To send 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 sending content to .
To send content items to your Kindle, first ensure email@example.com
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 sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent 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.
This study aimed to develop, validate and compare the performance of models predicting post-treatment outcomes for depressed adults based on pre-treatment data.
Individual patient data from all six eligible randomised controlled trials were used to develop (k = 3, n = 1722) and test (k = 3, n = 918) nine models. Predictors included depressive and anxiety symptoms, social support, life events and alcohol use. Weighted sum scores were developed using coefficient weights derived from network centrality statistics (models 1–3) and factor loadings from a confirmatory factor analysis (model 4). Unweighted sum score models were tested using elastic net regularised (ENR) and ordinary least squares (OLS) regression (models 5 and 6). Individual items were then included in ENR and OLS (models 7 and 8). All models were compared to one another and to a null model (mean post-baseline Beck Depression Inventory Second Edition (BDI-II) score in the training data: model 9). Primary outcome: BDI-II scores at 3–4 months.
Models 1–7 all outperformed the null model and model 8. Model performance was very similar across models 1–6, meaning that differential weights applied to the baseline sum scores had little impact.
Any of the modelling techniques (models 1–7) could be used to inform prognostic predictions for depressed adults with differences in the proportions of patients reaching remission based on the predicted severity of depressive symptoms post-treatment. However, the majority of variance in prognosis remained unexplained. It may be necessary to include a broader range of biopsychosocial variables to better adjudicate between competing models, and to derive models with greater clinical utility for treatment-seeking adults with depression.
While taxonomy segregates anxiety symptoms into diagnoses, patients typically present with multiple diagnoses; this poses major challenges, particularly for youth, where mixed presentation is particularly common. Anxiety comorbidity could reflect multivariate, cross-domain interactions insufficiently emphasized in current taxonomy. We utilize network analytic approaches that model these interactions by characterizing pediatric anxiety as involving distinct, inter-connected, symptom domains. Quantifying this network structure could inform views of pediatric anxiety that shape clinical practice and research.
Participants were 4964 youths (ages 5–17 years) from seven international sites. Participants completed standard symptom inventory assessing severity along distinct domains that follow pediatric anxiety diagnostic categories. We first applied network analytic tools to quantify the anxiety domain network structure. We then examined whether variation in the network structure related to age (3-year longitudinal assessments) and sex, key moderators of pediatric anxiety expression.
The anxiety network featured a highly inter-connected structure; all domains correlated positively but to varying degrees. Anxiety patients and healthy youth differed in severity but demonstrated a comparable network structure. We noted specific sex differences in the network structure; longitudinal data indicated additional structural changes during childhood. Generalized-anxiety and panic symptoms consistently emerged as central domains.
Pediatric anxiety manifests along multiple, inter-connected symptom domains. By quantifying cross-domain associations and related moderation effects, the current study might shape views on the diagnosis, treatment, and study of pediatric anxiety.
We perform a static analysis of a circular cylinder that forms a barrier between surfactant-laden and surfactant-free portions of a liquid–gas interface. In addition to determining the general implications of the balances for forces and torques, we quantify how the imbalance
between the uniform surface tension
of the surfactant-free portion of the interface and the uniform surface tension
of the surfactant-laden portion of the interface influences the load-bearing capacity of a hydrophobic cylinder. Moreover, we demonstrate that the difference between surface tensions on either side of a cylinder with a cross-section of arbitrary shape induces a horizontal force component
in magnitude, when measured per unit length of the cylinder. With an energetic argument, we show that this relation also applies to a rod-like barrier with cross-sections of variable shape. In addition, we apply our analysis to amphiphilic Janus cylinders and we discuss practical implications of our findings for Marangoni propulsion and surface pressure measurements.
As a pilot study to investigate whether personalized medicine approaches could have value for the reduction of malaria-related mortality in young children, we evaluated questionnaire and biomarker data collected from the Mother Offspring Malaria Study Project birth cohort (Muheza, Tanzania, 2002–2006) at the time of delivery as potential prognostic markers for pediatric severe malarial anemia. Severe malarial anemia, defined here as a Plasmodium falciparum infection accompanied by hemoglobin levels below 50 g/L, is a key manifestation of life-threatening malaria in high transmission regions. For this study sample, a prediction model incorporating cord blood levels of interleukin-1β provided the strongest discrimination of severe malarial anemia risk with a C-index of 0.77 (95% CI 0.70–0.84), whereas a pragmatic model based on sex, gravidity, transmission season at delivery, and bed net possession yielded a more modest C-index of 0.63 (95% CI 0.54–0.71). Although additional studies, ideally incorporating larger sample sizes and higher event per predictor ratios, are needed to externally validate these prediction models, the findings provide proof of concept that risk score-based screening programs could be developed to avert severe malaria cases in early childhood.
Neighboring tidewater glaciers often exhibit asynchronous dynamic behavior, despite relatively uniform regional atmospheric and oceanic forcings. This variability may be controlled by a combination of local factors, including glacier and fjord geometry, fjord heat content and circulation, and glacier surface melt. In order to characterize and understand contrasts in adjacent tidewater glacier and fjord dynamics, we made coincident ice-ocean-atmosphere observations at high temporal resolution (minutes to weeks) within a 10 000 km2 area near Uummannaq, Greenland. Water column velocity, temperature and salinity measurements reveal systematic differences in neighboring fjords that imply contrasting circulation patterns. The observed ocean velocity and hydrography, combined with numerical modeling, suggest that subglacial discharge plays a major role in setting fjord conditions. In addition, satellite remote sensing of seasonal ice flow speed and terminus position reveal both speedup and slow-down in response to melt, as well as differences in calving style among the neighboring glaciers. Glacier force budgets and modeling also point toward subglacial discharge as a key factor in glacier behavior. For the studied region, individual glacier and fjord geometry modulate subglacial discharge, which leads to contrasts in both fjord and glacier dynamics.
A prototype expanded-beam spectroscopic ellipsometer has been developed that uses uncollimated (non-parallel, diffuse) illumination with a detection system consisting of an angle-of-incidence-sensitive pinhole camera for high-speed, large-area imaging/mapping applications. The performance of this novel instrument is being tested for imaging/mapping of mixed-phase hydrogenated silicon films having graded amorphous (a-Si:H) and nanocrystalline (nc-Si:H) components throughout the film depth. The speed of the measurement system makes the instrument suitable for use on production lines. The precision enables detection of subnanometer thicknesses, and refractive index and extinction coefficient changes of 0.01. Angle-of-incidence and mirror calibrations are made via well-known sample structures. Alternative commercial instrumentation for mapping by spectroscopic ellipsometry must translate the sample or ellipsometer in two dimensions. For this instrumentation, even a 15 × 15 cm2 sample with cm2 resolution requires > 200 measurements and at least 15 min. By imaging along one dimension in parallel, the expanded-beam system can measure with similar resolution in < 2 min. The focus of recent instrumentation efforts is on improving the overall system spectral range and its performance.
Creating optical quality thin films with a high refractive index is increasingly important for waveguide sensor applications. In this study, we present optical models to measure the layer thickness, vertical and lateral homogeneity, the refractive index and the extinction coefficients of the polymer films with nanocrystal inclusions using spectroscopic ellipsometry. The optical properties can be determined in a broad wavelength range from 190 to 1700 nm. The sensitivity of spectroscopic ellipsometry allows a detailed characterization of the nanostructure of the layer, i.e. the surface roughness down to the nm scale, the interface properties, the optical density profile within the layer, and any other optical parameters that can be modeled in a proper and consistent way. In case of larger than about 50 nm particles even the particle size can be determined from the onset of depolarization due to light scattering. Besides the refractive index, the extinction coefficient, being a critical parameter for waveguiding layers, was also determined in a broad wavelength range. Using the above information from the ellipsometric models the preparation conditions can be identified. A range of samples were investigated including doctor bladed films using TiO2 nanoparticles.
Clinical manifestations of lactase (LCT) deficiency include intestinal and extra-intestinal symptoms. Lactose hydrogen breath test (H2-BT) is considered the gold standard to evaluate LCT deficiency (LD). Recently, the single-nucleotide polymorphism C/T− 13 910 has been associated with LD. The objectives of the present study were to evaluate the agreement between genetic testing of LCT C/T− 13 910 and lactose H2-BT, and the diagnostic value of extended symptom assessment. Of the 201 patients included in the study, 194 (139 females; mean age 38, range 17–79 years, and 55 males, mean age 38, range 18–68 years) patients with clinical suspicion of LD underwent a 3–4 h H2-BT and genetic testing for LCT C/T− 13 910. Patients rated five intestinal and four extra-intestinal symptoms during the H2-BT and then at home for the following 48 h. Declaring H2-BT as the gold standard, the CC− 13 910 genotype had a sensitivity of 97 % and a specificity of 95 % with a κ of 0·9 in diagnosing LCT deficiency. Patients with LD had more intense intestinal symptoms 4 h following the lactose challenge included in the H2-BT. We found no difference in the intensity of extra-intestinal symptoms between patients with and without LD. Symptom assessment yielded differences for intestinal symptoms abdominal pain, bloating, borborygmi and diarrhoea between 120 min and 4 h after oral lactose challenge. Extra-intestinal symptoms (dizziness, headache and myalgia) and extension of symptom assessment up to 48 h did not consistently show different results. In conclusion, genetic testing has an excellent agreement with the standard lactose H2-BT, and it may replace breath testing for the diagnosis of LD. Extended symptom scores and assessment of extra-intestinal symptoms have limited diagnostic value in the evaluation of LD.
Using a simpler formalism than in the original paper on this subject, we verify the earlier result that, for a pump frequency separation Δ approximately equal to twice the ion acoustic frequency Ω, the use of two long-wavelength pumps can reduce the threshold for parametric excitation of ion-acoustic waves when, and only when, the Langmuir wave damping rate γ is much larger than Ω. The threshold is then reduced by a factor of order Ω/Ω, the optimum value of t being ▵ 2Ω –Γ for equal pump amplitudes, where Γ is the ion-acoustic wave damping rate and Γ ≪ Ω. The analysis presented in a recent paper is shown to be valid only for γ ≪ Ω, where the threshold reduction is quite small, vanishing in the limit of weak ion-acoustic wave damping (Te/Ti≫ 1).
A theory of the amplitude modulation of plasma waves is developed by applying the Karpman-Krushkal theory of quasi-monochromatic wave propagation analysis of the nonlinear wave-particle resonant effect leads to the modified nonlinear Schrüdinger equation with a non-local nonlinear term, which has been independently derived by Ichikawa & Taniuti on the basis of a reductive perturbation approach. The effect of the non-local nonlinear term is described explicity by investigating the modulation instability of an ion plasma wave.
Patients exhibiting considerable blood loss are prone to develop dilutional coagulopathy following volume supply. In such patients, in addition to transfusing stored blood components, cell saver systems are used to minimize allogeneic transfusion. Since red cell transfusion might influence the haemostatic system by further dilution, we investigated the effects of re-transfusion of salvaged washed red blood cells on the haemostatic process in an animal model of controlled haemorrhage using rotational thrombelastometry (ROTEM®; Pentapharm Co., Munich, Germany).
Anaesthetized pigs (n = 20) developed coagulopathy following haemorrhagic shock (withdrawal of 66% of estimated blood volume) and volume resuscitation with 6% hydroxyethyl starch 130/0.4. The shed blood was processed in a Cellsaver device (CATS ®; Fresenius AG, Bad Homburg, Germany), and the resulting salvaged red blood cells were re-transfused. ROTEM assays were performed at baseline, after blood loss, after volume resuscitation and following re-transfusion of salvaged red blood cells.
As compared with baseline, blood loss and subsequent volume resuscitation resulted in significantly increased median values of clotting time (CT: 47.0, 5 .3 and 103.5 s), and clot formation time (CFT: 36.0, 40.0 and 186.0 s), whigggle maximum clot firmness decreased (MCF: 72.0, 68.5 and 39.5 mm). After re-transfusion of salvaged red blood cells (805 ± 175 mL) all these parameters improved (CT: 80.5 s; P = 0.05, CFT: 144.0 s; P = 0.0008, MCF: 42.0 mm; P = 0.0019) although baseline values were not reached.
In the case of extreme isovolaemic haemodilution, increasing the circulating red cell mass by re-transfusing salvaged red blood cells did not worsen the findings of dilutional coagulopathy but interestingly, at least partially, improves the clot formation process.
To examine the effects of early emotional neglect on children's
affective development, we assessed children who had experienced
institutionalized care prior to adoption into family environments. One
task required children to identify photographs of facial expressions of
emotion. A second task required children to match facial expressions to
an emotional situation. Internationally adopted, postinstitutionalized
children had difficulty identifying facial expressions of emotion. In
addition, postinstitutionalized children had significant difficulty
matching appropriate facial expressions to happy, sad, and fearful
scenarios. However, postinstitutionalized children performed as well as
comparison children when asked to identify and match angry facial
expressions. These results are discussed in terms of the importance of
emotional input early in life on later developmental organization.The authors thank Paul Ekman and Linda Camras
for making their facial expression stimuli available to us. Dirk
Wilker, Ziggy Bialzik, and Craig Rypstat provided invaluable assistance
with computer programming and the computerized implementation of the
tasks reported in this article. We also appreciate the assistance of
Gabrielle Sowle, Marna Brown, Justin Martin, Susan Perlman, Kristi
Johnson, Anne Kolan, Erin Eatough, and Sarah Pluck in the collection of
these data. Linda Camras provided very helpful comments on an earlier
version of this manuscript. These experiments would not be possible
without the participation of many children and their families, for
whose collaboration we are extremely appreciative. A preliminary
version of these data were presented at the 2003 Biennial Meeting of
the Society for Research in Child Development. This research was
supported by grants from the National Institute of Mental Health to
Seth Pollak (MH 68858 and MH 61285). Alison Wismer Fries was also
supported by a National Institutes of Health Training Program in
Emotion Research (MH 18931).
We report the discovery of one unique cataclysmic variable drawn from the Hamburg Quasar Survey, HS 2331 + 3905. Follow-up observations obtained over three years unveiled a very unusual picture. The large amplitude 3.5 h radial velocity variations obtained from our optical spectroscopy is not the orbital period of the system, as one would normally expect. Instead, extensive CCD photometry strongly suggests that HS 2331 + 3005 is a short orbital period cataclysmic variable with Рorb = 81.09 min, containing a cold white dwarf which appears to exhibit ZZ Ceti pulsations.
From a 45ks Chandra observation of V42G Oph we have obtained high-resolution X-ray spectra at moderate signal-to-noise, and a, good quality, uninterrupted lightcurve. The spectra are reasonably fit with a cooling flow model, similar to EX Hya and U Gem. Our analysis of the Chandra and additional X-ray/optical lightcurves reveals a persistent modulation at 4.2 hr from 1988 to 2003, likely the white dwarf spin period indicating an intermediate polar nature for V426 Oph.
This study investigated the nature of the immune response of C57BL/6 mice infected with the trematode Echinostoma
caproni. To determine the preferential development of either a Th1 or Th2 cytokine pattern during early stages of infection,
cytokine production by spleen and mesenteric lymph node (MLN) cells during the first 3 weeks of infection was followed.
Whereas spleen cells failed to respond to antigen stimulation, MLN cells produced IFN-γ and to a lesser extent IL-4.
IL-5 levels were elevated throughout the period studied. The humoral response was consistent with a Th1 cytokine pattern
as antigen-specific IgG2a antibodies were preferentially developed. We investigated whether IFN-γ is critical for
establishment of E. caproni infection. Worm burden in infected mice treated with a single injection of anti-IFN-γ mAb
was significantly reduced compared to that of animals treated with a control antibody.
The cobalt chrome alloy Co-28Cr-6Mo is widely used in human joint replacement applications. These joints are highly sensitive to wear and are usually replaced after approximately ten years of use. In order to extend these implants' service lifetimes, a thin film of diamond may be applied to the implant wear surfaces by microwave plasma chemical vapor deposition (MPCVD) following MPCVD nitridation. Diamond films often delaminate from cobalt chrome due to a high thermal expansion mismatch. Additionally, under most conditions diamond films degrade into graphite by dissolution of nuclei into solvents like Co and Cr. By nitriding the cobalt chrome through MPCVD prior to diamond deposition, a usable diamond film may be achieved. It may be possible to merge both the nitriding and deposition steps into a single process, since both nitridation and deposition will be performed by MPCVD. In addition, controlled amounts of nitrogen in hydrogen/methane plasma under CVD conditions result in a nanostructured diamond coating. We have investigated the formation of both micro- and nanocrystalline diamond formation on cobalt chrome.