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.
Arising from the 2019 Darwin College Lectures, this book presents essays from seven prominent public intellectuals on the theme of vision. Each author examines this theme through the lens of their own particular area of expertise, making for a lively interdisciplinary volume including chapters on neuroscience, colour perception, biological evolution, astronomy, the future of technology, computer vision, and the visionary core of science. Featuring contributions by professors of neuroscience Paul Fletcher and Anya Hurlbert, professor of zoology Dan-Eric Nilsson, the futurist Sophie Hackford, Microsoft distinguished scientist Andrew Blake, theoretical physicist and author Carlo Rovelli, and Dr Carolin Crawford, the Public Astronomer at the University of Cambridge, this volume will be of interest to anybody curious about how we see the world.
Larvae of sea urchins, brittle stars, and allies are common, ecologically important, and diverse members of marine ecosystems in all of the world's oceans today. In contrast to modern representatives, the fossil record of echinoderm larvae is poorly known. This study reports the first ophiopluteus skeleton from Cretaceous sediments worldwide, obtained from chalky sediment of the Isle of Wolin, NW Poland. The evidence presented here, that it is possible to isolate fossil echinoderm larval skeletons from rocks, indicates a hidden diversity of such fragile fossils and thus the possibility of direct geological recording.
The importance of prototyping is unanimous with numerous studies into the media, types, roles and properties of prototypes. However, no recent papers have sought to examine and characterise industry practice and if and how this has changed since the early 2000s.
To address this, a snapshot of industrial prototyping practice with particular attention to the what, when, why, how, and by whom is reported. The study involved five small-medium sized design companies based in the South-West of the UK and validation of the findings by two independent practitioners.
The snapshot revealed that 3D printing and virtual prototyping tools have reached widespread adoption in SMEs,that their design processes are highly agile and iterative and are difficult to fit to any extant design process model.
Rather, the approaches appear to implicitly comprise of three levels of design convergence: macro, meso, and micro, which correspond to finer/more detailed changes.
The results also reveal the frequent transitions between digital and physical media and the need to manage these transitions to ensure the product representations in different media are appropriately up-to-date.
Digital inclusion is becoming more important as many consumer products and engineered systems adopt increasingly digital interfaces. The designers of such services often assume that users have a certain level of digital interface competence, but this is not the case for many users. In this paper, we present a set of personas that could help designers to better understand and consider the range of digital expertise across the population. The personas are based on survey data from 338 people across England and Wales in 2019. The survey examined various factors that affect ability to use digital interfaces, including technology experience, attitudes towards technology and competence with basic interface operations. Twelve clusters were identified using K-means cluster analysis, and twelve personas were developed based on these. The personas help to bring to life the range of digital expertise and highlight people at risk of digital exclusion. In addition, the cluster sizes indicate the proportion of the population represented by each persona and thus the scale of potential digital exclusion.
David Kepesh, the protagonist of The Breast (1972), The Professor of Desire (1977), and The Dying Animal (2001), is one such protagonist. This chapter will discuss “The Kepesh novels” as a whole, addressing the benefits and drawbacks of considering these novels as a neatly combined unit, and examining their place within Roth’s body of work as a whole, commenting on what they reveal evolution of his ideas about literature, psychoanalysis, masculinity, and aging.
An ‘ethnic’ or ‘group’ density effect in psychosis has been observed, whereby the risk of psychosis in minority group individuals is inversely related to neighbourhood-level proportions of others belonging to the same group. However, there is conflicting evidence over whether this effect differs between minority groups and limited investigation into other moderators.
To conduct a comprehensive systematic review and meta-analysis of the group density effect in psychosis and examine moderators.
Four databases were systematically searched. A narrative review was conducted and a three-level meta-analysis was performed. The potential moderating effect of crudely and specifically defined minority groups was assessed. Country, time, area size and whether studies used clinical or non-clinical outcomes were also tested as moderators.
Thirty-two studies were included in the narrative review and ten in the meta-analysis. A 10 percentage-point decrease in own-group density was associated with a 20% increase in psychosis risk (OR = 1.20, 95% CI 1.09−1.32, P < 0.001). This was moderated by crudely defined minority groups (F6,68 = 6.86, P < 0.001), with the strongest associations observed in Black populations, followed by a White Other sample. Greater heterogeneity was observed when specific minority groups were assessed (F25,49 = 7.26, P < 0.001).
This is the first review to provide meta-analytic evidence that the risk of psychosis posed by lower own-group density varies across minority groups, with the strongest associations observed in Black individuals. Heterogeneity in effect sizes may reflect distinctive social experiences of specific minority groups. Potential mechanisms are discussed, along with the implications of findings and suggestions for future research.
We examine the effects of horizontally layered heterogeneities on the spreading of two-phase gravity currents in a porous medium, with application to numerous environmental flows, most notably geological carbon sequestration. Heterogeneities, which are ubiquitous within geological reservoirs, affect the large-scale propagation of two-phase flows through the action of small-scale capillary forces, yet the relationship between these small- and large-scale processes is poorly understood. Here, we derive a simple upscaled model for a gravity current under an impermeable cap rock, which we use to investigate the effect of a wide range of centimetre-scale heterogeneities on kilometre-scale plume migration. By parameterising in terms of different types of archetypal layering, we assess the sensitivity of the gravity current to the distribution and magnitude of these heterogeneities. Furthermore, since field measurements of heterogeneities are often sparse or incomplete, we quantify how uncertainty in such measurements manifests as uncertainty in the macroscale flow predictions. Using realistic parameter values, we demonstrate that heterogeneities can enhance plume migration speeds by as much as 200 %, and that uncertainty in field measurements can have dramatic consequences on flow predictions, particularly in post-injection scenarios where the role of capillary forces in heterogeneities is accentuated.
Popular and scholarly information concerning the life of James Croll has been accumulating slowly since the death in 1890 of the self-taught climate change pioneer. The papers in the current volume offer thorough assessments of topics associated with Croll's work, but this contribution seeks to provide a personal context for an understanding of James Croll the man, as well as James Croll the scholar of sciences and religion. Using archival as well as published sources, emphasis is placed upon selected components of his life and some of the less recognised features of his biography. These include his family history, his many homes, his health, participation in learned societies and attitudes to collegiality, financial problems including the failed efforts to secure a larger pension, and friendship. Life delivered a mixture of ‘trials and sorrows’, but it seems clear from the affection and respect accorded him that many looked upon James Croll as a ‘man greater far than his work’.
In the early days of the first global wave of the COVID-19 pandemic, the potential for a post-viral syndrome to manifest following COVID-19 infection was highlighted.
It was pointed out that an early intervention applying management techniques used in patients with CFS/ME appeared to help reduce the fatigue related symptoms of Long COVID.
Here we present an analysis of a consecutive case series of the first twenty patients’ data collected. Our aim was to evaluate the potential of this mode of treatment for Long COVID.
Face to face treatment sessions with the practitioners occurred once a week, involving effleurage and other manual articulatory techniques.
The individuals being treated also undertook a daily self-massage along with gentle mobility exercises and alternating warm and cool gel packs on the upper spine, to encourage a reduction of spinal inflammation and further aid lymph drainage of the brain and spine.
Symptom severity was recorded using the self-reported 54-item Profile of Fatigue Related States (PFRS).
The mean age of the men was 41.8 years with a range of 29.1-53.1 years with the corresponding mean age for women being 39.3 years with a range of 28.3-50.4 years.
The average time interval between onset of Coronavirus symptoms and start of treatment for Long COVID was just over 20 weeks. The average number of treatment sessions was similar at 9.7 in men and 9.4 in women.
The change in Profile of Fatigue Related States (PFRS) score was similar in men with a significant decrease (-45%) as in women (-52%) (F 4.8, p < 0.001).
None of the individuals had any prior diagnosis of chronic fatigue syndrome.
All were new attendees to the clinic at the time of initial assessment.
Our findings indicate that this intervention based on massage and mobility exercises significantly reduced fatigue related to Long COVID.
It may be that early intervention and supportive treatments at the end of the acute phase of COVID-19 can help overcome acute phase symptoms and prevent them becoming chronic/enduring.
In March 2020, when the COVID-19 outbreak emerged, Technology Enabled Care (TEC) Cymru went into partnership with the Welsh Government and CWTCH Cymru to offer a safe solution to protect the NHS and the public by developing and rolling-out a National Video Consulting (VC) Service on an All-Wales basis.
The aim was to quickly develop and roll-out an NHS-approved communication platform (Attend Anywhere) to all primary, secondary and community care services, and into care homes, prisons, dentistry, optometry and pharmacy to offer video consultations to patients.
The NHS Wales Video Consulting (VC) Service used a robust mixed methodology of surveys and interviews with patients, families and professionals. The real-time quality improvement approach was invaluable to the team as findings continually informed the approach and direction.
Based upon 10,000 survey responses from patients and professionals, and more than 300 interviews the results demonstrate that video consulting is consistently high in satisfaction, clinical suitability and acceptability across a wide range of patient demographics and clinical specialties in Wales. The key findings are
Very high in patient and clinician satisfaction (slightly higher in patients).
Clinically suitable across a wide range of specialties, care sectors and Health Boards.
Very high in patient and clinician satisfaction (slightly higher in patients).
High acceptability of VC, which is believed to be associated to the ‘Welsh Way’ of digital implementation processes.
Consistent data patterns across patient demographics (age, gender, urban/rural location).
Consistent data patterns across clinical settings and Health Boards.
There is large appetite for VC in Wales, with high potential of sustainability and long-term use beyond COVID-19. The service is now working with clinicians, patients, carers and policy makers to explore the long-term use and sustainability of video consultations in Wales
Complete an audit of Section 2 and Section 3 Mental Health Act Paperwork in Derby Inpatient psychiatric units using an audit tool developed in a study by Mason et al. (2012).
The 1983 Mental Health Act enables doctors approved on behalf of the Secretary of State under Section 12 to be able to make recommendations for the detention of individuals with a mental health problem where the degree and/or nature, and associated risk to that person's health or safety, or that of others, makes inpatient care necessary. For the detention and the associated deprivation of their liberty to be lawful, it is necessary that the clinical situation meets certain criteria as outlined in the Mental Health Act.
Ward status was reviewed for each inpatient ward in Derby and the first five patients alphabetically, who were detained under sections 2 or 3 were selected. The Mental Health Act medical recommendation documents were reviewed according to the necessary criteria, using an assessment tool generated from a study by Mason et al. in 2012 ‘Compulsion under the Mental Health Act 1983: audit of the quality of medical recommendations’. A junior colleague was trained to analyse Mental Health Act paperwork using the audit tool. Medical recommendations were reviewed and rated as ‘clear’, ‘implied’ or ‘none’ for each criterion.
Evidence of a mental health problem and the nature or degree of illness was well documented. Evidence regarding why informal admission was not appropriate was also reasonable but with room for improvement. Poor compliance was evident mostly in relation to the justification related to risk to health, safety or others, the lowest clearly documented percentage of these appear to be regarding health.
From analysing the documentation, often written justification incorporated general safety as a whole; however health and safety are identified by the mental health act as separate criterion requiring clear justification of each. In a number of occasions people failed to identify which of the three risk categories were relevant for the patient. Potential criticisms of this audit include the subjective nature of the interpretation of clearly explained and implied and that data analysis was completed by a non-section 12 approved doctor. Data were presented at the local weekly academic teaching to raise awareness of the results and a recommendation was made for the subject to be included in the junior doctor induction.
To measure the rate of patients receiving high dosage antipsychotics.
To review the adherence to maximum recommended doses of antipsychotics as per the product information approved by Australian Therapeutic Goods Administration, product information approved by Medsafe (the New Zealand Medicines and Medical Devices Safety Authority) and Therapeutic Guidelines (Psychotropic Writing Group, 2013)
High dose antipsychotics or combination of antipsychotics are associated with significant adverse effects including QTc prolongation, arrhythmias, sudden cardiac death, seizures, increased incidence and severity of adverse effects, longer hospital stay and possibly increased mortality. High dose antipsychotic prescribing may arise as a result of EITHER single antipsychotic drug prescribed at a daily dose above the recommended limit (High Dose single drug) OR More than one antipsychotic prescribed concurrently where the sum of doses given expressed as a percentage of the SPC maximum of each drug exceeds 100% (High-Dose through the prescribing of multiple drugs).
The data were gathered from all the drug charts for all patients admitted to HDU and Acute ward on 9th April 2019. The Audit standards were 1) Individual antipsychotic dose should be within recommended limit as 100% and 2) Combined antipsychotics should be within recommended limit as 100%
Total number of patients on both the HDU and Acute wards = 33
Total number of patients on antipsychotics = 30
Number of patients on > 100% of recommended cumulative dosage = 13/30 = 43.3%
Number of patients on > 100% maximum limits of regular antipsychotics = 3 = 10%
Number of patients on > 100% maximum limits of PRN antipsychotics = 0/30
Number of patients on 2 antipsychotic = 18/30 = 60%
Number of patients on 3 antipsychotic = 8/30 = 26.6%
Number of patients on 4 antipsychotic = 2/30 = 6.6%
Out of the 30 patients on antipsychotics, almost half were on more than 100% of the recommended cumulative maximum limits of antipsychotics doses, almost 2/3rds were on 2 or more antipsychotic and a quarter on 3 or more. This can be associated with significant adverse effects including QTc prolongation, arrhythmias, sudden cardiac death, seizures, increased incidence and severity of adverse effects, longer hospital stay and possibly increased mortality. There is a need to review PRN antipsychotics prescribed as a norm, clear documentation and need for a protocol for increased vital sign monitoring for patients on high dose antipsychotic treatment.