We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save 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 saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
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 saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved 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.
Syncope is a common presenting complaint to emergency departments, and can lead to costly and often fruitless inpatient hospitalizations. Observation units can be particularly helpful in the assessment of an unexplained syncopal event by providing a period of monitoring and a chance to obtain further testing in those patients who are not deemed low risk enough for immediate discharge and outpatient follow-up, nor high risk for adverse events. This chapter will discuss some of the tips and pitfalls in the assessment of the syncope patient and some of the traditional diagnostic options during the patient’s evaluation.
We consider a stochastic model, called the replicator coalescent, describing a system of blocks of k different types that undergo pairwise mergers at rates depending on the block types: with rate $C_{ij}\geq 0$ blocks of type i and j merge, resulting in a single block of type i. The replicator coalescent can be seen as a generalisation of Kingman’s coalescent death chain in a multi-type setting, although without an underpinning exchangeable partition structure. The name is derived from a remarkable connection between the instantaneous dynamics of this multi-type coalescent when issued from an arbitrarily large number of blocks, and the so-called replicator equations from evolutionary game theory. By dilating time arbitrarily close to zero, we see that initially, on coming down from infinity, the replicator coalescent behaves like the solution to a certain replicator equation. Thereafter, stochastic effects are felt and the process evolves more in the spirit of a multi-type death chain.
Regression is a fundamental prediction task common in data-centric engineering applications that involves learning mappings between continuous variables. In many engineering applications (e.g., structural health monitoring), feature-label pairs used to learn such mappings are of limited availability, which hinders the effectiveness of traditional supervised machine learning approaches. This paper proposes a methodology for overcoming the issue of data scarcity by combining active learning (AL) for regression with hierarchical Bayesian modeling. AL is an approach for preferentially acquiring feature-label pairs in a resource-efficient manner. In particular, the current work adopts a risk-informed approach that leverages contextual information associated with regression-based engineering decision-making tasks (e.g., inspection and maintenance). Hierarchical Bayesian modeling allow multiple related regression tasks to be learned over a population, capturing local and global effects. The information sharing facilitated by this modeling approach means that information acquired for one engineering system can improve predictive performance across the population. The proposed methodology is demonstrated using an experimental case study. Specifically, multiple regressions are performed over a population of machining tools, where the quantity of interest is the surface roughness of the workpieces. An inspection and maintenance decision process is defined using these regression tasks, which is in turn used to construct the active-learning algorithm. The novel methodology proposed is benchmarked against an uninformed approach to label acquisition and independent modeling of the regression tasks. It is shown that the proposed approach has superior performance in terms of expected cost—maintaining predictive performance while reducing the number of inspections required.
Dientamoeba fragilis (D. fragilis) is an intestinal protozoan parasite with uncertain pathogenic potential. In the United States, data on D. fragilis in the era of molecular detection are limited. The aim of this retrospective chart review was to evaluate the epidemiology and clinical characteristics of D. fragilis cases identified using polymerase chain reaction assays between 2016 and 2024 at our academic medical centre located in Utah. We identified 28 unique cases with varying gastrointestinal symptomatology including diarrhoea, abdominal pain, nausea, vomiting, and bloating. Approximately half (52%) of patients with follow-up data demonstrated improvement in symptoms following initial treatment for D. fragilis. The overall prevalence of D. fragilis was low among those tested (0.6% positivity). Additional research, including case-control studies, is needed to better describe the etiologic role of D. fragilis.
An improved understanding of the factors associated with self-harm in young people who die by suicide can inform suicide prevention measures.
Aims
To describe sociodemographic and clinical characteristics and service utilisation related to self-harm in a national sample of young people who died by suicide.
Method
We carried out a descriptive study of self-harm in a national consecutive case series (N = 544) of 10- to 19-year-olds who died by suicide over 3 years (2014–2016) in the UK as identified from national mortality data. Information was collected from coroner inquest hearings, child death investigations, criminal justice system and National Health Service serious incident reports.
Results
Almost half (49%) of these young people had harmed themselves at some point in their lives, a quarter (26%) in the 3 months before death. Girls were twice as likely as boys to have recent self-harm (40 v. 20%; P < 0.001). Compared to the no self-harm group, young people with recent self-harm were more likely to have a mental illness diagnosis (63 v. 23%; P < 0.001); misused alcohol (19 v. 9%; P = 0.07); experienced physical, sexual or emotional abuse (17 v. 3%; P < 0.01); and recent life adversity (95 v. 75%; P < 0.001). Furthermore, they were more likely to be in contact with mental health services (60 v. 10%), or emergency departments or general physicians for a mental health condition (52 v. 10%) in the 3 months before death.
Conclusions
Presentation to services in young people who self-harm is an important opportunity to intervene through comprehensive psychosocial assessment and treatment of underlying conditions.
An overview of changes in the classification of personality disorders from ICD-10 to ICD-11 is presented. The new classification incorporates a dimensional approach centred on severity with five domains available to describe personality pathology. The potential clinical utility of the new approach is discussed.
The year is 1600. It is April and Japan's iconic cherry trees are in full flower. A battered ship drifts on the tide into Usuki Bay in southern Japan. On board, barely able to stand, are twenty-three Dutchmen and one Englishman, the remnants of a fleet of five ships and 500 men that had set out from Rotterdam in 1598. The Englishman was William Adams, later to be known as Anjin Miura by the Japanese, whose subsequent transformation from wretched prisoner to one of the Shogun's closest advisers is the centrepiece of this book. As a native of Japan, and a scholar of seventeenth-century Japanese history, the author delves deep into the cultural context facing Adams in what is one of the great examples of assimilation into the highest reaches of a foreign culture. Her access to Japanese sources, including contemporary accounts offers us a fuller understanding of the life lived by William Adams as a high-ranking samurai and his grandstand view of the collision of cultures that led to Japan's self-imposed isolation, lasting over two centuries. This is a highly readable account of Adams' voyage to and twenty years in Japan and that is supported by detailed observations of Japanese culture and society at this time. New light is shed on Adams' relations with the Dutch and his countrymen, the shipbuilding skills that enabled Japan to advance its international maritime ambitions, and the scientific and technical support Adams provided in the refining process of Japan's gold and silver.
Broad-spectrum micronutrients (minerals and vitamins) have shown benefit for treatment of depressive symptoms.
Aims
To determine whether additional micronutrients reduce symptoms of antenatal depression.
Method
Eighty-eight medication-free pregnant women at 12–24 weeks gestation, who scored ≥13 on the Edinburgh Postnatal Depression Scale (EPDS), were randomised 1:1 to micronutrients or active placebo (containing iodine and riboflavin), for 12 weeks. Micronutrient doses were generally between recommended dietary allowance and tolerable upper level. Primary outcomes (EPDS and Clinical Global Impression – Improvement Scale (CGI-I)) were analysed with constrained longitudinal data analysis.
Results
Seventeen (19%) women dropped out, with no group differences, and four (4.5%) gave birth before trial completion. Both groups improved on the EPDS, with no group differences (P = 0.1018); 77.3% taking micronutrients and 72.7% taking placebos were considered recovered. However, the micronutrient group demonstrated significantly greater improvement, based on CGI-I clinician ratings, over time (P = 0.0196). The micronutrient group had significantly greater improvement on sleep and global assessment of functioning, and were more likely to identify themselves as ‘much’ to ‘very much’ improved (68.8%) compared with placebo (38.5%) (odds ratio 3.52, P = 0.011; number needed to treat: 3). There were no significant group differences on treatment-emergent adverse events, including suicidal ideation. Homocysteine decreased significantly more in the micronutrient group. Presence of personality difficulties, history of psychiatric medication use and higher social support tended to increase micronutrient response compared with placebo.
Conclusions
This study highlights the benefits of active monitoring on antenatal depression, with added efficacy for overall functioning when taking micronutrients, with no evidence of harm. Trial replication with larger samples and clinically diagnosed depression are needed.
The fossil record is spatiotemporally heterogeneous: taxon occurrence data have patchy spatial distributions, and this patchiness varies through time. Large-scale quantitative paleobiology studies that fail to account for heterogeneous sampling coverage will generate uninformative inferences at best and confidently draw wrong conclusions at worst. Explicitly spatial methods of standardization are necessary for analyses of large-scale fossil datasets, because nonspatial sample standardization, such as diversity rarefaction, is insufficient to reduce the signal of varying spatial coverage through time or between environments and clades. Spatial standardization should control both geographic area and dispersion (spread) of fossil localities. In addition to standardizing the spatial distribution of data, other factors may be standardized, including environmental heterogeneity or the number of publications or field collecting units that report taxon occurrences. Using a case study of published global Paleobiology Database occurrences, we demonstrate strong signals of sampling; without spatial standardization, these sampling signatures could be misattributed to biological processes. We discuss practical issues of implementing spatial standardization via subsampling and present the new R package divvy to improve the accessibility of spatial analysis. The software provides three spatial subsampling approaches, as well as related tools to quantify spatial coverage. After reviewing the theory, practice, and history of equalizing spatial coverage between data comparison groups, we outline priority areas to improve related data collection, analysis, and reporting practices in paleobiology.
Chronic musculoskeletal pain is associated with neurobiological, physiological, and cellular measures. Importantly, we have previously demonstrated that a biobehavioral and psychosocial resilience index appears to have a protective relationship on the same biomarkers. Less is known regarding the relationships between chronic musculoskeletal pain, protective factors, and brain aging. This study investigates the relationships between clinical pain, a resilience index, and brain age. We hypothesized that higher reported chronic pain would correlate with older appearing brains, and the resilience index will attenuate the strength of the relationship between chronic pain and brain age.
Participants and Methods:
Participants were drawn from an ongoing observational multisite study and included adults with chronic pain who also reported knee pain (N = 135; age = 58.3 ± 8.1; 64% female; 49% non-Hispanic Black, 51% non-Hispanic White; education Mdn = some college; income level Mdn = $30,000 - $40,000; MoCA M = 24.27 ± 3.49). Measures included the Graded Chronic Pain Scale (GCPS), characteristic pain intensity (CPI) and disability, total pain body sites; and a cognitive screening (MoCA). The resilience index consisted of validated biobehavioral (e.g., smoking, waist/hip ratio, and active coping) and psychosocial measures (e.g., optimism, positive affect, negative affect, perceived stress, and social support). T1-weighted MRI data were obtained. Surface area metrics were calculated in FreeSurfer using the Human Connectome Project's multi-modal cortical parcellation scheme. We calculated brain age in R using previously validated and trained machine learning models. Chronological age was subtracted from predicted brain age to generate a brain age gap (BAG). With higher scores of BAG indicating predicated age is older than chronological age. Three parallel hierarchical regression models (each containing one of three pain measures) with three blocks were performed to assess the relationships between chronic pain and the resilience index in relation to BAG, adjusting for covariates. For each model, Block 1 entered the covariates, Block 2 entered a pain score, and Block 3 entered the resilience index.
Results:
GCPS CPI (R2 change = .033, p = .027) and GCPS disability (R2 change = 0.038, p = 0.017) significantly predicted BAG beyond the effects of the covariates, but total pain sites (p = 0.865) did not. The resilience index was negatively correlated and a significant predictor of BAG in all three models (p < .05). With the resilience index added in Block 3, both GCPS CPI (p = .067) and GCPS disability (p = .066) measures were no longer significant in their respective models. Additionally, higher education/income (p = 0.016) and study site (p = 0.031) were also significant predictors of BAG.
Conclusions:
In this sample, higher reported chronic pain correlated with older appearing brains, and higher resilience attenuated this relationship. The biobehavioral and psychosocial resilience index was associated with younger appearing brains. While our data is cross-sectional, findings are encouraging that interventions targeting both chronic pain and biobehavioral and psychosocial factors (e.g., coping strategies, positive and negative affect, smoking, and social support) might buffer brain aging. Future directions include assessing if chronic pain and resilience factors can predict brain aging over time.
Little is known about when youth may be at greatest risk for attempting suicide, which is critically important information for the parents, caregivers, and professionals who care for youth at risk. This study used adolescent and parent reports, and a case-crossover, within-subject design to identify 24-hour warning signs (WS) for suicide attempts.
Methods
Adolescents (N = 1094, ages 13 to 18) with one or more suicide risk factors were enrolled and invited to complete bi-weekly, 8–10 item text message surveys for 18 months. Adolescents who reported a suicide attempt (survey item) were invited to participate in an interview regarding their thoughts, feelings/emotions, and behaviors/events during the 24-hours prior to their attempt (case period) and a prior 24-hour period (control period). Their parents participated in an interview regarding the adolescents’ behaviors/events during these same periods. Adolescent or adolescent and parent interviews were completed for 105 adolescents (81.9% female; 66.7% White, 19.0% Black, 14.3% other).
Results
Both parent and adolescent reports of suicidal communications and withdrawal from social and other activities differentiated case and control periods. Adolescent reports also identified feelings (self-hate, emotional pain, rush of feelings, lower levels of rage toward others), cognitions (suicidal rumination, perceived burdensomeness, anger/hostility), and serious conflict with parents as WS in multi-variable models.
Conclusions
This study identified 24-hour WS in the domains of cognitions, feelings, and behaviors/events, providing an evidence base for the dissemination of information about signs of proximal risk for adolescent suicide attempts.
Depression is a major public health concern. Depressed individuals have received increasing treatment with antidepressants in Western countries. In this study, we examine the relationship among individual symptoms (sadness, worry and unhappiness), human development factors and antidepressant use in 29 OECD countries. We report that increased antidepressant prescribing is not associated with decreased prevalence of sadness, worry or unhappiness. However, income, education and life expectancy (measured using the Human Development Index) are associated with lower prevalence of all these symptoms. This suggests that increasing spending on depression treatment may not be as effective as general public health interventions at reducing depression in communities.
The U.S. Department of Agriculture–Agricultural Research Service (USDA-ARS) has been a leader in weed science research covering topics ranging from the development and use of integrated weed management (IWM) tactics to basic mechanistic studies, including biotic resistance of desirable plant communities and herbicide resistance. ARS weed scientists have worked in agricultural and natural ecosystems, including agronomic and horticultural crops, pastures, forests, wild lands, aquatic habitats, wetlands, and riparian areas. Through strong partnerships with academia, state agencies, private industry, and numerous federal programs, ARS weed scientists have made contributions to discoveries in the newest fields of robotics and genetics, as well as the traditional and fundamental subjects of weed–crop competition and physiology and integration of weed control tactics and practices. Weed science at ARS is often overshadowed by other research topics; thus, few are aware of the long history of ARS weed science and its important contributions. This review is the result of a symposium held at the Weed Science Society of America’s 62nd Annual Meeting in 2022 that included 10 separate presentations in a virtual Weed Science Webinar Series. The overarching themes of management tactics (IWM, biological control, and automation), basic mechanisms (competition, invasive plant genetics, and herbicide resistance), and ecosystem impacts (invasive plant spread, climate change, conservation, and restoration) represent core ARS weed science research that is dynamic and efficacious and has been a significant component of the agency’s national and international efforts. This review highlights current studies and future directions that exemplify the science and collaborative relationships both within and outside ARS. Given the constraints of weeds and invasive plants on all aspects of food, feed, and fiber systems, there is an acknowledged need to face new challenges, including agriculture and natural resources sustainability, economic resilience and reliability, and societal health and well-being.
We present the third data release from the Parkes Pulsar Timing Array (PPTA) project. The release contains observations of 32 pulsars obtained using the 64-m Parkes ‘Murriyang’ radio telescope. The data span is up to 18 yr with a typical cadence of 3 weeks. This data release is formed by combining an updated version of our second data release with $\sim$3 yr of more recent data primarily obtained using an ultra-wide-bandwidth receiver system that operates between 704 and 4032 MHz. We provide calibrated pulse profiles, flux density dynamic spectra, pulse times of arrival, and initial pulsar timing models. We describe methods for processing such wide-bandwidth observations and compare this data release with our previous release.
Perceived relationships between timbres are critical in electroacoustic music. Most studies assume timbres have fixed inter-relationships, but we tested whether distinct tasks change these. Thirty short sounds were used, from five categories: acoustic instruments, impulse responses, convolutions of the preceding, environmental sounds and computer-manipulated instrumental sounds. In Task 1, 46 non-musicians formed a ‘cohesive’ sonic ordering of unlabelled icons (sounds attached). In Task 2, they categorised the icons into four boxes. In Task 3 listeners separately ordered the sounds from each of Task 2’s boxes using the approach of Task 1. Tasks 1 and 2/3 revealed distinct orderings, consistent with conceptual flexibility. To analyse the orderings, we replaced conventional distance by adjacency measures, and described each system as a network (rather than spatial positions), confirming that the two task outcomes were distinct. Network analyses also showed that the two systems were mechanistically distinct and allowed us to predict temporally changing networks, modelling the observed networks as successive perceptions. Further simulated networks generated with the temporal model readily encompassed all possible pairings between the sounds and not just those we observed. The temporal network model thus confirms conceptual flexibility even in untrained listeners, clearly suitable for a composer to use.
The classical Greeks give us a substance ontology grounded in ‘being qua being’ or ‘being per se’ (to on he on) that guarantees a permanent and unchanging subject as the substratum for the human experience. With the combination of eidos and telos as the formal and final cause of independent things such as persons, this ‘substance’ necessarily persists through change. This substratum or essence includes its purpose for being, and is defining of the ‘what-it-means-to-be-a-thing-of-this-kind’ of any particular thing in setting a closed, exclusive boundary and the strict identity necessary for it to be this, and not that.
In the Yijing 易經 or Book of Changes we find a vocabulary that makes explicit cosmological assumptions that are a stark alternative to this substance ontology, and provides the interpretive context for the Confucian canons by locating them within a holistic, organic, and ecological worldview. To provide a meaningful contrast with this fundamental assumption of on or ‘being’ we might borrow the Greek notion of zoe or ‘life’ and create the neologism ‘zoe-tology’ as ‘the art of living’. This cosmology begins from ‘living’ (sheng 生) itself as the motive force behind change, and gives us a world of boundless ‘becomings’: not ‘things’ that are, but ‘events’ that are happening, a contrast between an ontological conception of the human ‘being’ and a process conception of what I will call human ‘becomings’.
The United States Department of Agriculture Agricultural Marketing Service (USDA AMS) began publishing formula base price information in August 2021. Considerable variation in the types of cattle priced via formula has raised questions about the level of base price transparency that can be gleaned from formula base price reports. This study employs 6 years of transactions to estimate hedonic models assessing the capability of existing data to describe variation in formula base prices. Results suggest factors beyond those reported to USDA AMS by packers influence base prices. We offer suggestions for improved data collection to make hedonic modeling of base prices more effective for reporting market information.
There is an urgent need to improve the clinical management of major depressive disorder (MDD), which has become increasingly prevalent over the past two decades. Several gaps and challenges in the awareness, detection, treatment, and monitoring of MDD remain to be addressed. Digital health technologies have demonstrated utility in relation to various health conditions, including MDD. Factors related to the COVID-19 pandemic have accelerated the development of telemedicine, mobile medical apps, and virtual reality apps and have continued to introduce new possibilities across mental health care. Growing access to and acceptance of digital health technologies present opportunities to expand the scope of care and to close gaps in the management of MDD. Digital health technology is rapidly evolving the options for nonclinical support and clinical care for patients with MDD. Iterative efforts to validate and optimize such digital health technologies, including digital therapeutics and digital biomarkers, continue to improve access to and quality of personalized detection, treatment, and monitoring of MDD. The aim of this review is to highlight the existing gaps and challenges in depression management and discuss the current and future landscape of digital health technology as it applies to the challenges faced by patients with MDD and their healthcare providers.
Psychological therapies following an episode of self-harm should happen quickly to ensure patients receive the care they need and to reduce the likelihood of repetition.
Aims
We sought to explore patients' subjective experience of accessing psychological therapies following self-harm and their views on improving practice.
Method
Between March and November 2019, we recruited 128 patients and 23 carers aged 18 years or over from 16 English mental health trusts, from community organisations and via social media. Thematic analyses were used to interpret the data.
Results
Participants reported long waiting times, multiple failed promises and rejection when trying to access psychological therapies following self-harm. Poor communication and information provision contributed to uncertainty, worsening mental health and further self-harm. Other barriers included: lack of tailored interventions, stigmatising responses, use of exclusionary thresholds to access services, and punitive approaches to treating these patients. Participant recommendations to improve access to psychological therapies included: (a) the importance of compassionate and informed staff; (b) having timely access to aftercare from well-funded and well-resourced teams; (c) continuity of care, improved communication, and support during waiting times and while navigating the referral process; (d) greater information on the availability and benefits of psychological therapies; and (e) greater choice and flexibility over interventions.
Conclusion
Our findings identify long waiting times and inadequate service provision as barriers to high-quality and safe aftercare for patients who have self-harmed. Consistent with clinical guidelines, all patients should receive prompt aftercare and access to tailored psychological treatments following a self-harm episode.