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We consider the complexity of special
$\alpha $
-limit sets, a kind of backward limit set for non-invertible dynamical systems. We show that these sets are always analytic, but not necessarily Borel, even in the case of a surjective map on the unit square. This answers a question posed by Kolyada, Misiurewicz, and Snoha.
Although mania is the hallmark symptom of bipolar I disorder (BD-I), most patients initially present for treatment with depressive symptoms. Misdiagnosis of BD-I as major depressive disorder (MDD) is common, potentially resulting in poor outcomes and inappropriate antidepressant monotherapy treatment. Screening patients with depressive symptoms is a practical strategy to help healthcare providers (HCPs) identify when additional assessment for BD-I is warranted. The new 6-item Rapid Mood Screener (RMS) is a pragmatic patient-reported BD-I screening tool that relies on easily understood terminology to screen for manic symptoms and other BD-I features in <2 minutes. The RMS was validated in an observational study in patients with clinically confirmed BD-I (n=67) or MDD (n=72). When 4 or more items were endorsed (“yes”), the sensitivity of the RMS for identifying patients with BP-I was 0.88 and specificity was 0.80; positive and negative predictive values were 0.80 and 0.88, respectively. To more thoroughly understand screening tool use among HCPs, a 10-minute survey was conducted.
Methods
A nationwide sample of HCPs (N=200) was selected using multiple HCP panels; HCPs were asked to describe their opinions/current use of screening tools, assess the RMS, and evaluate the RMS versus the widely recognized Mood Disorder Questionnaire (MDQ). Results were reported by grouped specialties (primary care physicians, general nurse practitioners [NPs]/physician assistants [PAs], psychiatrists, and psychiatric NPs/PAs). Included HCPs were in practice <30 years, spent at least 75% of their time in clinical practice, saw at least 10 patients with depression per month, and diagnosed MDD or BD in at least 1 patient per month. Findings were reported using descriptive statistics; statistical significance was reported at the 95% confidence interval.
Results
Among HCPs, 82% used a tool to screen for MDD, while 32% used a tool for BD. Screening tool attributes considered to be of the greatest value included sensitivity (68%), easy to answer questions (66%), specificity (65%), confidence in results (64%), and practicality (62%). Of HCPs familiar with screening tools, 70% thought the RMS was at least somewhat better than other screening tools. Most HCPs were aware of the MDQ (85%), but only 29% reported current use. Most HCPs (81%) preferred the RMS to the MDQ, and the RMS significantly outperformed the MDQ across valued attributes; 76% reported that they were likely to use the RMS to screen new patients with depressive symptoms. A total of 84% said the RMS would have a positive impact on their practice, with 46% saying they would screen more patients for bipolar disorder.
Discussion
The RMS was viewed positively by HCPs who participated in a brief survey. A large percentage of respondents preferred the RMS over the MDQ and indicated that they would use it in their practice. Collectively, responses indicated that the RMS is likely to have a positive impact on screening behavior.
Anomalous coronary arteries from the pulmonary artery are uncommon causes of heart failure in the adult population. This case demonstrates the unusual presentation in a patient with anomalous right coronary artery from the pulmonary artery and discusses the complex pathophysiology of this lesion and the role of guideline-directed medical therapy in the management of these patients.
International best-practice guidelines for the management of first-episode psychosis have recommended the provision of psychoeducation for multifamily groups. While there is ample evidence of their efficacy in multiepisode psychosis, there is a paucity of evidence supporting this approach specifically for first-episode psychosis. We sought to determine whether a six-week caregiver psychoeducation programme geared specifically at first-episode psychosis improves caregiver knowledge and attitudes.
Methods
Caregivers of people with first-episode psychosis completed a 23-item adapted version of the self-report Family Questionnaire (KQ) and a 17-item adapted version of the self-report Drug Attitudes Inventory (DAI) before and after the six-week DETECT Information and Support Course (DISC). Using a Generalised Linear Repeated Measures Model, we analyzed the differences in proportions of correct answers before and after the programme.
Results
Over a 24-month study period, 31 caregivers (13 higher socioeconomic; 13 lower socioeconomic; five unspecified socioeconomic; 19 female; 12 male) participated in the DISC programme and completed inventories before and after the course. Knowledge of psychosis and specific knowledge of medication treatment improved among caregivers overall (p < .01; effect sizes 0.78 and 0.94 respectively). There were no significant gender or socioeconomic differences in any improvement.
Discussion
This study confirms that caregiver psychoeducation specifically for first-episode psychosis directly improves knowledge of the illness overall and, in particular, knowledge of medication. Gender is not a factor in this, while the lack of any socioeconomic differences dispels the myth that patients in lower socioeconomic groups are disadvantaged because their caregivers know less.
Although there is some evidence that duration of untreated psychosis (DUP) is geographically stable, few have examined whether the phenomenon is temporally stable. We examined DUP in two cohorts within two discrete time periods (1995–1999 and 2003–2005) spanning a decade in the same geographically defined community psychiatric service with no early intervention programme. Patients were diagnosed by Structured Clinical Interview for DSM (SCID) and we determined the DUP using the Beiser Scale. The DUP of the 240 participants did not differ significantly between study periods.
Reconstructions of prehistoric vegetation composition help establish natural baselines, variability, and trajectories of forest dynamics before and during the emergence of intensive anthropogenic land use. Pollen–vegetation models (PVMs) enable such reconstructions from fossil pollen assemblages using process-based representations of taxon-specific pollen production and dispersal. However, several PVMs and variants now exist, and the sensitivity of vegetation inferences to PVM selection, variant, and calibration domain is poorly understood. Here, we compare the reconstructions, parameter estimates, and structure of a Bayesian hierarchical PVM, STEPPS, both to observations and to REVEALS, a widely used PVM, for the pre–Euro-American settlement-era vegetation in the northeastern United States (NEUS). We also compare NEUS-based STEPPS parameter estimates to those for the upper midwestern United States (UMW). Both PVMs predict the observed macroscale patterns of vegetation composition in the NEUS; however, reconstructions of minor taxa are less accurate and predictions for some taxa differ between PVMs. These differences can be attributed to intermodel differences in structure and parameter estimates. Estimates of pollen productivity from STEPPS broadly agree with estimates produced for use in REVEALS, while comparison between pollen dispersal parameter estimates shows no significant relationship. STEPPS parameter estimates are similar between the UMW and NEUS, suggesting that STEPPS parameter estimates are transferable between floristically similar regions and scales.
Above and below the knee amputations require basic anatomy knowledge of the muscle compartments, nerves, and arteries of the lower extremity.
The thigh has three compartments: anterior, posterior, and medial. The calf has four compartments: the anterior, lateral, or peroneal in addition to the deep and superficial posterior ones.
The lower extremity is perfused by the superficial and deep femoral artery. The superficial femoral artery continues as the popliteal artery after exiting the Hunter’s canal. The popliteal artery bifurcates into tibialis anterior artery and the tibioperoneal trunk. The tibioperoneal trunk gives the fibular artery and continues as the posterior tibial artery. The femoral and sciatic nerves provide innervation to the lower extremity.
Vitamins and minerals play an essential role within many cellular processes including energy production and metabolism. Biochemical changes and heightened metabolic demands lead to increases in the requirement for certain micronutrients alongside higher excretion of micronutrients through waste products, such as sweat and urine. Previously, supplementation with a multivitamin/mineral (MVM) for ≥ 28 days resulted in improvements to cognition and subjective state. Shifts in metabolism have also been demonstrated during cognitively demanding tasks following MVM in females, both acutely and following 8-week supplementation, suggesting that enhanced recovery is possible following MVM supplementation. The current study aimed to assess these effects further in males and females using metabolically challenging exercise and cognitive tasks.
Materials and Methods
This randomised, placebo-controlled, parallel groups study investigated the effects of a MVM complex in 82 healthy young (18–35y) exercisers. Subjective ratings and substrate metabolism were assessed during 30 minutes each of increasingly effortful incremental exercise and demanding cognitive tasks. Assessments took place on acute study days following a single dose (Day 1) of MVM, containing 3 times recommended daily allowance of water-soluble vitamins plus CoQ10, and following 4-week supplementation (Day 28).
Results
Energy expenditure (EE) was increased during cognitive tasks following MVM across Day 1 and Day 28, with greater effects in males. In males, MVM also increased carbohydrate oxidation and EE during exercise across Day 1 and Day 28. In females, mental tiredness was lower during exercise; increases in physical tiredness following 30 minutes of exercise were attenuated; and stress ratings following cognitive tasks were reduced following MVM. In males, MVM only lowered mental tiredness following 10 minutes of exercise. Those receiving MVM also reported lower ratings of perceived exertion following 10 minutes of exercise. These effects were apparent irrespective of day, but effects on mental tiredness were greater on Day 28. Ferritin levels were also higher on Day 28 in those receiving MVM.
Discussion
These findings extend on existing knowledge, demonstrating increased carbohydrate oxidation and EE in males following MVM supplementation for the first time. Importantly, they show modulation of EE and subjective tiredness following a single dose, providing further evidence for acute effects of MVM. Differential effects in men and women suggest that whilst males expend more energy, females may conserve their energy but report lower tiredness instead, demonstrating that sex may play an important role in the effects of MVM on energy metabolism and should be considered in future research.
Objectives: Autobiographical memory dysfunction is a marker of vulnerability to depression. Patients with obstructive sleep apnea (OSA) experience high rates of depression and memory impairment, and autobiographical memory impairments have been observed compared to healthy controls; however, these groups were not age-matched. This study aimed to determine whether individuals with untreated OSA have impaired autobiographical memory when compared to age-matched controls, and to assess the quality of autobiographical memories from three broad time points. Methods: A total of 44 participants with OSA (M age=49.4±13.0) and 44 age-matched controls (M age=50.0±13.1) completed the Autobiographical Memory Interview (AMI) to assess semantic and episodic memories from three different life stages, and 44 OSA participants and 37 controls completed the Autobiographical Memory Test (AMT) to assess overgeneral memory recall (an inability to retrieve specific memories). Results: OSA participants had significantly poorer semantic recall of early adult life on the AMI (p<.001), and more overgeneral autobiographical memories recalled on the AMT (=.001), than controls. Poor semantic recall from early adult life was significantly correlated with more depressive symptoms (p=0.006) and lower education (p<0.02), while higher overgeneral memory recall was significantly associated with older age (p=.001). Conclusions: A specific deficit in semantic autobiographical recall was observed in individuals with OSA. OSA patients recalled more overgeneral memories, suggesting that aspects of the sleep disorder affect their ability to recollect specific details of events from their life. These cognitive features of OSA may contribute to the high incidence of depression in this population. (JINS 2019, 25, 266–274)
The patterns and drivers of late Quaternary vegetation dynamics in the southeastern United States are poorly understood due to low site density, problematic chronologies, and a paucity of independent paleoclimate proxy records. We present a well-dated (15 accelerator mass spectrometry 14C dates) 30,000-yr record from White Pond, South Carolina that consists of high-resolution analyses of fossil pollen, macroscopic charcoal, and Sporormiella spores, and an independent paleotemperature reconstruction based on branched glycerol dialkyl tetraethers. Between 30,000 and 20,000 cal yr BP, open Pinus-Picea forest grew under cold and dry conditions; elevated Quercus before 26,000 cal yr BP, however, suggest warmer conditions in the Southeast before the last glacial maximum, possibly corresponding to regionally warmer conditions associated with Heinrich event H2. Warming between 19,700 and 10,400 cal yr BP was accompanied by a transition from conifer-dominated to mesic hardwood forest. Sporormiella spores were not detected and charcoal was low during the late glacial period, suggesting megaherbivore grazers and fire were not locally important agents of vegetation change. Pinus returned to dominance during the Holocene, with step-like increases in Pinus at 10,400 and 6400 cal yr BP, while charcoal abundance increased tenfold, likely due to increased biomass burning associated with warmer conditions. Low-intensity surface fires increased after 1200 cal yr BP, possibly related to the establishment of the Mississippian culture in the Southeast.
This article examines representations of imperialism, anti-colonial nationalism, and decolonization in US textbooks for American and World History courses between 1930 and 1965. Broadly speaking, 1930s and early 1940s texts lauded imperialism and associated European colonialism with American imperialist activities. Authors extolled the benefits for colonial peoples, including literacy, good government, and peace, and anti-colonial nationalists were caricatured as irrational and ungrateful. US global engagement during and after World War II gradually changed the narrative, particularly following Philippine independence in 1946, as texts subsequently portrayed the US as an enlightened decolonizer. Postwar textbooks tended to argue that nationalism was a product of Western ideas and that anti-colonial nationalism was a triumph for Western civilization. While constructing this narrative of the spread of Western values, textbook authors largely marginalized colonial actors, promoted unflattering and stereotyped views of Africans and Asians, and de-emphasized the extreme violence inherent in the decolonization process.
The Neotoma Paleoecology Database is a community-curated data resource that supports interdisciplinary global change research by enabling broad-scale studies of taxon and community diversity, distributions, and dynamics during the large environmental changes of the past. By consolidating many kinds of data into a common repository, Neotoma lowers costs of paleodata management, makes paleoecological data openly available, and offers a high-quality, curated resource. Neotoma’s distributed scientific governance model is flexible and scalable, with many open pathways for participation by new members, data contributors, stewards, and research communities. The Neotoma data model supports, or can be extended to support, any kind of paleoecological or paleoenvironmental data from sedimentary archives. Data additions to Neotoma are growing and now include >3.8 million observations, >17,000 datasets, and >9200 sites. Dataset types currently include fossil pollen, vertebrates, diatoms, ostracodes, macroinvertebrates, plant macrofossils, insects, testate amoebae, geochronological data, and the recently added organic biomarkers, stable isotopes, and specimen-level data. Multiple avenues exist to obtain Neotoma data, including the Explorer map-based interface, an application programming interface, the neotoma R package, and digital object identifiers. As the volume and variety of scientific data grow, community-curated data resources such as Neotoma have become foundational infrastructure for big data science.
To establish an initial conceptualisation of how psychiatrists understand and use formulation within adult psychiatry practice. Twelve psychiatrists took part in semi-structured interviews. Transcripts were analysed using a constructivist grounded theory methodology.
Results
Formulation was conceptualised as an addition to diagnosis, triggered by risk, complexity and a need for an enhanced understanding. Participants valued collaborative formulation with psychologists. Multiple contextual factors were perceived to either facilitate or inhibit the process. Barriers to formulation led to a disjointed way of working.
Clinical implications
Findings contribute to an understanding of formulation within psychiatry training and practice.
The Millimetre Astronomy Legacy Team 90 GHz survey aims to characterise the physical and chemical evolution of high-mass clumps. Recently completed, it mapped 90 GHz line emission towards 3 246 high-mass clumps identified from the ATLASGAL 870 μm Galactic plane survey. By utilising the broad frequency coverage of the Mopra telescope’s spectrometer, maps in 16 different emission lines were simultaneously obtained. Here, we describe the first catalogue of the detected line emission, generated by Gaussian profile fitting to spectra extracted towards each clumps’ 870 μm dust continuum peak. Synthetic spectra show that the catalogue has a completeness of > 95%, a probability of a false-positive detection of < 0.3%, and a relative uncertainty in the measured quantities of < 20% over the range of detection criteria. The detection rates are highest for the (1–0) transitions of HCO+, HNC, N2H+, and HCN (~77–89%). Almost all clumps (~95%) are detected in at least one of the molecular transitions, just over half of the clumps (~53%) are detected in four or more of the transitions, while only one clump is detected in 13 transitions. We find several striking trends in the ensemble of properties for the different molecular transitions when plotted as a function of the clumps’ evolutionary state as estimated from Spitzer mid-IR images, including (1) HNC is relatively brighter in colder, less evolved clumps than those that show active star formation, (2) N2H+ is relatively brighter in the earlier stages, (3) that the observed optical depth decreases as the clumps evolve, and (4) the optically thickest HCO+ emission shows a ‘blue-red asymmetry’ indicating overall collapse that monotonically decreases as the clumps evolve. This catalogue represents the largest compiled database of line emission towards high-mass clumps and is a valuable data set for detailed studies of these objects.
Clusters of associated colony fragments discovered weathering out of bedding planes in the Upper Ordovician of the Cincinnati, Ohio, region provide a rare opportunity to quantify intracolony variation in ramose stenolaemate bryozoans. Sixteen colonies were reassembled as completely as possible from 198 fragments, and the following colony-level characters were measured: colony dimensions, branch link length and diameter, and branch order. Results indicate that branch link length and diameter systematically decrease as colonies grow via branch bifurcation. Branching ratio (i.e., the number of distal first-order branches divided by the number of immediately proximal second-order branches) appears to be more genetically than environmentally controlled and to be consistent among orders of stenolaemates and perhaps across the phylum. Colonies with endozones mined out by endoskeletozoans result in broken branches as opposed to pristine growing tips. This varies stratigraphically, perhaps in response to the distribution of the boring animals. The rarity of borers and the systematic proximal increase in branch diameter in these colonies suggest the zooids in the proximal portions of the colonies were alive at the time of colony death. If the time and effort can be invested in reassembling colonies, these morphometric data can then be applied to taxonomic, phylogenetic, and paleoenvironmental studies.