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End-of-life care (EOLC) communication is beneficial but underutilized, particularly in conditions with a variable course such as chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF). Physicians’ emotional distress intolerance has been identified as a barrier to EOLC communication. However, studies of emotional distress intolerance in EOLC have largely relied on anecdotal reports, qualitative data, or observational studies of physician–patient communication. A free-standing measure of multiple dimensions of distress tolerance is warranted to enable the identification of individuals experiencing distress intolerance and to facilitate the effective targeting of interventions to improve distress tolerance.
Objectives
This study provides preliminary data on the reliability and validity of the Physician Distress Intolerance (PDI) scale. We examine potential subdimensions of emotional distress intolerance.
Method
Family medicine and internal medicine physicians completed the PDI, read vignettes describing patients with COPD or CHF, and indicated whether they initiated or delayed EOLC communication with their patients with similar conditions.
Results
Exploratory and confirmatory factor analyses were performed on separate samples. Confirmatory factor analysis confirmed that a three-factor solution was superior to a two- or one-factor solution. Three subscales were created: Anticipating Negative Emotions, Intolerance of Uncertainty, and Iatrogenic Harm. The full scale and subscales had adequate internal consistency and demonstrated evidence of validity. Higher scores on the PDI, indicating greater distress intolerance, were negatively associated with initiation and positively associated with delay of EOLC communication. Subscales provided unique information.
Significance of results
The PDI can contribute to research investigating and addressing emotional barriers to EOLC communication.
Childhood adversity and anxiety have been associated with increased risk for internalizing disorders later in life and with a range of brain structural abnormalities. However, few studies have examined the link between harsh parenting practices and brain anatomy, outside of severe maltreatment or psychopathology. Moreover, to our knowledge, there has been no research on parenting and subclinical anxiety symptoms which remain persistent over time during childhood (i.e., between 2.5 and 9 years old). Here, we examined data in 94 youth, divided into four cells based on their levels of coercive parenting (high / low) and of anxiety (high / low) between 2.5 and 9 years old. Anatomical images were analyzed using voxel-based morphometry (VBM) and FreeSurfer. Smaller gray matter volumes in the prefrontal cortex regions and in the amygdala were observed in youth with high versus low levels of harsh parenting over time. In addition, we observed significant interaction effects between parenting practices and subclinical anxiety symptoms in rostral anterior cingulate cortical thickness and in amygdala volume. These youth should be followed further in time to identify which youth will or will not go on to develop an anxiety disorder, and to understand factors associated with the development of sustained anxiety psychopathology.
Bipolar disorder is an episodic, highly impairing mood disorder that is estimated to have a prevalence of 2–3% in the general population and is one of the leading causes of years lived with a disability.(1) Lithium is the gold standard for the treatment of bipolar disorder, and although it is a simple element, its effects on the brain are very complex.(2) Lithium’s potential neurotrophic and neuroprotective effects raise the intriguing possibility that it can potentially ameliorate abnormalities in brain structure and thus alter the disease trajectory.
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.
A new high time resolution observing mode for the Murchison Widefield Array (MWA) is described, enabling full polarimetric observations with up to
$30.72\,$
MHz of bandwidth and a time resolution of
${\sim}$
$0.8\,\upmu$
s. This mode makes use of a polyphase synthesis filter to ‘undo’ the polyphase analysis filter stage of the standard MWA’s Voltage Capture System observing mode. Sources of potential error in the reconstruction of the high time resolution data are identified and quantified, with the
$S/N$
loss induced by the back-to-back system not exceeding
$-0.65\,$
dB for typical noise-dominated samples. The system is further verified by observing three pulsars with known structure on microsecond timescales.
We describe system verification tests and early science results from the pulsar processor (PTUSE) developed for the newly commissioned 64-dish SARAO MeerKAT radio telescope in South Africa. MeerKAT is a high-gain (
${\sim}2.8\,\mbox{K Jy}^{-1}$
) low-system temperature (
${\sim}18\,\mbox{K at }20\,\mbox{cm}$
) radio array that currently operates at 580–1 670 MHz and can produce tied-array beams suitable for pulsar observations. This paper presents results from the MeerTime Large Survey Project and commissioning tests with PTUSE. Highlights include observations of the double pulsar
$\mbox{J}0737{-}3039\mbox{A}$
, pulse profiles from 34 millisecond pulsars (MSPs) from a single 2.5-h observation of the Globular cluster Terzan 5, the rotation measure of Ter5O, a 420-sigma giant pulse from the Large Magellanic Cloud pulsar PSR
$\mbox{J}0540{-}6919$
, and nulling identified in the slow pulsar PSR J0633–2015. One of the key design specifications for MeerKAT was absolute timing errors of less than 5 ns using their novel precise time system. Our timing of two bright MSPs confirm that MeerKAT delivers exceptional timing. PSR
$\mbox{J}2241{-}5236$
exhibits a jitter limit of
$<4\,\mbox{ns h}^{-1}$
whilst timing of PSR
$\mbox{J}1909{-}3744$
over almost 11 months yields an rms residual of 66 ns with only 4 min integrations. Our results confirm that the MeerKAT is an exceptional pulsar telescope. The array can be split into four separate sub-arrays to time over 1 000 pulsars per day and the future deployment of S-band (1 750–3 500 MHz) receivers will further enhance its capabilities.
Depression and anxiety are the commonest psychiatric disorder in patient with thyroid disorders but continues to be significantly under-recognized and under treated. As a result, it may affect quality of life.
Objective
The objective was to determine the prevalence of depression and anxiety among thyroid patients and their associates.
Methods
This is a cross-sectional study conducted in the Endocrinology Clinic in University Malaya Medical Centre. The patients were interviewed by using MINI International Neuropsychiatry Inventory (MINI) for diagnostic assessment. Socio-demographic and the clinical data were obtained by interviewing the patients and also from the case notes. Quality of life was assessed by using Short Form Health Questionnaires (SF-36).
Results
A total of 160 subjects were recruited. Current prevalence of 9.4% for Major Depressive Disorder (MDD) and 22.5% for Anxiety Disorder (AD) were found using MINI. Lifetime prevalence was 17.5% for MDD and 27.5% for AD. Panic disorder was the commonest type of anxiety disorder (16.9%) followed by generalized anxiety disorder (11.3%), social phobia (4.4%), agoraphobia (2.5%) and obsessive compulsive disorder (1.9%). Having past history of depression or anxiety was highly significantly associated with MDD (p< 0.001, OR 276.6, 95% CI= 33.2-2306.9) and AD (p< 0.001, OR=16, 95% CI=4.9-51.6). The score for quality of life was lower in those with MDD and AD. It was more pronounced among MDD patients.
Conclusion
The prevalence of MDD and AD among patients with thyroid disorders should be recognised. In addition, patients with MDD and AD had poorer quality of life.
Frailty is associated with cognitive decline in older adults. However, the mechanisms explaining this relationship are poorly understood. We hypothesized that sleep quality may mediate the relationship between frailty and cognition.
Participants:
154 participants aged between 50-90 years (mean = 69.1 years, SD = 9.2 years) from the McKnight Brain Registry were included.
Measurements:
Participants underwent a full neuropsychological evaluation, frailty and subjective sleep quality assessments. Direct relationships between frailty and cognitive function were assessed using linear regression models. Statistical mediation of these relationships by sleep quality was assessed using nonparametric bootstrapping procedures.
Results:
Frailty severity predicted weaker executive function (B = −2.77, β = −0.30, 95% CI = −4.05 – −1.29) and processing speed (B = −1.57, β = −0.17, 95% CI = −3.10 – −0.16). Poor sleep quality predicted poorer executive function (B = −0.47, β = −0.21, 95% CI = −0.79 – −0.08), processing speed (B = −0.64, β = −0.28, 95% CI = −0.98 – −0.31), learning (B = −0.42, β = −0.19, 95% CI = −0.76 – −0.05) and delayed recall (B = −0.41, β = −0.16, 95% CI = −0.80 – −0.31). Poor sleep quality mediated the relationships between frailty severity and executive function (B = −0.66, β = −0.07, 95% CI = −1.48 – −0.39), learning (B = −0.85, β = −0.07, 95% CI = −1.85 – −0.12), delayed recall (B = −0.47, β = −0.08, 95% CI = −2.12 – −0.39) and processing speed (B = −0.90, β = −0.09, 95% CI = −1.85 – −0.20).
Conclusions:
Relationships between frailty severity and several cognitive outcomes were significantly mediated by poor sleep quality. Interventions to improve sleep quality may be promising avenues to prevent cognitive decline in frail older adults.
We report the observation of a nonlinear wave packet propagating through a relaxed Taylor state in the Swarthmore Spheromak eXperiment (SSX) device. The wave packet is launched by a fast, pulsed, high current (${\approx}21~\text{kA}$) single-turn theta-pinch coil mounted outside the plasma vessel. The theta-pinch coil is energized by discharging a 40 kV, 2 kJ capacitor circuit. The wave packet velocity is super-thermal and super-Alfvénic; its group velocity is more consistent with a whistler pulse than other characteristic velocities. We also observe a fast density pulse which indicates that it is not Alfvénic in nature.
Perinatal exposure to sucrose or high-fructose corn syrup-55 (HFCS-55) in rats has previously been associated with altered hepatic fat content and composition post-weaning, although the effects on hepatic metabolism are unknown. The current study aimed to determine the sex-specific effects of maternal consumption of sucrose or HFCS-55 on the expression of hepatic lipogenic genes in the offspring. Liver samples were collected from offspring of albino Wistar rats provided with ad libitum access to either water (control), 10% sucrose or 10% HFCS-55 solution during pregnancy and lactation at 3 weeks (control n=16, sucrose n=22, HFCS-55 n=16) and 12 weeks (control n=16, sucrose n=10, HFCS-55 n=16) of age. Hepatic expression of the transcription factors such as carbohydrate response element-binding protein, sterol regulatory element-binding protein-1c and downstream genes was determined by quantitative real-time PCR. Sucrose-exposed offspring had higher hepatic SREBP-1c messenger RNA expression compared with control and HFCS-55 groups at both 3 weeks (P=0.01) and 12 weeks (P=0.03) of age. There were no differences in the expression of other hepatic lipogenic genes between groups at either 3 or 12 weeks. Thus, perinatal exposure to sucrose may be more detrimental to offspring hepatic metabolism compared with HFCS-55, independent of sex, and it will be important to evaluate the longer-term effects of perinatal sucrose exposure in future studies.
Common cottonwood-based agroforestry system is widely adopted in Indian Indo-Gangetic plains. The stem cuttings of common cottonwood are raised in a nursery 10 to 12 months in rows spaced 0.5 mx0.5 m, before re-planting in the field. The longer duration of 10 to 12 months and wider spacing of stem cuttings in the nursery makes the entire transplants highly vulnerable to weed competition, especially during early establishment stages. The efficacy of preemergence herbicides and plastic and straw mulches for weed management in common cottonwood nursery was investigated at two sites in years 2014 and 2015. The major weed flora in the experimental field consisted of three grass weeds (crowfootgrass, feather lovegrass, and southern crabgrass), and four broadleaf weeds (scarlet pimpernel, garden spurge, niruri, and lesser swinecress). The integrated use of pendimethalin or alachlor applied PRE with paddy straw mulch significantly reduced density and biomass of both grass and broadleaf weeds compared to herbicide or straw mulch used alone, and provided similar level of weed control to hand weeding at both locations. Spreading of plastic mulch in the whole field after punching holes for common cottonwood stem cuttings, or in row spaces recorded similar weed control to hand-weeding. The integrated use of herbicides with straw mulch, and or plastic mulch alone significantly improved plant height, stem diameter, below- and above-ground biomass of common cottonwood plants compared to unweeded check. The study concluded that integrated use of herbicides plus paddy straw mulch or plastic mulch alone could be adopted for weed management in common cottonwood nursery plantations.
Measurements of local plasma parameters in dusty plasma are crucial for understanding
the physics issues related to such systems. The Langmuir probe, a small electrode
immersed in the plasma, provides such measurements. However, designing of a Langmuir
probe system in a dusty plasma environment demands special consideration. First, the
probe has to be miniaturized enough so that its perturbation on the ambient dust
structure is minimal. At the same time, the probe dimensions must be such that a
well-defined theory exists for interpretation of its characteristics. The associated
instrumentation must also support the measurement of current collected by the probe
with high signal to noise ratio. The most important consideration, of course, comes
from the fact that the probes are prone to dust contamination, as the dust particles
tend to stick to the probe surface and alter the current collecting area in
unpredictable ways. This article describes the design and operation of a Langmuir
probe system that resolves these challenging issues in dusty plasma. In doing so,
first, different theories that are used to interpret the probe characteristics in
collisionless as well as in collisional regimes are discussed, with special emphasis
on application. The critical issues associated with the current–voltage
characteristics of Langmuir probe obtained in different operating regimes are
discussed. Then, an algorithm for processing these characteristics efficiently in
presence of ion-neutral collisions in the probe sheath is presented.
In the present research work, the authors have investigated the self-focusing and defocusing of Hermite-cosh-Gaussian laser (HChG) beam in an inhomogeneous rippled density plasmas. By taking the relativistic non-linearity into account, an equation for envelope is set up and solved using Wentzel–Kramers–Brillouin and the paraxial ray approximation. An ordinary non-linear differential equation governing the beam width parameter as a function of propagation distance is set up for different mode structures of the beam. Further, a numerical study of this differential equation is carried for suitable set of plasma and laser parameters. The beam undergoes periodic self-focusing/defocusing due to relativistic non-linearity. We also report the comparison between self-focusing/defocusing of HChG beam in the absence and presence of density ripple. Presence of ripple does not only leads to substantial increase in self-focusing length, but also results in oscillatory character with decreasing f. In a relativistic case, strong oscillatory self-focusing and defocusing is observed. Further, self-focusing is enhanced with increased value of decentered parameter.
Human embryonic stem cells (hESCs) are known for their indefinite self-renewal ability and pluripotent nature. However, during long-term culture, normal hESCs can undergo neoplastic transformation and acquire enhanced self-renewal ability and aberrant differentiation potential. These transformed-hESCs (trans-hESCs) exhibit high expression of the pluripotent gene, LIN28A. LIN28A, an RNA binding protein, is known: for its role in self-renewal of hESCs, as a reprogramming factor for generating induced-pluripotent stem cells and as a potent oncogene in several poorly differentiated, highly malignant human cancers. Despite its multiple functions, how LIN28A contributes to neoplastic transformation of normal hESCs is poorly understood. Our preliminary data demonstrate that following LIN28A knockdown, trans-hESCs display normal hESCs morphology consisting of both pluripotent colony cells surrounded by more differentiated fibroblast-like cells. Neural precursors derived from LIN28A knockdown trans-hESCs also revert back to a state of normal cell morphology and growth. Further analyses revealed that the expression levels of stage-specific embryonic antigen (SSEA3), OCT3/4 and NANOG decreases and are comparable to that observed in normal hESCs following LIN28A downregulation. Expression of miRNA targets of LIN28A such as let7i and mir125b was increased to levels seen in normal hESCs. These preliminary results indicate that LIN28A is a major contributing factor to neoplastic transformation of hESCs and that this process can be reversed by cellular “reprogramming”. This study will enhance our understanding of role of LIN28A in the transformation process in various human cancers thus, underscoring the value of hESCs and their neoplastic-derivatives as cellular and molecular model for studying tumor progression.
The traditional approach to headache trigger management is to advise avoidance of all triggers, but we have advocated an alternative approach called ‘Learning to Cope with Triggers’ (LCT), in which the objective is to desensitise headache sufferers to some triggers or to build up tolerance for the triggers, using exposure techniques. A recent publication established the efficacy of this approach to trigger management. Reported here are three cases to illustrate how LCT is used in practice. Two cases were male and one was female, with ages ranging from 32 to 67 years. The headache diagnoses were frequent episodic tension-type headache, migraine without aura, and chronic tension-type headache; all had had headaches since childhood/adolescence. The headache triggers that were the focus of the intervention were heat, tiredness, and stress/anger. Post-treatment, changes in the capacity of the triggers to elicit headaches were reported in all three cases. Reductions in headaches from pre- to post-treatment, and from pre- to 4-month follow-up, were: case 1, 69% and 60% respectively; case 2, 76% and 80% respectively; and case 3, 73% and 61% respectively. Decreases in medication consumption, and enhanced self-efficacy were also recorded.
Aspiration pneumonia is an important cause of death in head and neck cancer patients. This study therefore aimed to evaluate the risk factors associated with aspiration pneumonia in head and neck cancer patients.
Methods:
Hospital death records from 12 years (2000–2012) were reviewed to obtain the number of deaths. Treatment details and cause of death were analysed. Statistical analysis was performed to identify the risk factors for aspiration pneumonia.
Results:
The records revealed that aspiration pneumonia was the cause of death in 51 out of 85 patients. Primary tumour site (oropharynx and hypopharynx, odds ratio 3.3; 95 per cent confidence interval 1.17–9.4, p = 0.02) and advanced tumour stage (odds ratio 4.2, 95 per cent confidence interval 1.16–15.61, p = 0.02) had significant negative impacts on aspiration pneumonia related mortality.
Conclusion:
Advanced pharyngeal cancer patients are at an increased risk of aspiration pneumonia related death. Investigations for the early detection of this condition are recommended in these high-risk patients.
Single step synthesis of monophase CuSbS2 thin films by electro-deposition in ionic liquid electrolyte based on choline chloride and urea (ChCl:U) eutectic mixture is described. The formation of binary CuxS and SbxSy film phases using CuCl2 and SbCl3 precursors along with Na2S2O3 as sulfur source in ChCl:U are established as -0.59 V and -0.36 V vs. Pt, respectively by cyclic voltammetry and used to optimize CuSbS2 thin films growth potential and precursor composition. CuSbS2 films deposited at -0.65 V vs Pt with 1:1 Cu to Sb precursor ratio at 80⁰C are highly crystalline in chalcostibite orthorhombic structure. Deviant Cu/Sb ratio at 1:0.71 and 1:1.4 reveal inclusion of Cu3SbS3 and Sb2S3, respectively. Direct 1.65 eV band gap for single phase CuSbS2 film and with inclusive secondary phases at 1.73±0.1 eV and 2.13 eV is observed. As-deposited CuSbS2 films are p-type and n-p hetero-junction device in the n-ZnO/p-CuSbS2/Ag structure shows rectifying I-V curves and dependence on the CuSbS2 film growth conditions.