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Tourette syndrome (TS) as well as its most common comorbidities are associated with a higher propensity for risky behaviour in everyday life. However, it is unclear whether this increased risk propensity in real-life contexts translates into a generally increased attitude towards risk. We aimed to assess decision-making under risk and ambiguity based on prospect theory by considering the effects of comorbidities and medication.
Methods
Fifty-four individuals with TS and 32 healthy controls performed risk and ambiguity decision-making tasks under both gains and losses conditions. Behavioural and computational parameters were evaluated using (i) univariate analysis to determine parameters difference taking independently; (ii) supervised multivariate analysis to evaluate whether our parameters could jointly account for between-group differences (iii) unsupervised multivariate analysis to explore the potential presence of sub-groups.
Results
Except for general ‘noisier’ (less consistent) decisions in TS, we showed no specific risk-taking behaviour in TS or any relation with tics severity or antipsychotic medication. However, the presence of comorbidities was associated with distortion of decision-making. Specifically, TS with obsessive–compulsive disorder comorbidity was associated with a higher risk-taking profile to increase gain and a higher risk-averse profile to decrease loss. TS with attention-deficit hyperactivity disorder comorbidity was associated with risk-seeking in the ambiguity context to reduce a potential loss.
Conclusions
Impaired valuation of risk and ambiguity was not related to TS per se. Our findings are important for clinical practice: the involvement of individuals with TS in real-life risky situations may actually rather result from other factors such as psychiatric comorbidities.
Identification of treatment-specific predictors of drug therapies for bipolar disorder (BD) is important because only about half of individuals respond to any specific medication. However, medication response in pediatric BD is variable and not well predicted by clinical characteristics.
Methods
A total of 121 youth with early course BD (acute manic/mixed episode) were prospectively recruited and randomized to 6 weeks of double-blind treatment with quetiapine (n = 71) or lithium (n = 50). Participants completed structural magnetic resonance imaging (MRI) at baseline before treatment and 1 week after treatment initiation, and brain morphometric features were extracted for each individual based on MRI scans. Positive antimanic treatment response at week 6 was defined as an over 50% reduction of Young Mania Rating Scale scores from baseline. Two-stage deep learning prediction model was established to distinguish responders and non-responders based on different feature sets.
Results
Pre-treatment morphometry and morphometric changes occurring during the first week can both independently predict treatment outcome of quetiapine and lithium with balanced accuracy over 75% (all p < 0.05). Combining brain morphometry at baseline and week 1 allows prediction with the highest balanced accuracy (quetiapine: 83.2% and lithium: 83.5%). Predictions in the quetiapine and lithium group were found to be driven by different morphometric patterns.
Conclusions
These findings demonstrate that pre-treatment morphometric measures and acute brain morphometric changes can serve as medication response predictors in pediatric BD. Brain morphometric features may provide promising biomarkers for developing biologically-informed treatment outcome prediction and patient stratification tools for BD treatment development.
A feedforward pathological signaling loop generated by TNFα and IFN-γ synergy in the inflamed lung, driving CXCL-10 (IP-10) and CXCL-9 chemokine-mediated activated T-cell and monocyte/macrophage tissue recruitment, may define the inflammatory biology of lethal COVID-19 respiratory failure.
Methods:
To assess TNFα-antagonist therapy, 18 hospitalized adults with hypoxic respiratory failure and COVID-19 pneumonia received single-dose infliximab-abda therapy 5 mg/kg intravenously between April and December 2020. The primary endpoint was time to increase in oxygen saturation to fraction of inspired oxygen ratio (SpO2/FiO2) by ≥50 compared to baseline and sustained for 48 h. Secondary endpoints included 28-day mortality, dynamic cytokine profiles, secondary infections, duration of supplemental oxygen support, and hospitalization.
Findings:
Patients were predominantly in critical respiratory failure (15/18, 83%), male (14/18, 78%), above 60 years (median 63 years, range 31–80), race-ethnic minorities (13/18, 72%), lymphopenic (13/18, 72%), steroid-treated (17/18, 94%), with a median ferritin of 1953 ng/ml. Sixteen patients (89%) met the primary endpoint within a median of 4 days; 14/18 (78%) were discharged in a median of 8 days and were alive at 28-day follow-up. Three deaths were attributed to secondary lung infection. Mean plasma IP-10 levels declined sharply from 9183 to 483 pg/ml at Day 3 and 146 pg/ml at Day 14/discharge. Significant Day 3 declines in IFN-
$\gamma $
, TNFα, IL-27, CRP, and ferritin occurred. IP-10 and CXCL-9 declines were strongly correlated among patients with lymphopenia reversal (Day 3, Pearson r: 0.98, P-value 0.0006).
Interpretation:
Infliximab-abda may rapidly abrogate pathological inflammatory signaling to facilitate clinical recovery in severe and critical COVID-19.
Brain imaging studies have shown altered amygdala activity during emotion processing in children and adolescents with oppositional defiant disorder (ODD) and conduct disorder (CD) compared to typically developing children and adolescents (TD). Here we aimed to assess whether aggression-related subtypes (reactive and proactive aggression) and callous-unemotional (CU) traits predicted variation in amygdala activity and skin conductance (SC) response during emotion processing.
Methods
We included 177 participants (n = 108 cases with disruptive behaviour and/or ODD/CD and n = 69 TD), aged 8–18 years, across nine sites in Europe, as part of the EU Aggressotype and MATRICS projects. All participants performed an emotional face-matching functional magnetic resonance imaging task.
Results
Differences between cases and TD in affective processing, as well as specificity of activation patterns for aggression subtypes and CU traits, were assessed. Simultaneous SC recordings were acquired in a subsample (n = 63). Cases compared to TDs showed higher amygdala activity in response to negative faces (fearful and angry) v. shapes. Subtyping cases according to aggression-related subtypes did not significantly influence on amygdala activity; while stratification based on CU traits was more sensitive and revealed decreased amygdala activity in the high CU group. SC responses were significantly lower in cases and negatively correlated with CU traits, reactive and proactive aggression.
Conclusions
Our results showed differences in amygdala activity and SC responses to emotional faces between cases with ODD/CD and TD, while CU traits moderate both central (amygdala) and peripheral (SC) responses. Our insights regarding subtypes and trait-specific aggression could be used for improved diagnostics and personalized treatment.
There is overlap between pathological mitral regurgitation seen in borderline rheumatic heart disease using World Heart Federation echocardiography criteria and physiologic regurgitation found in normal children. One possible contributing factor is higher rates of anaemia in endemic countries.
Objective:
To investigate the contribution of anaemia as a potential confounder in the diagnosis of rheumatic heart disease detected in echocardiographic screening.
Method/Design:
A novel Server 2012 data warehouse tool was used to incorporate haematology and echocardiography databases. The study included a convenience sample of patients from 5 to 18 years old without structural or functional heart disease that had a haemoglobin value within 1 month prior to an echocardiogram. Echocardiogram images were reviewed to determine presence or absence of World Heart Federation criteria for rheumatic heart disease. The rate of rheumatic heart disease among anaemic and non-anaemic children according to gender- and age-based norms groups was compared.
Results:
Of the 935 patients who met the study inclusion criteria, 406 were classified as anaemic. There was no difference in the rate of echocardiograms meeting criteria for borderline rheumatic heart disease in anaemic (2.0%, 95% CI 0.6–3.3%) and non-anaemic children (1.3%, 95% CI 0.3–2.3%). However, there was a statistically significant increase in rates of mitral regurgitation of unclear significance among anaemic versus non-anaemic patients (8.6 versus 3.6%; p = 0.0012).
Conclusion:
Anaemia does not increase the likelihood of meeting echocardiographic criteria for borderline rheumatic heart disease. Future studies should evaluate for the correlation between anaemia and mitral regurgitation in endemic settings.
Direct numerical simulations (DNS) of the flow in various rotating annular confinements have been conducted to investigate the effects of wall inclination on secondary fluid motions due to an unstable boundary layer. The inner wall resembles a truncated cone (frustum) whose apex half-angle is varied from $18^{\circ }$ to $0^{\circ }$ (straight cylinder). The large inner radius $r_{1}$, the mean rotation rate $\unicode[STIX]{x1D6FA}_{0}$ and the kinematic viscosity $\unicode[STIX]{x1D708}$ were kept constant resulting in the constant Ekman number $E=\unicode[STIX]{x1D708}/(\unicode[STIX]{x1D6FA}_{0}r_{1}^{2})=4\times 10^{-5}$. Flows were excited by time-harmonic modulation of the inner wall’s rotation rate (so-called longitudinal libration) by prescribing the amplitude $\unicode[STIX]{x1D700}\unicode[STIX]{x1D6FA}_{0}$ and the forcing frequency $\unicode[STIX]{x1D714}=\unicode[STIX]{x1D6FA}_{0}$. By steepening the inner wall and hence reducing the effect of the local Coriolis force in the boundary layer three different flow regimes can be realized: a rotation-dominated, a libration-dominated and an intermediate regime. In the present study we focus on the libration-dominated regime. For small libration amplitudes (here $\unicode[STIX]{x1D700}=0.2$), a laminar Ekman–Stokes boundary layer (ESBL) is realized at the librating wall. With the aid of laminar boundary layer theory and DNS we show that the ESBL exhibits an oscillatory mass flux along the librating wall (Ekman property) and an oscillatory azimuthal velocity, which resembles a radially damped wave (Stokes property). For large libration amplitudes (here $\unicode[STIX]{x1D700}=0.8$), the DNS results exhibit an intermittently unstable ESBL, which turns centrifugally unstable during the prograde (faster) part of a libration period. This instability is due to the Stokes property and gives rise to Görtler vortices, which are found to be tilted with respect to the azimuth when the librating wall is at a finite angle relative to the axis of rotation. We show that this tilt is related to the Ekman property of the ESBL. This suggests that linear and nonlinear dynamics are equally important for this intermittent instability. Our DNS results indicate further that the Görtler vortices propagate into the fluid bulk where they generate an azimuthal mean flow. This mean flow is notably different from the mean flow driven in the case of the stable ESBL. A diagnostic analysis of the Reynolds-averaged Navier–Stokes (RANS) equations in the unstable flow regime hints at a competition between the radial and axial turbulent transport terms which act as generating and destructing agents for the azimuthal mean flow, respectively. We show that the balance of both terms depends on the wall inclination, that is, on the wall-tangential component of the Coriolis force.
Recent proposals suggest early adversity sets in motion particularly chronic and neurobiologically distinct trajectories of internalizing symptoms. However, few prospective studies in high-risk samples delineate distinct trajectories of internalizing symptoms from preschool age onward. We examined trajectories in a high-risk cohort, oversampled for internalizing symptoms, several preschool risk/maintenance factors, and school-age outcomes. Parents of 325 children completed the Strengths and Difficulties Questionnaire on up to four waves of data collection from preschool (3–5 years) to school age (8–9 years) and Preschool Age Psychiatric Assessment interviews at both ages. Multi-informant data were collected on risk factors and symptoms. Growth mixture modelling identified four trajectory classes of internalizing symptoms with stable low, rising low-to-moderate, stable moderate, and stable high symptoms. Children in the stable high symptom trajectory manifested clinically relevant internalizing symptoms, mainly diagnosed with anxiety disorders/depression at preschool and school age. Trajectories differed regarding loss/separation experience, maltreatment, maternal psychopathology, temperament, and stress-hormone regulation with loss/separation, temperament, maternal psychopathology, and stress-hormone regulation (trend) significantly contributing to explained variance. At school age, trajectories continued to differ on symptoms, disorders, and impairment. Our study is among the first to show that severe early adversity may trigger a chronic and neurobiologically distinct internalizing trajectory from preschool age onward.
This chapter covers network-level solutions aiming at enhancing end-user experience and bringing down the Operational Expenditures (OPEX) of the 5G deployments.
After analyzing contemporary trends and predictions for 5G, it becomes evident that there are certain aspects of 5G deployments that have to be taken into consideration when designing future network-level solutions. These aspects are predominantly related to the network densification and increasing heterogeneity. While network densification will result in much smaller distances between the Base Stations (BSs) [1], the heterogeneity of 5G will manifest itself in multiple dimensions e.g. cell types or operating frequency. [2]. This complicated heterogeneous environment, apart from dimensioning and planning problems, brings also opportunities for an efficient mapping of users or services to optimal (from the overall system perspective) access technologies or BS types. Aspects related to efficient signaling exchange in this heterogeneous environment (also in scenarios with control/user plane decoupling) are related to a Lean System Control Plane design (cf. Chapter 2).
Based on the previously mentioned factors, it can be easily inferred that one of the most desired 5G features is broadly understood flexibility. The flexibility can be achieved in different ways, starting from a flexible allocation of radio resources in Time Division Duplexing (TDD) mode according to instantaneous traffic conditions, through an efficient exploitation of different Radio Access Technologies (RATs) or network layers, and finally as a freedom to dynamically reconfigure the network using BSs that are automatically configured and self-backhauled. Besides, the kind and extent of Moving Networks (MNs) expected to be introduced in 5G can be perceived as a dynamic reconfiguration enabler and an important part of the Dynamic Radio Access Network (RAN) described in Chapter 2.
The performance of the 5G system can be further enhanced by exploiting context information understood as “(…) any information that can be used to characterize the situation of an entity. An entity is a person, place, or object that is considered relevant to the interaction between a user and an application, including the user and application themselves” [3]. Today, there are already many application domains and envisioned use cases where devices (such as sensors) or services (such as cloud services) communicate for unconscious support of people in their everyday life tasks.
Different front-of-pack (FOP) labelling systems have been developed in Europe by industry and organisations concerned with health promotion. A study (n 2068) was performed to establish the extent to which inclusion of the most prevalent FOP systems – guideline daily amounts (GDA), traffic lights (TL), GDA+TL hybrid (HYB) and health logos (HL) – impact consumer perceptions of healthiness over and above the provision of a FOP basic label (BL) containing numerical nutritional information alone. The design included within- and between-subjects factors. The within-subjects factors were: food (pizzas, yogurts and biscuits), healthiness of the food (high health, medium health and low health) and the repeated measurements under BL and test FOP label conditions. The between-subjects factors were: the system (GDA, TL, GDA+TL hybrid, HL), portion size (typical portion size and a 50 % reduction of a typical portion) and country (the UK, Germany, Poland and Turkey). Although the FOP systems tested did result in small improvements for objective understanding under some conditions, there was little difference between the provision of an FOP label containing basic numerical nutritional information alone or between the various systems. Thus, any structured and legible presentation of key nutrient and energy information on the FOP label is sufficient to enable consumers to detect a healthier alternative within a food category when provided with foods that have distinctly different levels of healthiness. Future research should focus on developing greater understanding of the psychological and contextual factors that impact motivation and the opportunity to use the various FOP systems in real-world shopping settings.
The mechanism of localized inertial wave excitation and its efficiency is investigated for an annular cavity rotating with $\def \xmlpi #1{}\def \mathsfbi #1{\boldsymbol {\mathsf {#1}}}\let \le =\leqslant \let \leq =\leqslant \let \ge =\geqslant \let \geq =\geqslant \def \Pr {\mathit {Pr}}\def \Fr {\mathit {Fr}}\def \Rey {\mathit {Re}}\Omega _0$. Meridional symmetry is broken by replacing the inner cylinder with a truncated cone (frustum). Waves are excited by individual longitudinal libration of the walls. The geometry is non-separable and exhibits wave focusing and wave attractors. We investigated laboratory and numerical results for the Ekman number $E\approx 10^{-6}$, inclination $\alpha =5.71^\circ $ and libration amplitudes $\varepsilon \leq 0.2$ within the inertial wave band $0 < \omega < 2\Omega _0$. Under the assumption that the inertial waves do not essentially affect the boundary-layer structure, we use classical boundary-layer analysis to study oscillating Ekman layers over a librating wall that is at an angle $\alpha \neq 0$ to the axis of rotation. The Ekman layer erupts at frequency $\omega =f_{*}$, where $f_{*}\equiv 2 \Omega _0 \sin \alpha $ is the effective Coriolis parameter in a plane tangential to the wall. For the selected inclination this eruption occurs for the forcing frequency $\omega /\Omega _0=0.2$. For the librating lids eruption occurs at $\omega /\Omega _0=2$. The study reveals that the frequency dependence of the total kinetic energy $K_{\omega }$ of the excited wave field is strongly connected to the square of the Ekman pumping velocity $w_{{E}}(\omega )$ that, in the linear limit, becomes singular when the boundary layer erupts. This explains the frequency dependence of non-resonantly excited waves. By the localization of the forcing, the two configurations investigated, (i) frustum libration and (ii) lids together with outer cylinder in libration, can be clearly distinguished by their response spectra. Good agreement was found for the spatial structure of low-order wave attractors and periodic orbits (both characterized by a small number of reflections) in the frequency windows predicted by geometric ray tracing. For ‘resonant’ frequencies a significantly increased total bulk energy was found, while the energy in the boundary layer remained nearly constant. Inertial wave energy enters the bulk flow via corner beams, which are parallel to the characteristics of the underlying Poincaré problem. Numerical simulations revealed a mismatch between the wall-parallel mass fluxes near the corners. This leads to boundary-layer eruption and the generation of inertial waves in the corners.
Nutrition information aims to reduce information asymmetries between manufacturers and consumers. To date, however, it remains unclear how nutrition information that is shown on the front of the packaging should be designed in order to increase both visual attention and the tendency to make healthful food choices. The present study aimed to address this gap in research.
Design
An experimental laboratory study applying mobile eye-tracking technology manipulated the presence of two directive cues, i.e. health marks and traffic light colour-coding, as part of front-of-package nutrition information on actual food packages.
Setting
Participants wore mobile eye-tracking glasses during a simulated shopping trip. After the ostensible study had finished, they chose one snack (from an assortment of fifteen snacks) as a thank you for participation. All products were labelled with nutrition information according to the experimental condition.
Subjects
Consumers (n 160) who were mainly responsible for grocery shopping in their household participated in the study.
Results
The results showed that, in the absence of traffic light colouring, health marks reduced attention to the snack food packaging. This effect did not occur when the colouring was present. The combination of the two directive cues (v. presenting traffic light colours only) made consumers choose more healthful snacks, according to the nutrient profile.
Conclusions
Public policy makers may recommend retailers and manufacturers implement consistent front-of-pack nutrition labelling that contains both health marks and traffic light colouring as directive cues. The combination of the cues may increase the likelihood of healthful decision making.
We have studied Cu2S absorber layers prepared by physical vapor deposition (PVD) by calibrated spectral photoluminescence (PL) and by confocal PL as function of temperature T and excitation fluxes to obtain the absolute PL-yield at an excitation flux equivalent to the AM1.5 spectrum and to calculate the splitting of the quasi-Fermi levels (QFL) µ = Ef,n-Ef,p and the absorption coefficient α(E), both in the temperature range 20 K ≤ T ≤ 400 K. The PL-spectra reveal two peaks at E1 = 1.17 eV and E2 = 1.3 eV, of which the low energy peak is only detectable at temperatures T < 200 K. The samples show an impressive QFL-splitting of µ > 700 meV at 300 K associated with a pseudo band gap of Eg = 1.25 eV. The high energy peak shows an unexpected temperature behavior, namely an increase of the PL-yield with rising temperature at variance with the behavior of QFL-splitting that decreases with rising T from extrapolated T = 0K value of µ = 1.3 eV. The PL-yield versus temperature will be discussed in terms of different defect states in the band gap. Our observations indicate that, contrary to common believe, it is not the PL-yield, but rather the QFL-splitting that is the comprehensive indicator of the quality of the excited state in an illuminated semiconductor. A further examination of the lateral variation of the opto-electronic properties by confocal PL shows a strong correlation between the QFL-splitting, the Urbach energy EU and the optical band gap Eopt, respectively.
Objective: The incidence of preterm delivery has been increasing, and our aim was to estimate the influence of fetal sex on the risk of preterm delivery in dichorionic twins after spontaneous conception. Methods: 125 spontaneously conceived dichorionic twin gestations, with viable fetuses, born after 24 weeks and delivered spontaneously before 37 weeks, were enrolled. The impact of fetal sex, previous preterm delivery, maternal age, body-mass-index, smoking, and parity on gestational age at birth were evaluated. Results: Despite similar baseline characteristics in all three groups, women with one or two male fetuses delivered significantly more often before 34 weeks than patients with two female fetuses, 48% (23/48) and 43% (19/44) vs 21% (7/33), p = .04. Regression analyses, including fetal sex, maternal age, maternal body-mass-index, smoking, previous preterm delivery and parity, revealed that only fetal sex was significantly associated with spontaneous preterm delivery (p = .03). Conclusion: Fetal sex appears to be a risk factor for preterm delivery in spontaneously conceived dichorionic twin gestations. Twin pregnancies with one or two male fetuses seem to be at higher risk for spontaneous preterm delivery than those with only females.
The objective of our study was to evaluate the correlation of the cervical length at 20–25 weeks of gestation with the incidence of spontaneous preterm delivery in twins in a country with a high incidence of preterm delivery compared to other European countries. Cervical length was measured in 262 consecutive patients. Previous preterm delivery before 34 weeks of gestation, chorionicity, maternal age, body-mass-index, smoking habit and parity were recorded as risk factors for preterm delivery. Women who were symptomatic at 20–25 weeks and who delivered because of other reasons than spontaneous labour and preterm rupture of membranes or at term were excluded. The primary outcome was incidence of preterm birth before 34 weeks. Two hundred and twenty-three patients were analyzed. Thirty-two (14%) delivered before 34 weeks. There was a significant correlation between cervical length of less than 25 mm and spontaneous delivery before 34 weeks (50% vs. 13%, p = .007). In addition, logistic regression analysis found cervical length to be the only significant predictor of spontaneous delivery before 34 weeks (OR 1.084; 95% CI 1.015; 1.159; p = .017). We conclude that the risk of severe preterm delivery in twins is high. Cervical length at mid-gestation was the only predictor of delivery before 34 weeks.
The evolution of galaxies is greatly influenced by their interactions. As part of a program to study interacting galaxies, we have measured and modeled the spectral energy distributions (SEDs) from the ultraviolet (UV) to the far-infrared (FIR). We describe the constraints imposed on star formation histories by these SEDs, and the variations therein seen across the interaction sequence, and we compare the results of different star formation rate prescriptions applied to the data. The sample itself is based on the Spitzer Interacting Galaxy Survey (SIGS) of 111 galaxies in 50 systems, a project designed to probe a range of galaxy interaction parameters in the infrared. Our SEDs combine the Spitzer results with multiwavelength data from other missions, in particular GALEX and Herschel. The subset presented here is the sample for which FIR Herschel observations are currently publicly available.