We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure coreplatform@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Face masks reduce disease transmission by protecting the wearer from inhaled pathogens and reducing the emission of infectious aerosols. Although methods quantifying efficiency for wearer protection are established, current methods for assessing face mask containment efficiency rely on measurement of a low concentration of aerosols emitted from an infected or noninfected individual.
Methods:
A small port enabled the introduction of 0.05 µm sodium chloride particles at a constant rate behind the mask worn by a study participant. A condensation particle counter monitored ambient particle numbers 60 cm in front of the participant over 3-minute periods of rest, speaking, and coughing. The containment efficiency (%) for each mask and procedure was calculated as follows: 100 × (1 − average ambient concentration with face covering worn/average ambient concentration with a sham face covering in place). The protection efficiency (%) was also measured using previously published methods. The probability of transmission (%) from infected to uninfected (a function of both the containment efficiency and the protection efficiency) was calculated as follows: {1 − (containment efficiency/100)}×{1 − (protection efficiency/100)}×100.
Results:
The average containment efficiencies for each mask over all procedures and repeated measures were 94.6%, 60.9%, 38.8%, and 43.2%, respectively, for the N95 mask, the KN95 mask, the procedure face mask, and the gaiter. The corresponding protection efficiencies for each mask were 99.0%, 63.7%, 45.3%, and 24.2%, respectively. For example, the transmission probability for 1 infected and 1 uninfected individual in close proximity was ∼14.2% for KN95 masks, compared to 36%–39% when only 1 individual wore a KN95 mask.
Conclusion:
Overall, we detected a good correlation between the protection and containment that a face covering afforded to a wearer.
High-power-density tokamaks offer a potential solution to design cost-effective fusion devices. One way to achieve high power density is to operate at a high $\beta$ value (the ratio of thermal to magnetic pressure), i.e. $\beta \sim 1$. However, a $\beta \sim 1$ state may be unstable to various pressure- and current-driven instabilities or have unfavourable microstability properties. To explore these possibilities, we generate $\beta \sim 1$ equilibria and investigate their stability. First, we demonstrate the generation of high-$\beta$ equilibria with the computer code VMEC. We then analyse these equilibria to determine their stability against the infinite-$n$ ideal-ballooning mode. We follow that by engaging in a detailed microstability study using the GS2 code, beginning with assessments of electrostatic ion-temperature-gradient and trapped election mode instabilities. We observe interesting behaviour for the high-$\beta$ equilibria – stabilization of these modes through two distinct mechanisms – large negative local shear and reversal of electron precession drift. Finally, we perform electromagnetic gyrokinetic simulations and observe enhanced stability in the outer core of high-$\beta$ equilibria and absence of kinetic ballooning modes in the negative-triangularity, high-$\beta$ equilibria. The enhanced outer-core stability of high-$\beta$ equilibria is different from their lower-$\beta$ counterparts and offers an alternative, potentially favourable regime of tokamak operation.
It is unknown if the COVID-19 pandemic and public health measures had an immediate impact on stroke subtypes and etiologies in patients not infected with COVID-19. We aimed to evaluate if the proportion of non-COVID-19-related stroke subtypes (ischemic vs. hemorrhagic) and etiologies (cardioembolic, atherosclerosis, small vessel disease, and others) during the pandemic’s first wave were different from prepandemic.
Methods:
For this retrospective cohort study, we included patients without COVID-19 with ischemic or hemorrhagic stroke at two large Canadian stroke centers between March–May 2019 (prepandemic cohort) and March–May 2020 (pandemic cohort). Proportions of stroke subtypes and etiologies were compared between cohorts using chi-square tests.
Results:
The prepandemic cohort consisted of 234 stroke patients and the pandemic cohort of 207 stroke patients. There were no major differences in baseline characteristics. The proportions of ischemic versus hemorrhagic stroke were similar (ischemic stroke: 77% prepandemic vs. 75% pandemic; hemorrhagic stroke:12% prepandemic vs. 14% pandemic; p > 0.05). There were no differences in etiologies, except for a decreased proportion of ischemic stroke due to atherosclerosis in the pandemic cohort (26% prepandemic vs. 15% pandemic; difference: 10.6%, 95%CI: 1.4-19.7; p = 0.03). Notably, during the pandemic, the cause of ischemic stroke was more often unknown because of incomplete work-up (13.3% prepandemic vs. 28.2% pandemic, difference: 14.9%, 95%-CI: 5.7–24.2; p = <0.01).
Conclusions:
In this study, the pandemic had no clear effect on stroke subtypes and etiologies suggesting a limited impact of the pandemic on stroke triggers. However, the shift from atherosclerosis toward other causes warrants further exploration.
With increasing recognition of the prevalence and impact of perinatal mental health (PMH) disorders comes a responsibility to ensure that tomorrow's doctors can support families during the perinatal period. Online surveys seeking information about the inclusion of PMH education in undergraduate curricula were sent to psychiatry curriculum leads and student psychiatry societies from each university medical school in the UK between April and September 2021.
Results
Responses were received from 32/35 (91.4%) medical schools. Two-thirds reported specific inclusion of PMH content in the core curriculum, typically integrated into general adult psychiatry or obstetric teaching. Students at the remaining schools were all likely to be examined on the topic or see perinatal cases during at least one clinical attachment.
Clinical implications
PMH education offers an opportunity for collaboration between psychiatry and other disciplines. Future work looking at educational case examples with objective outcomes would be valuable.
This paper examines the experience of the Hyundai Motor Company (HMC) managing its employees in a new plant established in Chennai, India. The establishment of the Indian plant in 1998 marked an important attempt by HMC to ‘relaunch’ its globalisation strategy after an earlier failure to manufacture in Canada. The ability of HMC to adopt an appropriate employment relations strategy in India will be an important factor determining its success as a global manufacturer. A key issue facing the Hyundai Motor Company of India (HMI) is the role to be accorded to unions and employee representation in the plant.
Recent research has highlighted a tendency for more rational and deliberative decision-making in individuals with autism. We tested this hypothesis by using eye-tracking to investigate the information processing strategies that underpin multi-attribute choice in a sample of adults diagnosed with autism spectrum condition. We found that, as the number of attributes defining each option increased, autistic decision-makers were speedier, examined less of the available information, and spent a greater proportion of their time examining the option they eventually chose. Rather than indicating a more deliberative style, our results are consistent with a tendency for individuals with autism to narrow down the decision-space more quickly than does the neurotypical population.
Recent research has shown that risk and reward are positively correlated in many environments, and that people have internalized this association as a “risk-reward heuristic”: when making choices based on incomplete information, people infer probabilities from payoffs and vice-versa, and these inferences shape their decisions. We extend this work by examining people’s expectations about another fundamental trade-off — that between monetary reward and delay. In 2 experiments (total N = 670), we adapted a paradigm previously used to demonstrate the risk-reward heuristic. We presented participants with intertemporal choice tasks in which either the delayed reward or the length of the delay was obscured. Participants inferred larger rewards for longer stated delays, and longer delays for larger stated rewards; these inferences also predicted people’s willingness to take the delayed option. In exploratory analyses, we found that older participants inferred longer delays and smaller rewards than did younger ones. All of these results replicated in 2 large-scale pre-registered studies with participants from a different population (total N = 2138). Our results suggest that people expect intertemporal choice tasks to offer a trade-off between delay and reward, and differ in their expectations about this trade-off. This “delay-reward heuristic” offers a new perspective on existing models of intertemporal choice and provides new insights into unexplained and systematic individual differences in the willingness to delay gratification.
When choosing between immediate and future rewards, how do people deal with uncertainty about the value of the future outcome or the delay until its occurrence? Skylark et al. (2020) suggested that people employ a delay-reward heuristic: the inferred value of an ambiguous future reward is a function of the stated delay, and vice-versa. The present paper investigates the role of this heuristic in choice behaviour. In Studies 1a–2b, participants inferred the value of an ambiguous future reward or delay before the true value was revealed and a choice made. Preference for the future option was predicted by the discrepancy between the estimated and true values: the more pleasantly surprising the delayed option, the greater the willingness to choose it. Studies 3a–3c examined the association between inference and preference when the ambiguous values remained unknown. As predicted by the use of a delay-reward heuristic, inferred delays and rewards were positively related to stated rewards and delays, respectively. More importantly, choices were associated with inferred rewards and, in some circumstances, delays. Critically, estimates and choices were both order-dependent: when estimates preceded choices, estimates were more optimistic (people inferred smaller delays and larger rewards) and were subsequently more likely to choose the delayed option than when choices were made before estimates. These order effects argue against a simple model in which people deal with ambiguity by first estimating the unknown value and then using their estimate as the basis for decision. Rather, it seems that inferences are partly constructed from choices, and the role of inference in choice depends on whether an explicit estimate is made prior to choosing. Finally, we also find that inferences about ambiguous delays depend on whether the estimate has to be made in “days” or in a self-selected temporal unit, and replicate previous findings that older participants make more pessimistic inferences than younger ones. We discuss the implications and possible mechanisms for these findings.
Innovative shoe insoles, designed to enhance sensory information on the plantar surface of the feet, could help to improve walking in people with Multiple Sclerosis.
Objective:
To compare the effects of wearing textured versus smooth insoles, on measures of gait, foot sensation and patient-reported outcomes, in people with Multiple Sclerosis.
Methods:
A prospective, randomised controlled trial was conducted with concealed allocation, assessor blinding and intention-to-treat analysis. Thirty ambulant men and women with multiple sclerosis (MS) (Disease Steps rating 1–4) were randomly allocated to wear textured or smooth insoles for 12 weeks. Self-reported insole wear and falls diaries were completed over the intervention period. Laboratory assessments of spatiotemporal gait patterns, foot sensation and proprioception, and patient-reported outcomes, were performed at Weeks 0 (Baseline 1), 4 (Baseline 2) and 16 (Post-Intervention). The primary outcome was the size of the mediolateral base of support (stride/step width) when walking over even and uneven surfaces. Independent t-tests were performed on change from baseline (average of baseline measures) to post-intervention.
Results:
There were no differences in stride width between groups, when walking over the even or uneven surfaces (P ≥ 0.20) at post-intervention. There were no between-group differences for any secondary outcomes including gait (all P values > 0.23), foot sensory function (all P values ≥ 0.08) and patient-reported outcomes (all P values ≥ 0.23).
Conclusions:
In our small trial, prolonged wear of textured insoles did not appear to alter walking or foot sensation in people with MS who have limited foot sensory loss. Further investigation is needed to explore optimal insole design.
Clinical Trial Registration:
Australian and New Zealand Clinical Trials Registry (ACTRN12615000421538).
When one or several classes are much less prevalent than another class (unbalanced data), class error rates and variable importances of the machine learning algorithm random forest can be biased, particularly when sample sizes are smaller, imbalance levels higher, and effect sizes of important variables smaller. Using simulated data varying in size, imbalance level, number of true variables, their effect sizes, and the strength of multicollinearity between covariates, we evaluated how eight versions of random forest ranked and selected true variables out of a large number of covariates despite class imbalance. The version that calculated variable importance based on the area under the curve (AUC) was least adversely affected by class imbalance. For the same number of true variables, effect sizes, and multicollinearity between covariates, the AUC variable importance ranked true variables still highly at the lower sample sizes and higher imbalance levels at which the other seven versions no longer achieved high ranks for true variables. Conversely, using the Hellinger distance to split trees or downsampling the majority class already ranked true variables lower and more variably at the larger sample sizes and lower imbalance levels at which the other algorithms still ranked true variables highly. In variable selection, a higher proportion of true variables were identified when covariates were ranked by AUC importances and the proportion increased further when the AUC was used as the criterion in forward variable selection. In three case studies, known species–habitat relationships and their spatial scales were identified despite unbalanced data.
In a stably stratified shear layer, multiple competing instabilities produce sensitivity to small changes in initial conditions, popularly called the butterfly effect (as a flapping wing may alter the weather). Three ensembles of 15 simulated mixing events, identical but for small perturbations to the initial state, are used to explore differences in the route to turbulence, the maximum turbulence level and the total amount and efficiency of mixing accomplished by each event. Comparisons show that a small change in the initial state alters the strength and timing of the primary Kelvin–Helmholtz instability, the subharmonic pairing instability and the various three-dimensional secondary instabilities that lead to turbulence. The effect is greatest in, but not limited to, the parameter regime where pairing and the three-dimensional secondary instabilities are in strong competition. Pairing may be accelerated or prevented; maximum turbulence kinetic energy may vary by up to a factor of 4.6, flux Richardson number by 12 %–15 % and net mixing by a factor of 2.
How can force be used to pursue human security? Treatments of this issue are surprisingly rare. This chapter addresses the potentially positive uses of force to address basic human needs under the new doctrine of human security in international law. International laws, cases, and regimes addressing the constituent elements of human security are addressed in turn: personal and political security, economic, food, health, community and environmental security. The evolving structure and function of UN Peacekeeping Operations is demonstrated through cases of specific missions. Finally, the possibilities of 2001’s "Responsibility to Protect" doctrine are debated.
What is the best way to begin studying international law? This chapter jump-starts your study of international law, providing you with helpful resources on how to read cases and treaties, how to brief cases for later use, and how to read and use other documents you will encounter in this book. The end of the chapter provides a snapshot of the major theoretical approaches to international law and international relations that can shape your thinking about its usefulness, limits, and power to shape the behavior of states.
How do states create agreements with one another, and how do they ensure they are followed? The first half of this chapter details the process by which states make, maintain, and rescind treaties. We elaborate on the treaty process set forth in the Vienna Convention on the Law of Treaties, and explain different treaty types (e.g., bilateral vs. multilateral, self-executing vs. non-self-executing). Reservations—portions of a treaty a state does not wish to join—are also discussed, as well as their ramifications. The second half of the chapter establishes the centrality of diplomats to the creation and execution of much of international law, including treaties. We elaborate on diplomatic and consular functions as well as diplomatic immunity and asylum. Diplomats are noted as change agents in the international system, but the potential for abuse of that immunity is always present.
What is the relationship between the global economy and international law? In this chapter, we examine instruments that reflect the liberalism that has prevailed in international trading relations for the last half-century. The resulting instruments include the articles of the World Trade Organization, the World Intellectual Property Organization, and the Trade-Related Aspects of Intellectual Property Agreement. We also highlight anti-corruption instruments and various non-governmental organizations that also share the goals and processes of international liberalism. The middle section examines attempts to combat the various and increasingly sophisticated forms of corruption in international business transactions, especially the explosion of difficult-to-combat cyber fraud. The latter part of the chapter notes a growing trend towards economic nationalist goals, and anti-competitive behavior among state and business elites.
How does international law protect human rights? We trace the development of human rights, focusing on the international response to the atrocities of World War II and the rapid pace of human rights conventions. We demonstrate how the signing of the Universal Declaration of Human Rights started a wave of other conventions designed to codify the treatment to which every human is entitled. Not every state can achieve the wide array of protections these documents outline, but the UN has established methods for reporting violations that provide some minor satisfaction. The last half of the chapter is devoted to a discussion of regional human rights mechanisms, focusing on the European, Inter-American, and African systems and noting their jurisdictional differences. Finally, the development of mechanisms to respond to genocide, war crimes, and crimes against humanity are detailed, including the criminal tribunals set up for specific atrocities and the International Criminal Court.