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The US government invests substantial sums to control the HIV/AIDS epidemic. To monitor progress toward epidemic control, PEPFAR, or the President’s Emergency Plan for AIDS Relief, oversees a data reporting system that includes standard indicators, reporting formats, information systems, and data warehouses. These data, reported quarterly, inform understanding of the global epidemic, resource allocation, and identification of trouble spots. PEPFAR has developed tools to assess the quality of data reported. These tools made important contributions but are limited in the methods used to identify anomalous data points. The most advanced consider univariate probability distributions, whereas correlations between indicators suggest a multivariate approach is better suited. For temporal analysis, the same tool compares values to the averages of preceding periods, though does not consider underlying trends and seasonal factors. To that end, we apply two methods to identify anomalous data points among routinely collected facility-level HIV/AIDS data. One approach is Recommender Systems, an unsupervised machine learning method that captures relationships between users and items. We apply the approach in a novel way by predicting reported values, comparing predicted to reported values, and identifying the greatest deviations. For a temporal perspective, we apply time series models that are flexible to include trend and seasonality. Results of these methods were validated against manual review (95% agreement on non-anomalies, 56% agreement on anomalies for recommender systems; 96% agreement on non-anomalies, 91% agreement on anomalies for time series). This tool will apply greater methodological sophistication to monitoring data quality in an accelerated and standardized manner.
The proposal by Clarke and Beck offers a new explanation for the association between the approximate number system (ANS) and math. Previous explanations have largely relied on developmental arguments, an underspecified notion of the ANS as an “error detection mechanism,” or affective factors. The proposal that the ANS represents rational numbers suggests that it may directly support a broader range of math skills.
As the US faced its lowest levels of reported trust in government, the COVID-19 crisis revealed the essential service that various federal agencies provide as sources of information. This Element explores variations in trust across various levels of government and government agencies based on a nationally-representative survey conducted in March of 2020. First, it examines trust in agencies including the Department of Health and Human Services, state health departments, and local health care providers. This includes variation across key characteristics including party identification, age, and race. Second, the Element explores the evolution of trust in health-related organizations throughout 2020 as the pandemic continued. The Element concludes with a discussion of the implications for agency-specific assessments of trust and their importance as we address historically low levels of trust in government. This title is also available as Open Access on Cambridge Core.
The Variables and Slow Transients Survey (VAST) on the Australian Square Kilometre Array Pathfinder (ASKAP) is designed to detect highly variable and transient radio sources on timescales from 5 s to
$\sim\!5$
yr. In this paper, we present the survey description, observation strategy and initial results from the VAST Phase I Pilot Survey. This pilot survey consists of
$\sim\!162$
h of observations conducted at a central frequency of 888 MHz between 2019 August and 2020 August, with a typical rms sensitivity of
$0.24\ \mathrm{mJy\ beam}^{-1}$
and angular resolution of
$12-20$
arcseconds. There are 113 fields, each of which was observed for 12 min integration time, with between 5 and 13 repeats, with cadences between 1 day and 8 months. The total area of the pilot survey footprint is 5 131 square degrees, covering six distinct regions of the sky. An initial search of two of these regions, totalling 1 646 square degrees, revealed 28 highly variable and/or transient sources. Seven of these are known pulsars, including the millisecond pulsar J2039–5617. Another seven are stars, four of which have no previously reported radio detection (SCR J0533–4257, LEHPM 2-783, UCAC3 89–412162 and 2MASS J22414436–6119311). Of the remaining 14 sources, two are active galactic nuclei, six are associated with galaxies and the other six have no multi-wavelength counterparts and are yet to be identified.
The motion of a rigid sphere in ambient simple shear flow of a Newtonian fluid between infinite parallel walls is calculated via the lattice Boltzmann method for various particle Reynolds numbers, ${\textit {Re}}_p=Ga^2/\nu$, where $G$ is the velocity gradient of the shear; $a$ is the particle radius; and $\nu$ is the kinematic viscosity of the fluid. For a neutrally buoyant sphere, there exists a critical ${\textit {Re}}_p$ below which the hydrodynamic lift force has a single zero crossing, driving the particle to an equilibrium position at the centre of the channel. Above the critical ${\textit {Re}}_p$, the equilibrium position of the sphere undergoes a supercritical pitchfork bifurcation; inertial lift creates three equilibrium positions: an unstable equilibrium position at the centre and two stable equilibria equidistant from the centre. The critical ${\textit {Re}}_p$ occurs below the transition to unsteady flow, and increases with increasing particle confinement ratio, $\kappa =a/H$, where $H$ is the channel height. The equilibrium position of a non-neutrally buoyant sphere shifts toward a confining wall of the channel, in a manner that is dependent on the orientation, i.e. horizontal or vertical, of the channel. In both channel alignments, the gravitational force breaks the symmetry of the particle dynamics about the centreline of the channel, resulting in an imperfect bifurcation above a critical ${\textit {Re}}_p$. However, a sufficiently strong gravitational force will break the bifurcation and produce a single off-centre equilibrium position. We finally consider a neutrally buoyant sphere under the cessation or reversal of shear flow.
The INSYTE study provides an understanding of the management of Parkinson disease psychosis (PDP) in actual practice settings, including use of antipsychotic (APs) and their impact on clinical, economic, and humanistic outcomes. Treatment paradigms or the benefits/consequences of various “real world” PDP treatment strategies have not been evaluated. Thus, providers may be using a wide range of AP treatment strategies that contrast with consensus recommendations.
Method:
The INSYTE study is enrolling up to 750 patients from up to 100 sites in the US. Data are compiled at the baseline (BL) visit and from standard-of-care follow up visits over 3 years. PDP treatment pathways are defined from 3 BL cohorts reflecting (1) no AP medication, (2) use of pimavanserin (PIM), or (3) other AP treatment. Information about APs used is collected at each follow-up visit: history, duration, dose, adjustment, and rationale for adjustment of treatment. Outcomes assessments (clinical, quality of life, disease burden) by the physician, patient, and caregiver are also collected. AP medication and outcomes data are analyzed for patients completing a BL and 1 follow up visit (FU1).
Results:
For 404 patients with BL and FU1 visits (mean 120.7 days from BL), 56.8% used no AP medications, 26.0% used PIM, and 13.6% used other APs at BL. The No Medication group was noted to be less severe in key BL disease parameters. Considering primary PDP treatments at BL and FU1 (including no treatment), 26 distinct pathways were being employed. 12.6% of patients had AP medication adjustments between BL and FU1 visits, most frequently from the non-PIM group. Adjustments of APs occurred in many forms: introduction of a single AP (64.7%%), introduction of multiple APs (5.9%), switching to another AP (3.9%), decreasing the number of APs (5.9%), and discontinuation (19.6%).
Conclusions:
Multiple, divergent AP treatment strategies for PDP exist in actual practice. No identifiable BL characteristics correlated with the broad range of AP treatment pathways. The numerous distinct AP treatment pathways utilized (n=26) reflect discordance with the updated 2019 MDS evidence-based recommendations, which recognize only 2 APs as “efficacious” and “clinically useful”: pimavanserin and clozapine. Education of healthcare professionals remains a priority for PDP management.
UK Biobank is a well-characterised cohort of over 500 000 participants including genetics, environmental data and imaging. An online mental health questionnaire was designed for UK Biobank participants to expand its potential.
Aims
Describe the development, implementation and results of this questionnaire.
Method
An expert working group designed the questionnaire, using established measures where possible, and consulting a patient group. Operational criteria were agreed for defining likely disorder and risk states, including lifetime depression, mania/hypomania, generalised anxiety disorder, unusual experiences and self-harm, and current post-traumatic stress and hazardous/harmful alcohol use.
Results
A total of 157 366 completed online questionnaires were available by August 2017. Participants were aged 45–82 (53% were ≥65 years) and 57% women. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status. Lifetime depression was a common finding, with 24% (37 434) of participants meeting criteria and current hazardous/harmful alcohol use criteria were met by 21% (32 602), whereas other criteria were met by less than 8% of the participants. There was extensive comorbidity among the syndromes. Mental disorders were associated with a high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
Conclusions
The UK Biobank questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed because of selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
Borsboom et al. confuse biological approaches with extreme biological reductionism and common-cause models of psychopathology. In muddling these concepts, they mistakenly throw the baby out with the bathwater. Here, we highlight recent work underscoring the unique value of clinical and translational neuroscience approaches for understanding the nature and origins of psychopathology and for developing improved intervention strategies.