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One out of every twenty emergency department (ED) visits in the United States is due to a psychiatric issue. Providing a gateway between the community and the mental health system, psychiatry emergency clinicians are responsible for assessing and managing a wide array of clinical presentations and conditions. Among emergency mental health-related visits, substance-related disorders, mood disorders, anxiety disorders, psychosis, and suicide attempts are among the most prevalent presentations. Although urgent conditions are common, increasing numbers of patients who present to the emergency department seek treatment for routine or non-acute psychiatric symptoms. Some patients self-refer to the emergency department, while others may be referred by family, friends, outpatient treatment providers, public agencies, or representatives of the law enforcement system.
Wireless connectivity has been realized for multiple environments and different frequency bands. However, little research exists about mmWave communication in industrial environments. This paper presents the 60 GHz double-directional radio channel for mmWave communication in a ship hull for Line-of-Sight (LOS) and non-Line-of-Sight (NLOS) conditions. We performed channel measurements using the Terragraph channel sounder at different locations in the ship hull and fitted LOS path loss to a one-slope path loss model. Path loss and root-mean-square delay spread of the LOS path is compared to the reflected path with lowest path loss. NLOS communication via this first-order reflected path is modeled by calculating the path distance and determining the reflection loss. The reflection losses have a considerable contribution to the signal attenuation of the reflected path. The channel models are implemented in an indoor coverage prediction tool, which was extended with a ray launching algorithm and validated by comparison with an analytical electromagnetic solver. The results show that the mmWave radio channel allows high-throughput communication within a ship hull compartment, even when no LOS path between the transmitter and receiver is present.
Sharks have a long and rich fossil record that consists predominantly of isolated teeth due to the poorly mineralized cartilaginous skeleton. Tiger sharks (Galeocerdo), which represent apex predators in modern oceans, have a known fossil record extending back into the early Eocene (ca. 56 Ma) and comprise 22 recognized extinct and one extant species to date. However, many of the fossil species remain dubious, resulting in a still unresolved evolutionary history of the tiger shark genus. Here, we present a revision of the fossil record of Galeocerdo by examining the morphological diversity and disparity of teeth in deep time. We use landmark-based geometric morphometrics to quantify tooth shapes and qualitative morphological characters for species discrimination. Employing this combined approach on fossil and extant tiger shark teeth, our results only support six species to represent valid taxa. Furthermore, the disparity analysis revealed that diversity and disparity are not implicitly correlated and that Galeocerdo retained a relatively high dental disparity since the Miocene despite its decrease from four to one species. With this study, we demonstrate that the combined approach of quantitative geometric morphometric techniques and qualitative morphological comparisons on isolated shark teeth provides a useful tool to distinguish between species with highly similar tooth morphologies.
The aim of this study was to estimate the seroprevalence and risk factors associated with Toxoplasma gondii exposure in dogs and cats from Bangkok, Thailand. Blood samples from 318 dogs and 321 cats were tested for T. gondii antibodies by modified agglutination test (cut-off 1:25). Additionally, 18 dogs and 20 cats were longitudinally sampled for T. gondii antibodies during the same study period, between June and July 2019. The overall seroprevalence in dogs and cats was 7.9% (25/318; 95% CI 4.9–10.8%) and 18.7% (95% CI 14.4–23.0%), respectively. For dogs, risk factors identified were being a mixed-breed animal and living totally outdoors, while increasing age was shown to be a risk factor for cats. Seroconversion was not detected and titres from positive animals remained constant over longitudinal study. The present study indicates that there is a prominent presence of T. gondii in urban and peri-urban areas of Bangkok, suggesting that outdoor dogs and cats should be considered as a possible risk factor for humans.
Healthcare workers (HCWs) not fulfilling the coronavirus disease 2019 (COVID-19) case definition underwent severe acute respiratory coronavirus virus 2 (SARS-CoV-2) screening. Risk of exposure, adherence to personal protective equipment (PPE), and symptoms were assessed. In total, 2,000 HCWs were screened: 5.5% were positive for SARS-CoV-2 by polymerase chain reaction (PCR). There were no differences in PPE use between SARS-CoV-2–positive and –negative HCWs (adherence, >90%). Nursing and kitchen staff were independently associated with positive SARS-CoV-2 results.
We establish the global regularity of multilinear Fourier integral operators that are associated to nonlinear wave equations on products of
$L^p$ spaces by proving endpoint boundedness on suitable product spaces containing combinations of the local Hardy space, the local BMO and the
During each Heinrich stadial (HS), temperatures in southern Europe typically dropped several degrees during several hundred to few thousand years. We have developed a one-dimensional thermal conduction model that transfers the typical surface temperature anomaly of a HS to a series of hypothetical underlying caves. The results show that with increasing depth, the thermal anomaly is attenuated, the lag time increases, and the signal structure experiences larger modifications. The model suggests that in most cases, it is not acceptable to assume a synchronous thermal variability and similar average temperature values between the surface atmosphere and the cave interior at millennial timescales. We also simulated the thermal impact of the modeled HS on speleothem δ18O records. The outputs of most model scenarios suggest that temperature changes associated with the HS produce δ18O anomalies capable of contributing significantly or even decisively to the speleothem isotope variability. Therefore, despite controls other than temperature often being considered more important when interpreting Pleistocene speleothem δ18O records in temperate climates, this research suggests that temperature is expected to be one of the major controls of δ18O values in most cave sites outside the tropics and should be included as a significant parameter affecting Pleistocene speleothem δ18O records.
Patients with schizophrenia spectrum disorders (SSD) tend to lack insight, which is linked to poor outcomes. The effect size of previous treatments on insight changes in SSD has been small. Metacognitive interventions may improve insight in SSD, although this remains unproved.
We carried out a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine the effects of metacognitive interventions designed for SSD, namely Metacognitive Training (MCT) and Metacognitive Reflection and Insight Therapy (MERIT), on changes in cognitive and clinical insight at post-treatment and at follow-up.
Twelve RCTs, including 10 MCT RCTs (n = 717 participants) and two MERIT trials (n = 90), were selected, totalling N = 807 participants. Regarding cognitive insight six RCTs (n = 443) highlighted a medium effect of MCT on self-reflectiveness at post-treatment, d = 0.46, p < 0.01, and at follow-up, d = 0.30, p < 0.01. There was a small effect of MCT on self-certainty at post-treatment, d = −0.23, p = 0.03, but not at follow-up. MCT was superior to controls on an overall Composite Index of cognitive insight at post-treatment, d = 1.11, p < 0.01, and at follow-up, d = 0.86, p = 0.03, although we found evidence of heterogeneity. Of five MCT trials on clinical insight (n = 244 participants), which could not be meta-analysed, four of them favoured MCT compared v. control. The two MERIT trials reported conflicting results.
Metacognitive interventions, particularly Metacognitive Training, appear to improve insight in patients with SSD, especially cognitive insight shortly after treatment. Further long-term RCTs are needed to establish whether these metacognitive interventions-related insight changes are sustained over a longer time period and result in better outcomes.
In order to determine the sex of Chelonia mydas individuals found within one of the principal foraging areas of the Gulf of California during any given stage of ontogeny, 529 individuals were sampled in Bahía de los Ángeles from 1995–2012, and their morphometric data were collected. A principal component analysis (PCA) was performed for the morphometric variables, and two principal components were obtained that unambiguously separated sexes and ontogenetic stages. The first component was defined by straight carapace length (SCL), curve carapace length (CCL), plastron length (PL) and carapace depth (CD), while the second factor was represented by total tail length (TTL). Allometric models were fitted with the most important variables determined by the PCA. The model PL = αSCLβ was able to distinguish between adults and immature individuals. For adult organisms, the model that best separated males from females was TTL = αSCLβ. Adult females had SCL values of 66–96.7 cm and TTL values of 16.3–25 cm, while adult males had SCL values of 66.4–12.5 cm and TTL values > 25 cm. As the organisms were considered immature only if SCL < 77.3, we were able to determine the TTL values for immature individuals by using elemental mathematics and solving for SCL in the equation TTL = αSCLβ for each group (i.e. adult females, adult males and immatures). So, considering the mathematical approach and acknowledging the lack of background information, immature individuals may be considered potential females if the TTL value is between 7.04–17.8 cm and potential males if the TTL value > 17.8 cm.
Standard external beam radiotherapy is a treatment option for patients with localised prostate cancer and is used in patients with low-, intermediate- and high-risk disease with androgen deprivation according to the risk of the disease. In the last few years, hypofractionated radiotherapy has been demonstrated to be as safe as standard radiotherapy if given over a shorter time than standard radiotherapy with larger doses per fraction. External radiotherapy for localised prostate cancer typically delivers 37–42 fractions of 1·8–2·0 Gy per fraction given 5 days per week over 7·5–8·5 weeks. Hypofractionated radiotherapy delivers 20–28 fractions of 2·5–2·6 Gy per fraction given 5 days per week over 4–5·6 weeks.
A retrospective analysis of assessment of 30 patients was undertaken from 2016 to 2018. The aim of this study was to evaluate the 2-year outcomes of 30 patients with prostate cancer treated with hypofractionated radiotherapy 70 Gy in 28 fractions.
Biochemical failure with hypofractionated radiotherapy was found in a total of 20% of patients. In the classification by risk groups, there were no biochemical failures in low-risk patients; in the low intermediate course, 3·3% of patients; in the high intermediate group, 3·3% patients; and in the high-risk group, the largest documented biochemical failure was in 13·3% of patients. For acute urinary toxicity, grade I was 56·6%; grade II, 6·6%. For acute rectal toxicity, grade I was 46·6%; grade II, 3·3%.
This is one of the first studies of hypofractionated radiotherapy in prostate cancer in Latin America, and the results of this study demonstrated that the outcomes were similar to the standard regimen in all risk groups.
Apathy and depression are the two most frequent neuropsychiatric symptoms in Alzheimer's disease (AD) and related disorders. Whereas neuroimaging studies have shown different neural pathways for these two symptoms, a clinical overlap between apathy and depression is frequently described.
To describe the prevalence of apathy and depression among elderly subjects with or without dementia criteria using specific diagnostic criteria for apathy and depression.
Subjects from an ongoing cross-sectional study were recruited in 4 centers (France, Indonesia, Spain, Argentina). Apathy and depression were assessed using the diagnostic criteria for apathy and for depression. Additionally, the apathy and dysphoria domains of the NPI-C (Neuropsychiatric Inventory-Clinician), as well as the 12 domains of the original NPI (Neuropsychiatric Inventory) were assessed.
431 subjects (mean age=74.6 ± 10.4 ; gender=♂ 29%) were recruited (France=100, Spain=90, Indonesia=182, Argentina=79). Among them, 25% were healthy elderly subjects, 9% had a diagnosis of MCI (Mild Cognitive Impairment), 46% had a diagnosis of dementia (including AD, Lewy body, vascular, mixed and fronto-temporal dementia). In the overall population, the prevalence of apathy and depression were respectively 41% and 25%. More specifically, the prevalence of apathy and depression in the AD sample were 67% and 25%.
Diagnostic criteria for apathy and depression, as well as the NPI-C, are recent assessment methods in the field of dementia, developed to increase the accuracy of the clinical evaluation of BPSD. It is therefore critical to propose multicenter observational studies comparing these new tools with classical assessment methods.
Decisions on the use of nature reflect the values and rights of individuals, communities and society at large. The values of nature are expressed through cultural norms, rules and legislation, and they can be elicited using a wide range of tools, including those of economics. None of the approaches to elicit peoples’ values are neutral. Unequal power relations influence valuation and decision-making and are at the core of most environmental conflicts. As actors in sustainability thinking, environmental scientists and practitioners are becoming more aware of their own posture, normative stance, responsibility and relative power in society. Based on a transdisciplinary workshop, our perspective paper provides a normative basis for this new community of scientists and practitioners engaged in the plural valuation of nature.
Sharing information between different countries is key for developing sustainable solutions to environmental change. Coastal wetlands in the Gulf of Mexico are suffering significant environmental and human-related threats. Working across national boundaries, this research project brings together scientists, specialists and local communities from Cuba and the USA. While important advances have been made in strengthening collaborations, important obstacles remain in terms of international policy constraints, different institutional and academic cultures and technology. Overcoming these limitations is essential to formulating a comprehensive understanding of the challenges that coastal socioecological systems are facing now and into the future.
Introduced species can have strong ecological, social and economic effects on their non-native environment. Introductions of megafaunal species are rare and may contribute to rewilding efforts, but they may also have pronounced socio-ecological effects because of their scale of influence. A recent introduction of the hippopotamus Hippopotamus amphibius into Colombia is a novel introduction of a megaherbivore onto a new continent, and raises questions about the future dynamics of the socio-ecological system into which it has been introduced. Here we synthesize current knowledge about the Colombian hippopotamus population, review the literature on the species to predict potential ecological and socio-economic effects of this introduction, and make recommendations for future study. Hippopotamuses can have high population growth rates (7–11%) and, on the current trajectory, we predict there could be 400–800 individuals in Colombia by 2050. The hippopotamus is an ecosystem engineer that can have profound effects on terrestrial and aquatic environments and could therefore affect the native biodiversity of the Magdalena River basin. Hippopotamuses are also aggressive and may pose a threat to the many inhabitants of the region who rely upon the Magdalena River for their livelihoods, although the species could provide economic benefits through tourism. Further research is needed to quantify the current and future size and distribution of this hippopotamus population and to predict the likely ecological, social and economic effects. This knowledge must be balanced with consideration of social and cultural concerns to develop appropriate management strategies for this novel introduction.
Positive symptoms are a useful predictor of aggression in schizophrenia. Although a similar pattern of abnormal brain structures related to both positive symptoms and aggression has been reported, this observation has not yet been confirmed in a single sample.
To study the association between positive symptoms and aggression in schizophrenia on a neurobiological level, a prospective meta-analytic approach was employed to analyze harmonized structural neuroimaging data from 10 research centers worldwide. We analyzed brain MRI scans from 902 individuals with a primary diagnosis of schizophrenia and 952 healthy controls.
The result identified a widespread cortical thickness reduction in schizophrenia compared to their controls. Two separate meta-regression analyses revealed that a common pattern of reduced cortical gray matter thickness within the left lateral temporal lobe and right midcingulate cortex was significantly associated with both positive symptoms and aggression.
These findings suggested that positive symptoms such as formal thought disorder and auditory misperception, combined with cognitive impairments reflecting difficulties in deploying an adaptive control toward perceived threats, could escalate the likelihood of aggression in schizophrenia.
The J-PAS survey will soon start observing thousands of square degrees of the Northern Sky with its unique set of 56 narrow band filters covering the entire optical wavelength range, providing, effectively, a low resolution spectra for every object detected. Active galaxies and quasars, thanks to their strong emission lines, can be easily identified and characterized with J-PAS data. A variety of studies can be performed, from IFU-like analysis of local AGN, to clustering of high-z quasars. We also expect to be able to extract intrinsic physical quasar properties from the J-PAS pseudo-spectra, including continuum slope and emission line luminosities. Here we show the first attempts of using the QSFit software package to derive the properties for 22 quasars at 0.8 < z < 2 observed by the miniJPAS survey, the first deg2 of J-PAS data obtained with an interim camera. Results are compared with the ones obtained by applying the same software to SDSS quasar spectra.
Cognitive-behavioural therapy (CBT) is an effective treatment for depressed adults. CBT interventions are complex, as they include multiple content components and can be delivered in different ways. We compared the effectiveness of different types of therapy, different components and combinations of components and aspects of delivery used in CBT interventions for adult depression. We conducted a systematic review of randomised controlled trials in adults with a primary diagnosis of depression, which included a CBT intervention. Outcomes were pooled using a component-level network meta-analysis. Our primary analysis classified interventions according to the type of therapy and delivery mode. We also fitted more advanced models to examine the effectiveness of each content component or combination of components. We included 91 studies and found strong evidence that CBT interventions yielded a larger short-term decrease in depression scores compared to treatment-as-usual, with a standardised difference in mean change of −1.11 (95% credible interval −1.62 to −0.60) for face-to-face CBT, −1.06 (−2.05 to −0.08) for hybrid CBT, and −0.59 (−1.20 to 0.02) for multimedia CBT, whereas wait list control showed a detrimental effect of 0.72 (0.09 to 1.35). We found no evidence of specific effects of any content components or combinations of components. Technology is increasingly used in the context of CBT interventions for depression. Multimedia and hybrid CBT might be as effective as face-to-face CBT, although results need to be interpreted cautiously. The effectiveness of specific combinations of content components and delivery formats remain unclear. Wait list controls should be avoided if possible.