), and body surveillance and food preoccupation compared to the Chinese sample (p>0.05).
The results indicate that self-objectification can be elicited from exposure to objectifying media images in women from varying cultural backgrounds. This understanding is crucial to the development of preventive measures of eating pathology.
Childhoods in urban or rural environments may differentially affect risk for neuropsychiatric disorders. Here, we leveraged on dramatic urbanization and rural-urban migration since the 1980s in China to explore the hypothesis that rural or urban childhoods may differentially influence memory processing and neural responses to neutral and aversive stimuli.
Explore the underlying mechanisms of childhood environment effect on brain function and neuropsychiatric risk.
We examined 420 adult subjects with similar current socioeconomic status and living in Beijing, China, but with differing rural (n = 227) or urban (n = 193) childhoods. In an episodic memory paradigm scanned in a 3 T GE MRI, subjects viewed blocks of neutral or aversive pictures in the encoding and retrieval sessions.
Episodic memory accuracy for neutral stimuli was less than for aversive stimuli (P < 0.001). However, subjects with rural childhoods apparently performed less accurately for memory of aversive but not neutral stimuli (P < 0.01). In subjects with rural childhoods, there was relatively increased engagement of bilateral striatum at encoding, increased engagement of bilateral hippocampus at retrieval of neutral and aversive stimuli, and increased engagement of amygdala at aversive retrieval (P < 0.05 FDR corrected, cluster size > 50).
Rural or urban childhoods appear associated with physiological and behavioural differences, particularly in the neural processing of aversive episodic memory at medial temporal and striatal brain regions. It remains to be explored the extent to which these effects relate to individual risk for neuropsychiatric or stress-related disorders.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
A scalable battery recycling strategy to recover and regenerate solid electrolytes and cathode materials in spent all solid-state batteries, reducing energy consumption and greenhouse gases.
With the rapidly increasing ubiquity of lithium-ion batteries (LIBs), sustainable battery recycling is a matter of growing urgency. The major challenge faced in LIB sustainability lies with the fact that the current LIBs are not designed for recycling, making it difficult to engineer recycling approaches that avoid breaking batteries down into their raw materials. Thus, it is prudent to explore new approaches to both fabricate and recycle next-generation batteries before they enter the market. Here, we developed a sustainable design and scalable recycling strategy for next-generation all solid-state batteries (ASSBs). We use the EverBatt model to analyze the relative energy consumption and environmental impact compared to conventional recycling methods. We demonstrate efficient separation and recovery of spent solid electrolytes and electrodes from a lithium metal ASSB and directly regenerate them into usable formats without damaging their core chemical structure. The recycled materials are then reconstituted to fabricate new batteries, achieving similar performance as pristine ASSBs, completing the cycle. This work demonstrates the first fully recycled ASSB and provides critical design consideration for future sustainable batteries.
A perspective on the current state of battery recycling and future improved designs to promote sustainable, safe, and economically viable battery recycling strategies for sustainable energy storage.
Recent years have seen the rapid growth in lithium-ion battery (LIB) production to serve emerging markets in electric vehicles and grid storage. As large volumes of these batteries reach their end of life, the need for sustainable battery recycling and recovery of critical materials is a matter of utmost importance. Global reserves for critical LIB elements such as lithium, cobalt, and nickel will soon be outstripped by growing cumulative demands. Despite advances in conventional recycling strategies such as pyrometallurgy and hydrometallurgy, they still face limitations in high energy consumption, high greenhouse gas emissions, as well as limited profitability. While new direct recycling methods are promising, they also face obstacles such as the lack of proper battery labeling, logistical challenges of inefficient spent battery collection, and components separation. Here, we discuss the importance of recovering critical materials, and how battery designs can be improved from the cell to module level in order to facilitate recyclability. The economic and environmental implications of various recycling approaches are analyzed, along with policy suggestions to develop a dedicated battery recycling infrastructure. We also discuss promising battery recycling strategies and how these can be applied to existing and future new battery chemistries.
This paper presents a comparative study on three types of slim coil structures used as a three-dimensional (3-D) receiver in a wireless power transfer system with a planar transmitter coil. The mutual coupling values and their variations between the receiver structures and the transmitter coil are compared under different distances and angular orientations with respect to the transmitter coil. The merits of performance are related to the consistency of the mutual coupling values under different orientations in a range of distances from the transmitter coil. The practical results show that slim 3-D receiver coil structures can be compatible with a planar transmitter coil with reasonably high-mutual coupling.
The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.