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Concerns have been raised about the utility of self-report assessments in predicting future suicide attempts. Clinicians in pediatric emergency departments (EDs) often are required to assess suicidal risk. The Death Implicit Association Test (IAT) is an alternative to self-report assessment of suicidal risk that may have utility in ED settings.
A total of 1679 adolescents recruited from 13 pediatric emergency rooms in the Pediatric Emergency Care Applied Research Network were assessed using a self-report survey of risk and protective factors for a suicide attempt, and the IAT, and then followed up 3 months later to determine if an attempt had occurred. The accuracy of prediction was compared between self-reports and the IAT using the area under the curve (AUC) with respect to receiver operator characteristics.
A few self-report variables, namely, current and past suicide ideation, past suicidal behavior, total negative life events, and school or social connectedness, predicted an attempt at 3 months with an AUC of 0.87 [95% confidence interval (CI), 0.84–0.90] in the entire sample, and AUC = 0.91, (95% CI 0.85–0.95) for those who presented without reported suicidal ideation. The IAT did not add significantly to the predictive power of selected self-report variables. The IAT alone was modestly predictive of 3-month attempts in the overall sample ((AUC = 0.59, 95% CI 0.52–0.65) and was a better predictor in patients who were non-suicidal at baseline (AUC = 0.67, 95% CI 0.55–0.79).
In pediatric EDs, a small set of self-reported items predicted suicide attempts within 3 months more accurately than did the IAT.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.
Images play a crucial role in shaping and reflecting political life. Digitization has vastly increased the presence of such images in daily life, creating valuable new research opportunities for social scientists. We show how recent innovations in computer vision methods can substantially lower the costs of using images as data. We introduce readers to the deep learning algorithms commonly used for object recognition, facial recognition, and visual sentiment analysis. We then provide guidance and specific instructions for scholars interested in using these methods in their own research.
Online learning has become an increasingly expected and popular component for education of the modern-day adult learner, including the medical provider. In light of the recent coronavirus pandemic, there has never been more urgency to establish opportunities for supplemental online learning. Heart University aims to be “the go-to online resource” for e-learning in CHD and paediatric-acquired heart disease. It is a carefully curated open access library of paedagogical material for all providers of care to children and adults with CHD or children with acquired heart disease, whether a trainee or a practising provider. In this manuscript, we review the aims, development, current offerings and standing, and future goals of Heart University.
Identifying early risk factors for the development of social anxiety symptoms has important translational implications. Accurately identifying which children are at the highest risk is of critical importance, especially if we can identify risk early in development. We examined continued risk for social anxiety symptoms at the transition to adolescence in a community sample of children (n = 112) that had been observed for high fearfulness at age 2 and tracked for social anxiety symptoms from preschool through age 6. In our previous studies, we found that a pattern of dysregulated fear (DF), characterized by high fear in low threat contexts, predicted social anxiety symptoms at ages 3, 4, 5, and 6 years across two samples. In the current study, we re-evaluated these children at 11–13 years of age by using parent and child reports of social anxiety symptoms, parental monitoring, and peer relationship quality. The scores for DF uniquely predicted adolescents’ social anxiety symptoms beyond the prediction that was made by more proximal measures of behavioral (e.g., kindergarten social withdrawal) and concurrent environmental risk factors (e.g., parental monitoring, peer relationships). Implications for early detection, prevention, and intervention are discussed.
This paper presents a theoretical and experimental study of the long-standing fluid mechanics problem involving the temporal resolution of a large localised initial disturbance into a sequence of solitary waves. This problem is of fundamental importance in a range of applications, including tsunami and internal ocean wave modelling. This study is performed in the context of the viscous fluid conduit system – the driven, cylindrical, free interface between two miscible Stokes fluids with high viscosity contrast. Owing to buoyancy-induced nonlinear self-steepening balanced by stress-induced interfacial dispersion, the disturbance evolves into a slowly modulated wavetrain and further into a sequence of solitary waves. An extension of Whitham modulation theory, termed the solitary wave resolution method, is used to resolve the fission of an initial disturbance into solitary waves. The developed theory predicts the relationship between the initial disturbance’s profile, the number of emergent solitary waves and their amplitude distribution, quantifying an extension of the well-known soliton resolution conjecture from integrable systems to non-integrable systems that often provide a more accurate modelling of physical systems. The theoretical predictions for the fluid conduit system are confirmed both numerically and experimentally. The number of observed solitary waves is consistently within one to two waves of the prediction, and the amplitude distribution shows remarkable agreement. Universal properties of solitary wave fission in other fluid dynamics problems are identified.
This study sought to compare disease recidivism rates between canal wall up mastoidectomy and a canal wall down with obliteration technique.
Patients undergoing primary cholesteatoma surgery at our institution over a five-year period (2013–2017) using the aforementioned techniques were eligible for inclusion in the study. Rates of discharge and disease recidivism were analysed using chi-square statistics.
A total of 104 ears (98 patients) were included. The mean follow-up period was 30 months (range, 12–52 months). A canal wall down with mastoid obliteration technique was performed in 55 cases and a canal wall up approach was performed in 49 cases. Disease recidivism rates were 7.3 per cent and 16.3 per cent in the canal wall down with mastoid obliteration and canal wall up groups respectively (p = 0.02), whilst discharge rates were similar (7.3 per cent and 10.2 per cent respectively).
Our direct comparative data suggest that canal wall down mastoidectomy with obliteration is superior to a canal wall up technique in primary cholesteatoma surgery, providing a lower recidivism rate combined with a low post-operative ear discharge rate.
This literature review provides an overview of the research using magnetic resonance imaging (MRI) in pediatric migraine and compares findings with the adult migraine literature. A literature search using PubMed was conducted using all relevant sources up to February 2019. Using MRI methods to categorize and explain pediatric migraine in comparison with adult migraine is important, in order to recognize and appreciate the differences between the two entities, both clinically and physiologically. We aim to demonstrate the differences and similarities between pediatric and adult migraine using data from white matter and gray matter structural studies, cerebral perfusion, metabolites, and functional MRI (fMRI) studies, including task-based and resting-state blood oxygen level-dependent studies. By doing this we identify areas that need further research, as well as possible areas where intervention could alter outcomes.
Fatigue syndromes (FSs) affect large numbers of individuals, yet evidence from epidemiological studies on adverse outcomes, such as premature death, is limited.
Cohort study involving 385 general practices in England that contributed to the Clinical Practice Research Datalink (CPRD) with linked inpatient Hospital Episode Statistics (HES) and Office for National Statistics (ONS) cause of death information. A total of 10 477 patients aged 15 years and above, diagnosed with a FS during 2000–2014, were individually matched with up to 20 comparator patients without a history of having a FS. Prevalence ratios (PRs) were estimated to compare the FS and comparison cohorts on clinical characteristics. Adjusted hazard ratios (HRs) for subsequent adverse outcomes were estimated from stratified Cox regression models.
Among patients diagnosed with FSs, we found elevated baseline prevalence of: any psychiatric illness (PR 1.77; 95% CI 1.72–1.82), anxiety disorders (PR 1.92; 1.85–1.99), depression (PR 1.89; 1.83–1.96), psychotropic prescriptions (PR 1.68; 1.64–1.72) and comorbid physical illness (PR 1.28; 1.23–1.32). We found no significant differences in risks for: all-cause mortality (HR 0.99; 0.91–1.09), natural death (HR 0.99; 0.90–1.09), unnatural death (HR 1.00; 0.59–1.72) or suicide (HR 1.68; 0.78–3.63). We did, however, observe a significantly elevated non-fatal self-harm risk: HR 1.83; 1.56–2.15.
The absence of elevated premature mortality risk is reassuring. The raised prevalence of mental illness and increased non-fatal self-harm risk indicate a need for enhanced assessment and management of psychopathology associated with fatigue syndromes.
To compare the effects of empiric carbapenems versus cycling cefepime and piperacillin/tazobactam on the rates of vancomycin-resistant Enterococcus (VRE) colonization, bloodstream infections, and outcomes of patients admitted with acute leukemia.
Retrospective clinical study with VRE molecular strain typing and gastrointestinal microbiome comparison.
A regional referral center for acute leukemia.
342 consecutive patients admitted with newly diagnosed acute leukemia.
In September 2015, we changed our empiric antibiotic of choice for neutropenic fever from a carbapenem to the cycling regimen. We studied 214 consecutive patients during the carbapenem period and 128 during the cycling period. Surveillance for VRE stool colonization was conducted weekly. Representative stool samples were analyzed for VRE MLST types and changes in the composition and diversity of the fecal microbiota.
The change in empiric antibiotics was associated with a significant decrease in VRE colonization (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.27–0.66), a switch in the dominant VRE MLST types on the unit, and some modifications in the gastrointestinal microbiome. There were no differences in total gram-positive or gram-negative BSIs. During the carbapenem period, we observed higher absolute numbers of Candida spp and fewer ESBL BSIs, but these did not reach statistical significance. Patients during the carbapenem period had longer lengths of stay and durations of severe neutropenia and 10% higher hospital cost.
Carbapenem-sparing empiric antibiotic regimens may have advantages related to VRE ecology, gastrointestinal dysbiosis, duration of neutropenia, cost and length of stay.
Optical parametric chirped-pulse amplification (OPCPA) [Dubietis et al., Opt. Commun. 88, 437 (1992)] implemented by multikilojoule Nd:glass pump lasers is a promising approach to produce ultraintense pulses (
). Technologies are being developed to upgrade the OMEGA EP Laser System with the goal to pump an optical parametric amplifier line (EP OPAL) with two of the OMEGA EP beamlines. The resulting ultraintense pulses (1.5 kJ, 20 fs,
) would be used jointly with picosecond and nanosecond pulses produced by the other two beamlines. A midscale OPAL pumped by the Multi-Terawatt (MTW) laser is being constructed to produce 7.5-J, 15-fs pulses and demonstrate scalable technologies suitable for the upgrade. MTW OPAL will share a target area with the MTW laser (50 J, 1 to 100 ps), enabling several joint-shot configurations. We report on the status of the MTW OPAL system, and the technology development required for this class of all-OPCPA laser system for ultraintense pulses.
Major depressive disorder (MDD) is a highly heterogeneous condition in terms of symptom presentation and, likely, underlying pathophysiology. Accordingly, it is possible that only certain individuals with MDD are well-suited to antidepressants. A potentially fruitful approach to parsing this heterogeneity is to focus on promising endophenotypes of depression, such as neuroticism, anhedonia, and cognitive control deficits.
Within an 8-week multisite trial of sertraline v. placebo for depressed adults (n = 216), we examined whether the combination of machine learning with a Personalized Advantage Index (PAI) can generate individualized treatment recommendations on the basis of endophenotype profiles coupled with clinical and demographic characteristics.
Five pre-treatment variables moderated treatment response. Higher depression severity and neuroticism, older age, less impairment in cognitive control, and being employed were each associated with better outcomes to sertraline than placebo. Across 1000 iterations of a 10-fold cross-validation, the PAI model predicted that 31% of the sample would exhibit a clinically meaningful advantage [post-treatment Hamilton Rating Scale for Depression (HRSD) difference ⩾3] with sertraline relative to placebo. Although there were no overall outcome differences between treatment groups (d = 0.15), those identified as optimally suited to sertraline at pre-treatment had better week 8 HRSD scores if randomized to sertraline (10.7) than placebo (14.7) (d = 0.58).
A subset of MDD patients optimally suited to sertraline can be identified on the basis of pre-treatment characteristics. This model must be tested prospectively before it can be used to inform treatment selection. However, findings demonstrate the potential to improve individual outcomes through algorithm-guided treatment recommendations.
While a direct relation between hospital construction and concomitant infection rates has been clearly established, few data are available regarding the environmental decontamination effects of renovation in which surfaces are replaced and regarding subsequent infection incidence.
Retrospective clinical study with vancomycin-resistant Enterococcus (VRE) molecular strain typing and environmental cultures.
A regional referral center for acute leukemia and hematopoietic stem-cell transplantation.
Overall, 536 consecutive hospital admissions for newly diagnosed acute leukemia or a first autologous or allogeneic stem-cell transplantation were reviewed.
During 2009–2010, our unit underwent complete remodeling including replacement of all surfaces. We assessed the effects of this construction on the incidence of hospital-acquired VRE colonization before, during, and after the renovation.
We observed a sharp decrease in VRE colonization rates (hazard ratio, <0.23; 95% confidence interval, 0.18–0.44; P<.0001) during the first year after the renovation, with a return to near baseline rates thereafter. The known risk factors for VRE colonization appeared to be stable over the study interval. Environmental cultures outside of patient rooms revealed several contaminated areas that are commonly touched by unit personnel. Multilocus sequence typing of VRE isolates that were cryopreserved over the study interval showed that dominant strains prior to construction disappeared and were replaced by other strains after the renovation.
Unit reconstruction interrupted endemic transmission of VRE, which resumed with novel strains upon reopening. Contamination of environmental surfaces and shared equipment may play an important role in endemic transmission of VRE.
Sustainable commercial use of native wildlife is an alternative economic means of land use by Indigenous people in remote rural areas. This situation applies within large tracts of land owned by Indigenous people across northern Australia. The commercial use of saltwater crocodiles Crocodylus porosus is a growing industry in Australia's Northern Territory. Although Indigenous people sell crocodile eggs and hatchlings, the majority of harvesting and incubation is done by non-indigenous people from less remote areas. One Indigenous community has been heavily involved in this industry and now manages its own harvest and incubation programme. We present a case study of this programme, which has transitioned from outside agencies managing the harvest, to complete local ownership and management. Egg harvests and incubation success rates declined by 40% following the switch to local management. Income increased, as did production costs; in particular, royalty payments made to Indigenous landowners. The declines reflect the community's motives for engaging in the industry, which have been socially rather than commercially driven, and damage to nesting habitat by feral animals. The increase in royalties reflects the need to compete with non-indigenous harvesters from outside the township, who are strictly commercially driven. Harvesting, incubation and trade in crocodile eggs and hatchlings can form a viable and sustainable enterprise for remote Indigenous communities. However, efficiency needs to be improved to fulfil the need for a reliable and dependable supply chain, and regulatory institutions should give Indigenous harvesters sufficient freedom to pursue innovative and viable livelihood options.
The complexity of helminth macroparasites is reflected in the intricate network of host cell types that participate in the Type 2 immune response needed to battle these organisms. In this context, adaptive T helper 2 cells and the Type 2 cytokines interleukin (IL)-4, IL-5, IL-9 and IL-13 have been the focus of research for years, but recent work has demonstrated that the innate immune system plays an essential role. Some innate immune cells that promote Type 2 immunity are relatively abundant, such as macrophages and eosinophils. However, we now appreciate that more rare cell types including group 2 innate lymphoid cells, basophils, mast cells and dendritic cells make significant contributions to these responses. These cells are found at low frequency but they are specialized to their roles – located at sites such as the skin, lung and gut, where the host combats helminth parasites. These cells respond rapidly and robustly to worm antigens and worm-induced damage to produce essential cytokines, chemokines, eicosanoids and histamine to activate damaged epithelium and to recruit other effectors. Thus, a greater understanding of how these cells operate is essential to understand how the host protects itself during helminth infection.