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Recent studies suggest that close-range blast exposure (CBE), regardless of acute concussive symptoms, may have negative long-term effects on brain health and cognition; however, these effects are highly variable across individuals. One potential genetic risk factor that may impact recovery and explain the heterogeneity of blast injury’s long-term cognitive outcomes is the inheritance of an apolipoprotein (APOE) ε4 allele, a well-known genetic risk factor for Alzheimer’s disease. We hypothesized that APOE ε4 carrier status would moderate the impact of CBE on long-term cognitive outcomes.
To test this hypothesis, we examined 488 post-9/11 veterans who completed assessments of neuropsychological functioning, psychiatric diagnoses, history of blast exposure, military and non-military mild traumatic brain injuries (mTBIs), and available APOE genotypes. We separately examined the effects of CBE on attention, memory, and executive functioning in individuals with and without the APOE ε4 allele.
As predicted, we observed a differential impact of CBE status on cognition as a function of APOE ε4 status, in which CBE ε4 carriers displayed significantly worse neuropsychological performance, specifically in the domain of memory. These results persisted after adjusting for clinical, demographic, and genetic factors and were not observed when examining other neurotrauma variables (i.e., lifetime or military mTBI, distant blast exposure), though these variables displayed similar trends.
These results suggest APOE ε4 carriers are more vulnerable to the impact of CBE on cognition and highlight the importance of considering genetic risk when studying cognitive effects of neurotrauma.
Recent work by Kahan et al. (2017) on the psychology of motivated numeracy in the context of intracultural disagreement suggests that people are less likely to employ their capabilities when the evidence runs contrary to their political ideology. This research has so far been carried out primarily in the USA regarding the liberal–conservative divide over gun control regulation. In this paper, we present the results of a modified replication that included an active reasoning intervention with Western European participants regarding both the hierarchy–egalitarianism and individualism–collectivism divides over immigration policy (n = 746; considerably less than the preregistration sample size). We reproduce the motivated numeracy effect, though we do not find evidence of increased polarization of high-numeracy participants.
Depression contributes to persistent opioid analgesic use (OAU). Treating depression may increase opioid cessation.
To determine if adherence to antidepressant medications (ADMs) v. non-adherence was associated with opioid cessation in patients with a new depression episode after >90 days of OAU.
Patients with non-cancer, non-HIV pain (n = 2821), with a new episode of depression following >90 days of OAU, were eligible if they received ≥1 ADM prescription from 2002 to 2012. ADM adherence was defined as >80% of days covered. Opioid cessation was defined as ≥182 days without a prescription refill. Confounding was controlled by inverse probability of treatment weighting.
In weighted data, the incidence rate of opioid cessation was significantly (P = 0.007) greater in patients who adhered v. did not adhered to taking antidepressants (57.2/1000 v. 45.0/1000 person-years). ADM adherence was significantly associated with opioid cessation (odds ratio (OR) = 1.24, 95% CI 1.05–1.46).
ADM adherence, compared with non-adherence, is associated with opioid cessation in non-cancer pain. Opioid taper and cessation may be more successful when depression is treated to remission.
Several United States (US) federal agencies have developed visual resource inventory (VRI) and management systems that reflect specific agency missions and visual resource management objectives. These programs have varied in the degree to which they incorporate historic and cultural elements and values into the scenic inventory process. The recent nationwide expansion of renewable energy and associated transmission development is causing an increase in visual impacts on both scenic and historic/cultural resources. This increase has highlighted the need for better integration of visual and historic/cultural resource assessment and management activities for land use planning purposes. The US Department of the Interior National Park Service (NPS), in response to concerns arising from potential scenic impacts from renewable energy, electric transmission, and other types of development on lands and waters near NPS units, has developed a VRI process for high-value views both within and outside NPS unit boundaries. The NPS VRI incorporates historic and cultural elements and values into the scenic resource inventory process and provides practical guidance and metrics for successfully integrating historic and cultural concerns into the NPS’s scenic resource conservation efforts. This article describes the NPS VRI process and compares it with the VRI processes of the US Department of the Interior Bureau of Land Management and the US Department of Agriculture Forest Service, with respect to the incorporation of historic and cultural values. The article discusses why a scenic inventory approach that more robustly integrates the historic and cultural values of the landscape is essential for NPS landscapes, and for fulfillment of NPS’s mission. Inventories are underway at many NPS units, and the results indicate that the VRI process can be used successfully to capture important historic and cultural resource information and incorporate that information into the assessment of the scenic values of views within and outside NPS units.
A-theorists think there is a fundamental difference between the present and other times. This concern shows up in what kinds of properties they take to be instantiated, what objects they think exist and how they formalize their views. Nearly every contemporary A-theorist assumes that her metaphysics requires a tense logic – a logic with operators like (‘it was the case that...’) and (‘it will be the case that...’). In this paper, I show that there is at least one viable A-theory that does not require a logic with tense operators. And I will argue that three common indispensability arguments for tense operators are unsound.
A rare subclass of Type Ia supernovae (SNe Ia) shows evidence of strong interaction with a hydrogen-rich circumstellar medium (CSM); these objects are referred to as SNe Ia-CSM. PTF11kx began life as a SN Ia, but after a month it began to show indications of significant interaction with its CSM. This well-studied object solidified the connection between SNe Ia-CSM and more typical SNe Ia, despite their spectral similarity to Type IIn SNe (which likely come from massive star progenitors, as opposed to the white dwarf progenitors for the SNe Ia-CSM). The spectra of all ~20 known SNe Ia-CSM are dominated by Hα emission (with widths of ~2000 km s−1) and exhibit large Hα/Hβ intensity ratios; moreover, they have an almost complete lack of He I emission (see left panel of Figure 1). They also show possible evidence of dust formation through a decrease in the red wing of Hα 75–100 days past maximum brightness. The absolute magnitudes of SNe Ia-CSM are found to be -21.3 mag ≤ MR ≤ −19 mag (see right panel of Figure 1), and they also show ultraviolet emission at early times and strong infrared emission at late times (but no detected radio or X-ray emission). Finally, the host galaxies of SNe Ia-CSM imply that these objects come from a relatively young stellar population.
Whether contact precautions (CP) are required to control the endemic transmission of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) in acute care hospitals is controversial in light of improvements in hand hygiene, MRSA decolonization, environmental cleaning and disinfection, fomite elimination, and chlorhexidine bathing.
To provide a framework for decision making around use of CP for endemic MRSA and VRE based on a summary of evidence related to use of CP, including impact on patients and patient care processes, and current practices in use of CP for MRSA and VRE in US hospitals.
A literature review, a survey of Society for Healthcare Epidemiology of America Research Network members on use of CP, and a detailed examination of the experience of a convenience sample of hospitals not using CP for MRSA or VRE.
Hospital epidemiologists and infection prevention experts.
No high quality data support or reject use of CP for endemic MRSA or VRE. Our survey found more than 90% of responding hospitals currently use CP for MRSA and VRE, but approximately 60% are interested in using CP in a different manner. More than 30 US hospitals do not use CP for control of endemic MRSA or VRE.
Higher quality research on the benefits and harms of CP in the control of endemic MRSA and VRE is needed. Until more definitive data are available, the use of CP for endemic MRSA or VRE in acute care hospitals should be guided by local needs and resources.
Infect Control Hosp Epidemiol 2015;36(10):1163–1172
To explore attitudes and perceptions towards workplace-based assessment (WPBA) among psychiatric trainers in Wales and to compare them with those of trainees. To identify current problems and report recommendations made by survey respondents to streamline and successfully implement WPBA. An anonymous questionnaire-based cross-sectional online survey was conducted involving consultant psychiatrists in Wales and the results compared with a previous survey of specialty registrars.
In total, 104 of 164 consultants participated (63%), compared with 81 of 88 trainees (92%). Both surveys highlighted numerous problems and negative attitudes towards WPBA. Compared with widespread dissatisfaction among trainees, trainers appear more diverse in their opinions, although considerable numbers are dissatisfied with the new competency-based system.
Negative attitudes harboured by many trainees and trainers constitute a significant hurdle to the effective implementation of WPBA and undermine its efficacy as a tool intended to improve training. Specific measures with the potential to address various shortcomings are discussed, with a view to improving WPBA and rendering it more acceptable to both trainees and trainers – and thus facilitate improvement of training.
Never before has there been such a wealth of versatile ground- and space-based facilities with which to detect variable emission across the electromagnetic spectrum and beyond, to non-EM signals such as neutrinos and gravitational waves, to probe the most extreme phenomena in the Universe. The variable sky is already providing a wealth of new and surprising observations of phenomena such as GRBs, SNe and AGN that are pushing current theories beyond the state of the art. Multi-messenger follow-up will soon become de rigeur, and upcoming radio and optical all-sky transient surveys will revolutionise the study of the transient Universe. In addition to the technical and data challenges presented by such surveys, a major new challenge will be the interpretation of the wealth of available data and the identification of the underlying physics of new classes of variable (and potentially exotic) objects. Theoretical predictions will be vital for interpreting these future transient discoveries.
The goal of this workshop was to bring together theorists and observers in order to identify unexplored synergies across three main research areas of extreme physics: gamma-ray bursts, supernovæ and, more generically, relativistic jets. It aimed to discuss key outstanding questions in these rapidly moving fields, such as the composition and acceleration of GRB and AGN jets, GRB progenitors and central engines, the origin of the wide range of observed variability time-scales in GRB prompt and after-glow light curves and related cosmological applications, the physics of the newly-discovered ultra-luminous SN-like optical transients—as well as to speculate on what we might hope to discover with future technology.
The workshop absorbed two 90-minute sessions, selecting 3 main science topics (Relativistic Jets, GRBs and SNe) which it organised as structured discussions driven by a series of short but provocative questions. The final session featured a panel-led debate but with full audience participation.
We present photometry and spectroscopy of the peculiar Type II supernova SN 2010jp, also named PTF10aaxi. The light curve exhibits a linear decline with a relatively low peak absolute magnitude of only −15.9 (unfiltered), and a low radioactive decay luminosity at late times that suggests a low synthesized nickel mass of about 0.003 M⊙ or less. Spectra of SN 2010jp display an unprecedented triple-peaked Hα line profile, showing: (1) a narrow central component that suggests shock interaction with a dense circumstellar medium (CSM); (2) high-velocity blue and red emission features centered at −12,600 and +15,400 km s−1; and (3) very broad wings extending from −22,000 to +25,000 km s−1. We propose that this line profile indicates a bipolar jet-driven explosion, with the central component produced by normal SN ejecta and CSM interaction at mid and low latitudes, while the high-velocity bumps and broad line wings arise in a nonrelativistic bipolar jet. Jet-driven SNe II are predicted for collapsars resulting from a wide range of initial masses above 25 M⊙, especially at the sub-solar metallicity consistent with the SN host environment. It also seems consistent with the apparently low 56Ni mass that may accompany black hole formation. We speculate that the jet survives to produce observable signatures because the star's H envelope was very low mass, having been mostly stripped away by the previous eruptive mass loss.