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Digital health technologies have been enhancing the capacity of healthcare providers and, thereby, the delivery of targeted health services. The Southeast Asia Region (SEAR) has invested in strengthening digital public health. Many digital health interventions have been implemented in public health settings but are rarely assessed using the holistic health technology assessment (HTA) approach.
Methods
A systematic literature review was performed to provide an overview of evaluations of digital public health interventions in the World Health Organization (WHO) SEAR. Searches were conducted on four electronic databases. Screening title abstracts and full texts was independently conducted by two reviewers, followed by data extraction. Dimensions of HTA were analyzed against the EUnetHTA Core Model 3.0. Quality assessment of included articles was conducted using the JBI Checklist for Economic Evaluation and Consolidated Health Economic Evaluation Reporting Standards 2022 checklist to assess the reporting quality. The findings are presented using systematic evidence tables and bar charts.
Results
Of the forty-three studies screened at the full-text stage, thirteen studies conducted across six countries were included in the analysis. Telemedicine and m-health interventions were assessed in ten studies. Nine studies conducted cost-effectiveness analysis, and five assessments were conducted from a societal perspective. Four studies utilized more than one perspective for the assessment. Health problem definition and current use of technology, description and technical characteristics of the technology, clinical effectiveness, costs, economic evaluation, and organizational aspects were assessed by all the studies, whereas legal aspects were least assessed.
Conclusion
The lack of HTAs on digital public health interventions in the region highlights the need for capacity-building efforts.
There are six species of flamingos in the world, all under pressure from human activities in their wetland habitats. Obtaining global population estimates for flamingos is challenging because of their broad geographical range, nomadic movements, capacity for long-distance flight, and the complexity of international monitoring. Two species, the Andean Flamingo Phoenicoparrus andinus and Puna Flamingo P. jamesi, during key parts of their life cycle, use wetlands in the Andes of South America, where they coexist at various sites. We compiled historical information on population estimates and ecology for these two species and integrated data collected on regional simultaneous censuses to describe population trends, current and emerging threats, and provide recommendations for conservation action. Long-term population trends have been difficult to establish given the unreliability of population estimates prior to the late 1990s. Systematic, regional censuses carried out regularly since 1997 have produced robust population estimates for the Andean and Puna flamingos (most recently, 78,000 and 154,000, respectively) and show populations of both species to be stable and increasing. Increasingly rapid changes in wetlands caused by human activities such as industrial-scale mining in breeding and foraging sites in the high Andes wetlands, and agro-industrial activities in their lowland wintering sites, focused on areas of the highest concentrations of flamingos pose threats to their survival and ability to reproduce. In addition, climate change is projected to reduce wetland habitats and some localised effects have already been detected. Continued research on the ecological drivers of flamingo abundance, movements, and population genetics to understand population structure and dynamics are necessary, as well as the identification of response variables to changing environmental conditions. Interdisciplinary and systems-level approaches in the context of international collaboration in monitoring and conservation planning among a diversity of stakeholders will be required to safeguard flamingo populations and wetland habitats.
Stranded seals are often infected with a broad range of parasites, although whether they are the cause of significant morbidity or an incidental finding is usually unclear. In this study we used stable isotope ratio analysis, a method frequently used to investigate food webs, to explore the extent to which common seal parasites feed directly on host tissue and fluids or absorb host-derived metabolites, which in turn may give an indication of their potential impact on the host's health. The trophic discrimination factor Δ15N for the nasal mite, Halarachne halichoeri, was mostly positive, ranging between −0.015 and 3.2‰ (n = 6), while for the Acanthocephalan worm, Corynosoma strumosum and the anisakid nematode, Pseudoterranova decipiens, Δ15N ranged between −4.2 and −2.0‰ (n = 7), and between −6.7 and −0.8‰ (n = 5) respectively. In the case of the lungworm, Otostrongylus circumlitus, Δ15N measured between −5.6 and 0‰ for worms collected in the stomach (n = 5), between −1.1 and 0.2‰ for worms collected from the heart (n = 3), between −0.7 and 1.9‰ for worms situated in the lungs (n = 4). Based on Δ15N, parasites could be clearly divided into those that were on a higher trophic level than their host suggesting a predator–prey-like relationship, and those that were not. It is hypothesized that Δ15N may be indicative of the clinical significance of parasite–host associations.
In X-ray diffraction (XRD) analysis, preparation of oriented clay specimens enhances their 00l reflections by arranging basal surfaces parallel to the specimen surface. In one-dimensional modeling of XRD intensities, degree of preferred orientation is one of the variable parameters and a user may choose different σ* values for different minerals. The usual assumption is, however, that the layers of all clay minerals that are present exhibit a similar degree of preferred orientation to that of the clay mineral flakes parallel to the basal plane. If the orientation of individual clay minerals is significantly different, and if this is not taken into account, the relative proportions of the constituent minerals cannot be modeled accurately. The actual or so-called ‘preferred’ orientation is a potentially large source of error in any attempt at quantitative XRD analysis because it cannot be assumed to be constant among different minerals and may also vary as a result of pretreatment. In the present study the influence of sample composition and sample pretreatment on the degree of preferred orientation was determined using the parameter σ*. A statistical parameter was calculated to determine and ensure the reproducibility of σ* measurements. The most important result was that, when mixed together, clay minerals influence each other in terms of the degree of preferred orientation. Among individual samples, the degree of preferred orientation can be different for each clay mineral. The power of sonication used in sample pretreatment of a pure kaolinite and a pure illite had no significant influence on the degree of preferred orientation. The changes in intensities upon variation of the tilting angle (χ) allowed for calculation of σ* of smectites in pure samples, in admixtures, and in samples treated in two different ways (air-dried and glycerol-intercalated), which is reported here for the first time. Smectites are very fine grained with flexible morphology which is believed to be the reason for their tendency to exhibit poor orientation (σ* = 22°); further research is required to establish whether this is a general feature of smectites. After glycerol treatment a soil smectite showed a slightly better orientation compared to the air-dried pattern. The results of the study illustrate the difficulty of predicting changes in preferred orientation of clay mineral admixtures, even if non-platy minerals such as clay-sized quartz are added. In general, σ* decreased when non-platy minerals were added, which is explained by changes in geometry of the specimen. Not all clay minerals, however, showed simultaneous changes in their orientation behavior.
Allophane is a very fine-grained clay mineral which is especially common in Andosols. Its importance in soils derives from its large reactive surface area. Owing to its short-range order, allophane cannot be quantified by powder X-ray diffraction (XRD) directly. It is commonly dissolved from the soil by applying extraction methods. In the present study the standard extraction method (oxalate) was judged to be unsuitable for the quantification of allophane in a soil/clay deposit from Ecuador, probably because of the large allophane content (>60 wt.%). This standard extraction method systematically underestimated the allophane content but the weakness was less pronounced in samples with small allophane contents. In the case of allophane-rich materials, the Rietveld XRD technique, using an internal standard to determine the sum of X-ray amorphous phases, is recommended if appropriate structural models are available for the other phases present in the sample. The allophane (+imogolite) content is measured by subtracting the amount of oxalate-soluble phases (e.g. ferrihydrite). No correction would be required if oxalate-soluble Fe were incorporated in the allophane structure. The present study, however, provides no evidence for this hypothesis. Mössbauer and scanning electron microscopy investigations indicate that goethite and poorly ordered hematite are the dominant Fe minerals and occur as very fine grains (or coatings) being dispersed in the cloud-like allophane aggregates.
Allophane is known to adsorb appreciable amounts of water, depending on ambient conditions. The mass fraction of the sample attributed to this mineral thus changes accordingly; the choice of a reference hydration state is, therefore, a fundamental factor in the quantification of allophane in a sample. Results from the present study revealed that (1) drying at 105ºC produced a suitable reference state, and (2) water adsorption has no effect on quantification by XRD analysis.
In Ecuador, DINAGE (known today as the Servicio Geológico Nacional) and the German Federal Institute for Geosciences and Natural Resources have discovered a huge allophane deposit covering an area of >4000 km2. This study presents the results from an investigation of a 16-m thick vertical sequence from this deposit, supposedly the weathering product of two different volcanic ash deposits. In particular, the distribution of alkali metals within the uppermost layer indicates that the weathering process is still ongoing.
According to the mineralogical composition, an allophane-rich layer (allophane facies) could be distinguished from the underlying halloysite-rich layer (halloysite facies). A 2-m thick transition zone is characterized by the presence of gibbsite and intermediate specific surface area values. Only a few imogolite fibers could be identified (by scanning electron microscopy), indicating the dominance of allophane over imogolite in the allophane facies. Single allophane particles were investigated by atomic force microscopy, though this method was less accurate than transmission electron microscopy with respect to the determination of the primary particle diameter. Carbon isotope analysis (14C) suggested an age of ∼20,000 y for the allophane layer.
Within the allophane facies, a 4-m thick layer occurs containing 70–80 wt.% allophane with an N2-BET specific surface area of >300 m2/g. Based on infrared and energy-dispersive X-ray diffraction measurements, an Al/Si ratio of 1.3–1.4 was established for this allophane, which is between Al-rich and Si-rich allophane. The allophane layer may be of economic value due to the large allophane content, the small amount of organic matter, and the significant thickness of the deposit.
The Central Graben is a Mesozoic sedimentary basin that is significantly influenced by rift and salt tectonics. Its southern part is located in the German and Dutch sectors of the North Sea. Even though studies exist on the tectonic and stratigraphic development of the Danish and Dutch Central Graben, the German Central Graben as an important link is less investigated. We aim to fill this gap and to investigate the sedimentary development from the Latest Triassic to the Early Cretaceous, the relative influence of salt and rift tectonics on subsidence and how our results fit into the existing studies of the Danish and Dutch Central Graben. Knowledge of the development of the graben and its sedimentation is critical for any possible economic use like hydrocarbon exploitation or carbon capture and storage. Therefore, we mapped nine laterally traceable horizons on 2D and 3D reflection seismic data from the Lower Jurassic to the Lower Cretaceous within the German Central Graben and adjacent Danish Salt Dome Province as well as the northern Dutch Central Graben. These horizons include the base horizons of four tectonostratigraphic mega-sequences of the southern Central Graben adopted from the current Dutch tectonostratigraphic concept. Based on the mapping results, we constructed subsidence, thickness and erosion maps of the tectonostratigraphic mega-sequences and their subdivisions. The tectonostratigraphic mega-sequences were then correlated with well logs to determine the lithology. The results show that the structural and stratigraphic architecture of the German Central Graben was consecutively dominated by either subsidence controlled by rifting, salt tectonics or by thermal uplift and subsidence. We suggest that the German Central Graben is divided by a large strike-slip fault zone, the Mid Central Graben Transverse Zone, into a northern part that geologically rather belongs to the Danish and a southern part that rather belongs to the Dutch Central Graben. We discuss how this division and the tectonics influenced the regional lithology.
The Richtmyer–Meshkov instability (RMI) results from the impulsive acceleration of a density interface where either it or the acceleration is perturbed. Density interfaces may arise due to a change in gas species, isotope, temperature or a combination of these. We computationally investigate the effect of interface type on the plasma RMI, which is relevant for a range of applications, including inertial confinement fusion. We simulate the evolution of single-mode perturbed thermal, species and isotope interfaces in an ideal ion–electron plasma using the multi-fluid plasma (MFP) model. We find that, in the MFP model, the evolution of different types of interface differs significantly, in contrast to single-fluid models where they behave similarly if the Atwood number is matched. The thermal and species interfaces produce the most severe response to shock acceleration, experiencing the secondary instabilities and enhanced primary mode growth. The isotope interface evolution is restrained in comparison with the former cases, resembling the response predicted by single-fluid models. The determining factor in the severity of the MFP RMI is the density ratio across the initial interface in the electron fluid, which is unity for an isotope interface. We observe that, as the density ratio across the electron interface decreases, so do the magnitudes of the self-generated fields and consequently the severity of the growth amplification. Generally, the evolution of the RMI with different types of interface becomes more similar as the level of coupling between the ion and electron fluids is increased, characterised by reducing the plasma non-dimensional skin depth.
The functional differentiation of the mammary gland (MG) is fundamental for the prevention of mammary pathologies. This process occurs throughout pregnancy and lactation, making these stages key events for the study of pathologies associated with development and differentiation. Many studies have investigated the link between mammary pathologies and thyroid diseases, but most have ignored the role of thyroid hormone (TH) in the functional differentiation of the MG. In this work, we show the long-term impact of hypothyroidism in an animal model whose lactogenic differentiation occurred at low TH levels. We evaluated the ability of the MG to respond to hormonal control and regulate cell cycle progression. We found that a deficit in TH throughout pregnancy and lactation induces a long-term decrease in Rb phosphorylation, increases p53, p21, Cyclin D1 and Ki67 expression, reduces progesterone receptor expression, and induces nonmalignant lesions in mammary tissue. This paper shows the importance of TH level control during mammary differentiation and its long-term impact on mammary function.
The finite dual $H^{\circ}$ of an affine commutative-by-finite Hopf algebra H is studied. Such a Hopf algebra H is an extension of an affine commutative Hopf algebra A by a finite dimensional Hopf algebra $\overline{H}$. The main theorem gives natural conditions under which $H^{\circ}$ decomposes as a crossed or smash product of $\overline{H}^{\ast}$ by the finite dual $A^{\circ}$ of A. This decomposition is then further analysed using the Cartier–Gabriel–Kostant theorem to obtain component Hopf subalgebras of $H^{\circ}$ mapping onto the classical components of $A^{\circ}$. The detailed consequences for a number of families of examples are then studied.
Accumulating evidence suggests beneficial effects of media stories featuring individuals mastering their suicidal crises, but effects have not been assessed for psychiatric patients.
Methods
We randomized n = 172 adult psychiatric patients (n = 172, 97.1% inpatients) to read an educative article featuring a person mastering a suicidal crisis (n = 92) or an unrelated article (n = 80) in a single-blind randomized controlled trial. Questionnaire data were collected before (T1) and after exposure (T2) as well as 1 week later (study end-point, T3). The primary outcome was suicidal ideation as assessed with the Reasons for Living Inventory; secondary outcomes were help-seeking intentions, mood, hopelessness, and stigmatization. Differences between patients with affective versus other diagnoses were explored based on interaction tests.
Results
We found that patients with affective disorders (n = 99) experienced a small-sized reduction of suicidal ideation at 1-week follow up (mean difference to control group [MD] at T3 = −0.17 [95% CI −0.33, −0.03], d = −0.15), whereas patients with nonaffective diagnoses (n = 73) experienced a small-sized increase (T2: MD = 0.24 [95% CI 0.06, 0.42], d = 0.19). Intervention group participants further experienced a nonsustained increase of help-seeking intentions (T2: MD = 0.53 [95% CI 0.11, 0.95], d = 0.19) and a nonsustained deterioration of mood (T2: MD = −0.14 [95% CI −0.27, −0.02], d = −0.17).
Conclusions
This study suggests that patients with affective disorders appear to benefit from media materials featuring mastery of suicidal crises. More research is needed to better understand which patient groups are at possible risk of unintended effects.
There seems to exist a general consensus on how to conceptualize cooperation in the field of international relations (IR). We argue that this impression is deceptive. In practice, scholars working on the causes of international cooperation have come to implicitly employ various understandings of what cooperation is. Yet, an explicit debate about the discipline's conceptual foundations never materialized, and whatever discussion occurred did so only latently and without much dialog across theoretical traditions. In this paper, we develop an updated conceptual framework by exploring the nature of these differing understandings and situating them within broader theoretical conversations about the role of cooperation in IR. Drawing on an array of studies in IR and philosophy, our framework distinguishes between three distinct types of cooperative state interactions – cooperation through tacit policy coordination (‘minimal’ cooperation), cooperation through explicit policy coordination (‘thin’ cooperation), and cooperation based on joint action (‘thick’ cooperation). The framework contributes to better theorization about cooperation in two main ways: it allows scholars across theoretical traditions to identify important sources of disagreement and previously unnoticed theoretical common ground; and the conceptual disaggregation it provides grants scholars crucial theoretical leverage by enabling type-specific causal theorization.
This study aims at providing estimates on the transmission risk of SARS-CoV-2 in schools and day-care centres. We calculated secondary attack rates (SARs) using individual-level data from state-wide mandatory notification of index cases in educational institutions, followed by contact tracing and PCR-testing of high-risk contacts. From August to December 2020, every sixth of overall 784 independent index cases was associated with secondary cases in educational institutions. Monitoring of 14 594 institutional high-risk contacts (89% PCR-tested) of 441 index cases during quarantine revealed 196 secondary cases (SAR 1.34%, 0.99–1.78). SARS-CoV-2 infection among high-risk contacts was more likely around teacher-indexes compared to student-/child-indexes (incidence rate ratio (IRR) 3.17, 1.79–5.59), and in day-care centres compared to secondary schools (IRR 3.23, 1.76–5.91), mainly due to clusters around teacher-indexes in day-care containing a higher mean number of secondary cases per index case (142/113 = 1.26) than clusters around student-indexes in schools (82/474 = 0.17). In 2020, SARS-CoV-2 transmission risk in educational settings was low overall, but varied strongly between setting and role of the index case, indicating the chance for targeted intervention. Surveillance of SARS-CoV-2 transmission in educational institutions can powerfully inform public health policy and improve educational justice during the pandemic.
Recently developed quantitative models of psychopathology (i.e., Hierarchical Taxonomy of Psychopathology) identify an Antagonistic Externalizing spectrum that captures the psychological disposition toward criminal and antisocial behavior. The purpose of the present study was to examine relations between Antagonistic psychopathology (and associated Five-Factor model Antagonism/Agreeableness) and neural functioning related to social-cognitive Theory of Mind using a large sample (N = 973) collected as part of the Human Connectome Project (Van Essen et al., 2013a). No meaningful relations between Antagonism/Antagonistic Externalizing and Theory of Mind-related neural activity or synchrony were observed (p < .005). We conclude by outlining methodological considerations (e.g., validity of social cognition task and low test–retest reliability of functional biomarkers) that may account for these null results, and present recommendations for future research.
Negotiated agreements in criminal proceedings have often been regarded as the embodiment of a negative wider trend towards the informalization of the criminal procedure, and have—especially in Germany—long been the subject of vivid controversies. A criminal proceeding in the traditional sense aims to establish the truth ex officio, which is achieved by means of a comprehensive inquiry into the facts conducted by the court during the trial, followed by a sentence that appropriately reflects the individual guilt of the defendant, which can then, in turn, achieve the procedural objective of “justice.” A streamlining of the extensive inquiry into the facts that the court would normally have to conduct via the consensual process of negotiation does not, a priori, fit the mold of a criminal procedure in the aforementioned sense. At the same time, the consensual termination of criminal proceedings—which also includes other forms of termination of the proceeding besides the concept of Verständigung, which occur by means of a preferment of public charges—is, in fact, more prevalent in practice these days than judgments rendered in adversarial trials are. Our Article focuses on the reasons why this stark contrast between legal doctrine and reality came to pass and which aspects of the implementation of the concept of consensus into the German law of criminal procedure still seem problematic.
Air-breathing propulsion has the potential to decrease the cost per kilogram for access-to-space, while increasing the flexibility of available low earth orbits. However, to meet the performance requirements, fuel-air mixing inside of scramjet engines and thermal management still need to be improved.
An option to address these issues is to use intrinsically generated vortices from scramjet inlets to enhance fuel-air mixing further downstream, leading to shorter, less internal drag generating, and thus more efficient engines. Previous works have studied this vortex-injection interaction numerically, but validation was impractical due to lack of published experimental data. This paper extends upon these previous works by providing experimental data for a canonical geometry, obtained in the T4 Stalker Tube at Mach 8 flight conditions, and assesses the accuracy of numerical methodologies such as RANS CFD to predict the vortex-injection interaction.
Focus is placed on understanding the ability of the numerical methodology to replicate the most important aspects of the vortex-injection interaction. Results show overall good agreement between the numerical and experimental results, as all major features are captured. However, limitations are encountered, especially due to a localised region of over predicted heat flux.
Genetic and environmental influences are both known to be causal factors in the development and maintenance of obesity. Stress related chronic stimulation of the hypothalamic-pituitary-adrenal (HPA) axis and resulting increased glucocorticoid exposure is known to be an important pathophysiological mechanism in the development of obesity. We show that the natriuretic peptide system, that mediates endocrine and behavioural responses to stress, plays a role in the control of long-term body weight in chronically ethanol drinking mice. In mice lacking functional NPR-A receptors, physical, and in particular psychological stress leads to enhanced and continuous increase in body weight in homozygote NPR-A mice. The effect of repeated stress on body weight appeared rapidly and persisted throughout life. Over a longer period of time without stress, body weights do not differ between the different genotypes. Moreover, we could demonstrate that NPR-A homozygote mice show significant higher corticosterone levels following stress. Heterozygote animals show an intermediate phenotype concerning body weights and corticosterone levels following stress. Alterations in the NPR-A receptor gene may constitute a genetic risk factor for stress-induced eating and obesity.
Neurophysiological hyperactivation of cortical and subcortical brain areas has been reported in obsessive-compulsive disorder (OCD) using functional imaging techniques and electroencephalography (EEG). Also sleep disturbances and delayed sleep phases have been associated with OCD symptomatology. However, vigilance regulation in OCD during the transition phase from wakefulness to sleep onset remains unclear. Therefore the aim of this study was to analyze EEG-source estimates and EEG vigilance regulation in OCD patients in comparison to healthy controls.
A 15 minute resting EEG was recorded in 30 unmedicated OCD patients and 30 healthy, age and gender matched controls. EEG power source estimates of the whole time series were computed by exact Low Resolution Brain Electromagnetic Tomography (eLORETA). Each consecutive one second EEG-segment was classified into one out of seven EEG-vigilance stages (0, A1, A2, A3, B1, B2/3, C) using Vigilance Algorithm Leipzig (VIGALL). The eLORETA analysis (log of F-ratios, p < 0.05, corrected for multiple comparison) revealed significantly increased delta power in the right superior frontal gyrus for OCD patients in comparison to healthy controls. Vigilance analysis yielded significantly increased amounts of high vigilance stage A2 (Mann-Whitney test, p < 0.001, corrected for multiple comparison) for OCD patients.
This study repeated findings of altered EEG-power in frontal areas in OCD patients. Alterations of EEG-vigilance regulation were found with increased amounts of high vigilance stage A2. This is in line with a hypothesis of cortical hyperactivation in OCD. The value of EEG-vigilance as a possible biological marker for e.g. treatment response should be focus of further studies.