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 firstname.lastname@example.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 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.
Novel, evidence-based treatments are required for treatment-resistant post-traumatic stress disorder (PTSD). 3,4-Methylenedioxymethamphetamine (MDMA) has beneficially augmented psychotherapy in several small clinical trials.
To review the use of MDMA-assisted psychotherapy in treatment-resistant PTSD.
Systematic searches of four databases were conducted from inception to February 2020. A meta-analysis was performed on trials which were double-blinded, randomised, and compared MDMA-assisted psychotherapy to psychotherapy and placebo. The primary outcomes were the differences in Clinician Administered PTSD Scale (CAPS-IV) score and Beck’s Depression Inventory (BDI). Secondary outcome measures included neurocognitive and physical adverse effects, at the time, and within seven days of intervention.
Four randomised controlled trials (RCTs) met inclusion criteria. When compared to active placebo, intervention groups taking 75mg (MD -46.90; 95% CI -58.78, -35.02), 125mg (MD -20.98; 95% CI -34.35, -7.61) but not 100mg (MD -12.90; 95% CI -36.09, 10.29) of MDMA with psychotherapy, had significant decreases in CAPS-IV scores, as did the inactive placebo arm (MD -33.20; 95% CI -40.53, -25.87). A significant decrease in BDI when compared to active placebo (MD -10.80; 95% CI -20.39, -1.21) was only observed at 75mg. Compared to placebo, participants reported significantly more episodes of low mood, nausea and jaw-clenching during sessions and lack of appetite after seven days.
These results demonstrate potential therapeutic benefit with minimal physical and neurocognitive risk for the use of MDMA-assisted psychotherapy in TR-PTSD, despite little effect on Beck’s Depression Inventory. Better powered RCTs are required to investigate further.
James Rucker has attended trial related meetings paid for by Compass Pathways Ltd.
The migration and accumulation of immiscible silicate liquids may play a significant role in the differentiation of crustal magma bodies and the formation of some economic mineral deposits. However, our understanding of the processes that control the segregation of these liquids is currently limited by the short timescales of petrological experiments. Detailed microstructural investigations of Palaeogene basaltic dykes from Northeast England, coupled with simple 1D thermal models, constrain the effects of cooling rate on the microstructure of unmixed immiscible silicate liquids under natural conditions. The size of unmixed Fe-rich droplets within a continuous silicic phase is related to the cooling rate by a power law, with droplet diameter increasing with decreasing cooling rate, accompanied by an increase in the number of droplets. Fe-rich droplet coarsening is a result of diffusion-controlled growth. The average apparent aspect ratio and grain size of matrix plagioclase crystals indicate that nucleation and growth of these grains probably occurred in a static (or only weakly convecting) fluid dynamical regime.
Studies have consistently shown that subthreshold depression is associated with an increased risk of developing major depression. However, no study has yet calculated a pooled estimate that quantifies the magnitude of this risk across multiple studies.
We conducted a systematic review to identify longitudinal cohort studies containing data on the association between subthreshold depression and future major depression. A baseline meta-analysis was conducted using the inverse variance heterogeneity method to calculate the incidence rate ratio (IRR) of major depression among people with subthreshold depression relative to non-depressed controls. Subgroup analyses were conducted to investigate whether IRR estimates differed between studies categorised by age group or sample type. Sensitivity analyses were also conducted to test the robustness of baseline results to several sources of study heterogeneity, such as the case definition for subthreshold depression.
Data from 16 studies (n = 67 318) revealed that people with subthreshold depression had an increased risk of developing major depression (IRR = 1.95, 95% confidence interval 1.28–2.97). Subgroup analyses estimated similar IRRs for different age groups (youth, adults and the elderly) and sample types (community-based and primary care). Sensitivity analyses demonstrated that baseline results were robust to different sources of study heterogeneity.
The results of this study support the scaling up of effective indicated prevention interventions for people with subthreshold depression, regardless of age group or setting.
Few trials have compared psychosocial therapies for people with bipolar affective disorder, and conventional meta-analyses provided limited comparisons between therapies.
To combine evidence for the efficacy of psychosocial interventions used as adjunctive treatment of bipolar disorder in adults, using network meta-analysis (NMA).
Systematic review identified studies and NMA was used to pool data on relapse to mania or depression, medication adherence, and symptom scales for mania, depression and Global Assessment of Functioning (GAF).
Carer-focused interventions significantly reduced the risk of depressive or manic relapse. Psychoeducation alone and in combination with cognitive–behavioural therapy (CBT) significantly reduced medication non-adherence. Psychoeducation plus CBT significantly reduced manic symptoms and increased GAF. No intervention was associated with a significant reduction in depression symptom scale scores.
Only interventions for family members affected relapse rates. Psychoeducation plus CBT reduced medication non-adherence, improved mania symptoms and GAF. Novel methods for addressing depressive symptoms are required.
The Antarctic Roadmap Challenges (ARC) project identified critical requirements to deliver high priority Antarctic research in the 21st century. The ARC project addressed the challenges of enabling technologies, facilitating access, providing logistics and infrastructure, and capitalizing on international co-operation. Technological requirements include: i) innovative automated in situ observing systems, sensors and interoperable platforms (including power demands), ii) realistic and holistic numerical models, iii) enhanced remote sensing and sensors, iv) expanded sample collection and retrieval technologies, and v) greater cyber-infrastructure to process ‘big data’ collection, transmission and analyses while promoting data accessibility. These technologies must be widely available, performance and reliability must be improved and technologies used elsewhere must be applied to the Antarctic. Considerable Antarctic research is field-based, making access to vital geographical targets essential. Future research will require continent- and ocean-wide environmentally responsible access to coastal and interior Antarctica and the Southern Ocean. Year-round access is indispensable. The cost of future Antarctic science is great but there are opportunities for all to participate commensurate with national resources, expertise and interests. The scope of future Antarctic research will necessitate enhanced and inventive interdisciplinary and international collaborations. The full promise of Antarctic science will only be realized if nations act together.
Historically, alloy development with better radiation performance has been focused on traditional alloys with one or two principal element(s) and minor alloying elements, where enhanced radiation resistance depends on microstructural or nanoscale features to mitigate displacement damage. In sharp contrast to traditional alloys, recent advances of single-phase concentrated solid solution alloys (SP-CSAs) have opened up new frontiers in materials research. In these alloys, a random arrangement of multiple elemental species on a crystalline lattice results in disordered local chemical environments and unique site-to-site lattice distortions. Based on closely integrated computational and experimental studies using a novel set of SP-CSAs in a face-centered cubic structure, we have explicitly demonstrated that increasing chemical disorder can lead to a substantial reduction in electron mean free paths, as well as electrical and thermal conductivity, which results in slower heat dissipation in SP-CSAs. The chemical disorder also has a significant impact on defect evolution under ion irradiation. Considerable improvement in radiation resistance is observed with increasing chemical disorder at electronic and atomic levels. The insights into defect dynamics may provide a basis for understanding elemental effects on evolution of radiation damage in irradiated materials and may inspire new design principles of radiation-tolerant structural alloys for advanced energy systems.
School-based psychological interventions encompass: universal interventions targeting youth in the general population; and indicated interventions targeting youth with subthreshold depression. This study aimed to: (1) examine the population cost-effectiveness of delivering universal and indicated prevention interventions to youth in the population aged 11–17 years via primary and secondary schools in Australia; and (2) compare the comparative cost-effectiveness of delivering these interventions using face-to-face and internet-based delivery mechanisms.
We reviewed literature on the prevention of depression to identify all interventions targeting youth that would be suitable for implementation in Australia and had evidence of efficacy to support analysis. From this, we found evidence of effectiveness for the following intervention types: universal prevention involving group-based psychological interventions delivered to all participating school students; and indicated prevention involving group-based psychological interventions delivered to students with subthreshold depression. We constructed a Markov model to assess the cost-effectiveness of delivering universal and indicated interventions in the population relative to a ‘no intervention’ comparator over a 10-year time horizon. A disease model was used to simulate epidemiological transitions between three health states (i.e., healthy, diseased and dead). Intervention effect sizes were based on meta-analyses of randomised control trial data identified in the aforementioned review; while health benefits were measured as Disability-adjusted Life Years (DALYs) averted attributable to reductions in depression incidence. Net costs of delivering interventions were calculated using relevant Australian data. Uncertainty and sensitivity analyses were conducted to test model assumptions. Incremental cost-effectiveness ratios (ICERs) were measured in 2013 Australian dollars per DALY averted; with costs and benefits discounted at 3%.
Universal and indicated psychological interventions delivered through face-to-face modalities had ICERs below a threshold of $50 000 per DALY averted. That is, $7350 per DALY averted (95% uncertainty interval (UI): dominates – 23 070) for universal prevention, and $19 550 per DALY averted (95% UI: 3081–56 713) for indicated prevention. Baseline ICERs were generally robust to changes in model assumptions. We conducted a sensitivity analysis which found that internet-delivered prevention interventions were highly cost-effective when assuming intervention effect sizes of 100 and 50% relative to effect sizes observed for face-to-face delivered interventions. These results should, however, be interpreted with caution due to the paucity of data.
School-based psychological interventions appear to be cost-effective. However, realising efficiency gains in the population is ultimately dependent on ensuring successful system-level implementation.
Data were pooled from three Australian sentinel general practice influenza surveillance networks to estimate Australia-wide influenza vaccine coverage and effectiveness against community presentations for laboratory-confirmed influenza for the 2012, 2013 and 2014 seasons. Patients presenting with influenza-like illness at participating GP practices were swabbed and tested for influenza. The vaccination odds of patients testing positive were compared with patients testing negative to estimate influenza vaccine effectiveness (VE) by logistic regression, adjusting for age group, week of presentation and network. Pooling of data across Australia increased the sample size for estimation from a minimum of 684 to 3,683 in 2012, from 314 to 2,042 in 2013 and from 497 to 3,074 in 2014. Overall VE was 38% [95% confidence interval (CI) 24–49] in 2012, 60% (95% CI 45–70) in 2013 and 44% (95% CI 31–55) in 2014. For A(H1N1)pdm09 VE was 54% (95% CI–28 to 83) in 2012, 59% (95% CI 33–74) in 2013 and 55% (95% CI 39–67) in 2014. For A(H3N2), VE was 30% (95% CI 14–44) in 2012, 67% (95% CI 39–82) in 2013 and 26% (95% CI 1–45) in 2014. For influenza B, VE was stable across years at 56% (95% CI 37–70) in 2012, 57% (95% CI 30–73) in 2013 and 54% (95% CI 21–73) in 2014. Overall VE against influenza was low in 2012 and 2014 when A(H3N2) was the dominant strain and the vaccine was poorly matched. In contrast, overall VE was higher in 2013 when A(H1N1)pdm09 dominated and the vaccine was a better match. Pooling data can increase the sample available and enable more precise subtype- and age group-specific estimates, but limitations remain.
Citizen science monitoring programmes are making increasingly important contributions to wildlife conservation, often at spatial and temporal scales unachievable by individual or teams of researchers. They are particularly valuable in estimating population trends and management impacts, and thus informing effective conservation decisions for declining species. The quality and potential biases of citizen science data are of concern, however, and appropriate experimental design and analysis are needed to ensure that the maximum scientific value is extracted. We investigated these issues in a citizen science survey of the Endangered Carnaby's black-cockatoo Calyptorhynchus latirostris. Since 2010, citizen scientists have conducted synchronized annual counts of Carnaby's black-cockatoo at roost sites to estimate the population trend. Survey effort was substantial, with c. 150 sites surveyed by > 260 volunteers each year. Relatively few sites were occupied, however, and only 42 (16%) of the 265 sites surveyed in total accounted for 95% of all observations. Many sites were empty and survey effort was often inconsistent. Taking these issues into account, analysis showed a statistically significant decline in roost occupancy rate and a non-significant decline in the mean size of roosting flocks, with an estimated overall trend of 14% decline per annum in the number of roosting birds. We highlight three important issues for citizen science monitoring programmes: the need to maintain regular surveys of sample sites to avoid patchy data, use an appropriate model that accounts for variable survey effort, high frequency of zero counts, and sampling site turnover, and incorporate information on site characteristics to help explain variation.
For several decades, breeding goals in dairy cattle focussed on increased milk production. However, many functional traits have negative genetic correlations with milk yield, and reductions in genetic merit for health and fitness have been observed. Herd management has been challenged to compensate for these effects and to balance fertility, udder health and metabolic diseases against increased production to maximize profit without compromising welfare. Functional traits, such as direct information on cow health, have also become more important because of growing concern about animal well-being and consumer demands for healthy and natural products. There are major concerns about the impact of drugs used in veterinary medicine on the spread of antibiotic-resistant strains of bacteria that can negatively impact human health. Sustainability and efficiency are also increasingly important because of the growing competition for high-quality, plant-based sources of energy and protein. Disruptions to global environments because of climate change may encourage yet more emphasis on these traits. To be successful, it is vital that there be a balance between the effort required for data recording and subsequent benefits. The motivation of farmers and other stakeholders involved in documentation and recording is essential to ensure good data quality. To keep labour costs reasonable, existing data sources should be used as much as possible. Examples include the use of milk composition data to provide additional information about the metabolic status or energy balance of the animals. Recent advances in the use of mid-infrared spectroscopy to measure milk have shown considerable promise, and may provide cost-effective alternative phenotypes for difficult or expensive-to-measure traits, such as feed efficiency. There are other valuable data sources in countries that have compulsory documentation of veterinary treatments and drug use. Additional sources of data outside of the farm include, for example, slaughter houses (meat composition and quality) and veterinary labs (specific pathogens, viral loads). At the farm level, many data are available from automated and semi-automated milking and management systems. Electronic devices measuring physiological status or activity parameters can be used to predict events such as oestrus, and also behavioural traits. Challenges concerning the predictive biology of indicator traits or standardization need to be solved. To develop effective selection programmes for new traits, the development of large databases is necessary so that high-reliability breeding values can be estimated. For expensive-to-record traits, extensive phenotyping in combination with genotyping of females is a possibility.
Dansgaard–Oeschger (D–O) cycles had far-reaching effects on Northern Hemisphere and tropical climate systems during the last glacial period, yet the climatic response to D–O cycles in western North America is controversial, especially prior to 55 ka. We document changes in precipitation along the western slope of the central Sierra Nevada during early Marine Oxygen Isotope Stages (MIS) 3 and 4 (55–67 ka) from a U-series dated speleothem record from McLean's Cave. The timing of our multi-proxy geochemical dataset is coeval with D–O interstadials (15–18) and stadials, including Heinrich Event 6. The McLean's Cave stalagmite indicates warmer and drier conditions during Greenland interstadials (GISs 15–18), signified by elevated δ18O, δ13C, reflectance, and trace element concentrations, and less radiogenic 87Sr/86Sr. Our record extends evidence of a strong linkage between high-latitude warming and reduced precipitation in western North America to early MIS 3 and MIS 4. This record shows that the linkage persists in diverse global climate states, and documents the nature of the climatic response in central California to Heinrich Event 6.
Morphological and molecular sequence data were combined with cross-hybridization studies and used to identify a new Steinernema sp. from Free State, South Africa. Molecular and morphological data indicate that the new species belongs to the ‘glaseri-group’ of Steinernema spp. Key morphological diagnostic characters for S. innovationi n. sp. include the morphometric features of the third-stage infective juveniles: total body length = 1054 (1000–1103) μm, tail length = 108 (97–117) μm, location of the excretory pore = 88 (82–91) μm, and D% = 58 (54–63), E% = 115 (104–137) and H% = 43 (37–46). Additionally, the morphology of the spicules and gubernaculum of the first-generation males are considered key diagnostic traits. Steinernema innovationi n. sp. was also characterized by analysis of both rDNA and mitochondrial gene sequence data, which further indicate the uniqueness of this Steinernema species.
This chapter examines the convergence of historical and anthropological practices that connected vernacular music practices to time and place. It establishes the ways in which the very collections of folk song yielded the possibility for history and history writing that proliferated to form the narratives of nineteenth-century Romanticism, particularly its political forms as nationalism. Folk song entered world-music history eponymously, that is, as narratives about people, the Volk. The chapter explores Johann Gottfried Herder's influence as a translator of epic, direct and indirect, deserved and undeserved, on the synthesis and fragmentation of world-music histories that accompanied the expansion of nationalism into colonialism and the subsequent human crises of modern history in the twentieth century and beyond. As epic, Herder's Cid relies on the language of power that divides Europe from Africa, the history of Europe from that of its other.
Dementia is a complex and variable condition which makes recognition of it particularly difficult in a low prevalence primary care setting. This study examined the factors associated with agreement between an objective measure of cognitive function (the revised Cambridge Cognitive Assessment, CAMCOG-R) and general practitioner (GP) clinical judgment of dementia.
This was a cross-sectional study involving 165 GPs and 2,024 community-dwelling patients aged 75 years or older. GPs provided their clinical judgment in relation to each of their patient's dementia status. Each patient's cognitive function and depression status was measured by a research nurse using the CAMCOG-R and the 15-item Geriatric Depression Scale (GDS), respectively.
GPs correctly identified 44.5% of patients with CAMCOG-R dementia and 90% of patients without CAMCOG-R dementia. In those patients with CAMCOG-R dementia, two patient-dependent factors were most important for predicting agreement between the CAMCOG-R and GP judgment: the CAMCOG-R score (p = 0.006) and patient's mention of subjective memory complaints (SMC) to the GP (p = 0.040). A higher CAMCOG-R (p < 0.001) score, female gender (p = 0.005), and larger practice size (p < 0.001) were positively associated with GP agreement that the patient did not have dementia. Subjective memory complaints (p < 0.001) were more likely to result in a false-positive diagnosis of dementia.
Timely recognition of dementia is advocated for optimal dementia management, but early recognition of a possible dementia syndrome needs to be balanced with awareness of the likelihood of false positives in detection. Although GPs correctly agree with dimensions measured by the CAMCOG-R, improvements in sensitivity are required for earlier detection of dementia.
The low-redshift Lyα forest of absorption lines provides a probe of large-scale baryonic structures in the intergalactic medium, some of which may be remnants of physical conditions set up during the epoch of galaxy formation. We discuss our recent Hubble Space Telescope (HST) observations and interpretation of low-z Lyα clouds toward nearby Seyferts and QSOs, including their frequency, space density, estimated mass, association with galaxies, and contribution to Ωb. Our HST/GHRS detections of ∼ 70 Lyα absorbers with Nhi ≥ 1012·6 cm−2 along 11 sightlines covering pathlength Δ(cz) = 114,000 km s−1 show f (>Nhi) α Nhi−0·63±0·04 and a line frequency dN/dz = 200 ± 40 for Nhi > 1012·6 cm−2 (one every 1500 km s−1 of redshift). A group of strong absorbers toward PKS 2155–304 may be associated with gas (400–800) kpc from four large galaxies, with low metallicity (≤0·003 solar) and D/H ≤ 2 × 10−4. At low-z, we derive a metagalactic ionising radiation field from AGN of J0 = × 10−23 erg cm−2 s−1 Hz−1 sr−1 and a Lyα-forest baryon density Ωb =(0·008 ± 0·004)[J−23N14b100]½ for clouds of characteristic size b = (100 kpc)b100.