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The Autistic Spectrum, published almost 30 years ago, remains an important text for all those who work with autistic individuals. This brief article highlights the significant contribution of Lorna Wing to how we view autism, including the observation that many of the issues being highlighted today regarding the appropriate management of autistic individuals are not new and can be found in the thoughts of Dr Wing.
Objectives/Goals: Micro-credentials (MCs) or digital badges are short programs designed to allow learners to gain knowledge and skills at their own pace to tailor their professional development. This study aims to examine the characteristics of learners completing MCs and explore their motivation for pursuing MCs through the University at Buffalo Clinical and Translational Science Institute (CTSI) program. Methods/Study Population: Currently, the CTSI offers five MCs in Effective Teaching, Good Clinical Practice, Responsible Research, Scientific Communication, and Translational Teamwork. Individuals who completed an MC (2019–2024) were identified by the UB Office of Micro-credentials. An invitation email and two reminders were sent to all individuals who received MCs asking them to complete a short online survey in July-August 2024. The survey included three questions about the type(s) of MCs completed, learners’ motivation for pursuing MCs, and perceived or actual benefits of completing an MC. The questions included multiple choice, select all that apply, and open-ended format, respectively. The survey was sent using Google Forms; data were analyzed using descriptive statistics. We received 25 completed surveys (29% response rate). Results/Anticipated Results: Since 2019, 85 individuals completed MCs at Buffalo CTSI including 21 faculty, 18 trainees, 26 students, and 20 staff. The most popular MC, Responsible Research (65% of completers), is based on the Responsible Conduct of Research series, which consists of modules on authorship ethics, ethical use of animals (IACUC) and human subjects (IRB), conflicts of interest/commitment, and responsible data acquisition and management. We found that 33% of responders were motivated to obtain the MC to advance their career and for professional development, 30% for lifelong learning, and 23% intended to use the badges to showcase their proficiency to potential employers. The greatest benefits reported were to obtain knowledge/skills for their professional career (46%) and improve their ability to receive research funding (14%). Discussion/Significance of Impact: Micro-credentials are valuable learning tools to stay current on changing research requirements, with ability to engage asynchronously. Badges also provide unique professional development opportunities for students and research workforce (staff and community stakeholders) who have limited resources (time and money).
The aim of this policy article is twofold: (i) to provide a summary and update of recent important policy developments, in particular relevant guidance on the use of real-world data/real-world evidence (RWD/RWE) by health technology assessment (HTA) bodies and (ii) to set out our policy recommendations on how the different elements of an “RWE framework” we have previously developed could support, further enhance and facilitate the use of RWE for HTA purposes and by HTA bodies and payers.
Methods
We undertook a targeted review and analysis of recent important policy developments. The aim was to build on our recommendations from previous work on the “RWE Framework,” and consider how the relevant tools from our Framework can further enhance and facilitate the use of RWE for HTA purposes and by HTA bodies/payers.
Results
We provide eight conditions that we argue would, in combination, constitute the optimal use and acceptance of RWD/RWE for HTA. We believe that, should the eight conditions hold, RWD/RWE would enable more efficient access to medicines and healthcare technologies for patients.
Conclusions
High-quality, fit-for-purpose RWD/RWE can and should be used more frequently in HTA. Multi-stakeholder and cross-geography collaborative partnerships are needed to align on best practices to optimize the evidence that needs to be generated to satisfy all stakeholders’ needs.
The current study examines the application of the Pediatric-Buccal-Epigenetic (PedBE) clock, designed for buccal epithelial cells, to endothelia. We evaluate the association of PedBE epigenetic age and age acceleration estimated from human umbilical vein endothelial cells (HUVECs) with length of gestation and birthweight in a racially and ethnically diverse sample (analytic sample n = 333). PedBE age was positively associated with gestational age at birth (r = 0.22, p < .001) and infant birth weight (r = 0.20, p < .001). Multivariate models revealed infants with higher birth weight (adjusted for gestational age) had greater PedBE epigenetic age acceleration (b = 0.0002, se = 0.0007, p = 0.002), though this effect was small; findings were unchanged excluding preterm infants born before 37 weeks’ gestation. In conclusion, the PedBE clock may have application to endothelial cells and provide utility as an anchoring sampling point at birth to examine epigenetic aging in infancy.
The record of mammal declines and extinctions in Australia raises concerns regarding geographically restricted and poorly known taxa. For many taxa, the existing data are insufficient to assess their conservation status and inform appropriate management. Concerns regarding the persistence of the subspecies of yellow-footed rock-wallaby Petrogale xanthopus celeris, which is endemic to Queensland, have been expressed since the 1970s because of red fox Vulpes vulpes predation, competition with feral goats Capra hircus and land clearing. This rock-wallaby is rarely observed, occupies rugged mountain ranges and, prior to our surveys, had not been surveyed for 25 years. We surveyed 138 sites across the range of this rock-wallaby during 2010–2023, including revisiting sites surveyed in the 1970s–1980s and locations of historical records. We examined occurrence in relation to habitat variables and threats. Occupancy and abundance remained similar over time at most sites. However, by 2023 the subspecies had recolonized areas in the north-east of its range where it had disappeared between surveys in the 1980s and 2010s, and three south-western subpopulations that were considered extinct in the 1980s were rediscovered. Recolonization and increases in abundance at numerous sites between the 2010s and 2020s are associated with declines in feral goat abundance, indicating dietary and habitat competition are major threats. Exclusion fences erected since 2010 could limit genetic exchange between rock-wallaby subpopulations whilst allowing domestic goats to be commercially grazed. Petrogale xanthopus celeris should remain categorized as Vulnerable based on these ongoing threats. Repeated monitoring approximately every decade should underpin management of this endemic taxon.
We present the Sydney Radio Star Catalogue, a new catalogue of stars detected at megahertz to gigahertz radio frequencies. It consists of 839 unique stars with 3 405 radio detections, more than doubling the previously known number of radio stars. We have included stars from large area searches for radio stars found using circular polarisation searches, cross-matching, variability searches, and proper motion searches as well as presenting hundreds of newly detected stars from our search of Australian SKA Pathfinder observations. The focus of this first version of the catalogue is on objects detected in surveys using SKA precursor and pathfinder instruments; however, we will expand this scope in future versions. The 839 objects in the Sydney Radio Star Catalogue are distributed across the whole sky and range from ultracool dwarfs to Wolf-Rayet stars. We demonstrate that the radio luminosities of cool dwarfs are lower than the radio luminosities of more evolved sub-giant and giant stars. We use X-ray detections of 530 radio stars by the eROSITA soft X-ray instrument onboard the Spectrum Roentgen Gamma spacecraft to show that almost all of the radio stars in the catalogue are over-luminous in the radio, indicating that the majority of stars at these radio frequencies are coherent radio emitters. The Sydney Radio Star Catalogue can be found in Vizier or at https://radiostars.org.
Background: Central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) are key healthcare-associated infection (HAI) quality metrics. In this qualitative analysis, we aimed to identify common issues contributing to CLABSIs and CAUTIs occurring during the COVID-19 pandemic. Methods: In an academic healthcare network in Atlanta, GA, four hospitals perform real-time, apparent cause analyses (ACAs) for all CLABSIs and CAUTIs. Contributing factors are entered as free text into an electronic database. We analyzed data from 8/2020–8/2022. We first performed a qualitative open card sort of all reported contributing factors to CLABSI and created a novel framework based on mutually defined critical tasks (e.g., line insertion) and cross-cutting issues (e.g., communication breakdown). Contributing factors could describe ≥1 critical task and/or ≥1 cross-cutting issue. After establishing interrater reliability, a multidisciplinary group applied this framework to classify each contributing factor. For CAUTI, we used the same set of cross-cutting issues but identified new critical tasks via open card sorting. We then used the framework to classify each CAUTI contributing factor. We used descriptive statistics to identify frequent critical tasks and cross-cutting issues. Results: We reviewed 350 CLABSI ACAs with 602 contributing factors and 240 CAUTI ACAs with 405 contributing factors (Figure 1). Our classification framework comprised 11 cross-cutting issues and 9 critical tasks for CLABSI and 7 critical tasks for CAUTI (Figure 2). CLABSI: The critical tasks most often reported were bathing (19%), central line dressing maintenance (15%), and assessing central line indication (8%; Figure 3). Within these tasks, the most frequent issues described for bathing were the task not being performed (20%) and unclear documentation (18%); for dressing maintenance, the task was not performed (15%), not documented (15%), or poorly performed due to lack of competency (15%); and for assessing line indication, there was frequent communication breakdown (33%). CAUTI: The critical tasks most often reported were urinary catheter care (26%) and assessing the indication for urinary catheter (22%; Figure 4). Within these tasks, urinary catheter care was frequently not documented (38%) or not performed (16%); assessing urinary catheter necessity was often not documented (29%) or involved breakdown of communication (19%). Conclusion: We created a novel framework to evaluate common causes of HAIs in an academic healthcare network. This framework can be used to identify and track gaps over time and to develop quality improvement initiatives targeting key tasks and associated factors, such as communication difficulties when assessing device indications.
1. Describe the establishment of an acute crisis management service within a Child and Adolescent Mental Health Service (CAMHS) in the Republic of Ireland.
2. Summarise clinical activity during the first six months of the service and qualitative feedback from service users and clinicians on their experience of the service.
Methods
In December 2021 the Republic of Ireland Health Service Executive approved the roll out of acute crisis management services for CAMHS – known as Hubs, with a remit to provide intensive brief interventions to support young people experiencing acute Psychiatric crises. Multiple weekly appointments are provided in clinic, at home or via telehealth.
The Lucena Clinic CAMHS – based in Counties Dublin and Wicklow, was chosen as a pilot site. Staff were recruited in January 2023 consisting of:
1 FTE Consultant Child and Adolescent Psychiatrist
1 Candidate Advance Nurse Practitioner
1 Senior Social Worker
1 Senior Occupation Therapist
1 Administrator
A multi-disciplinary Steering Group was established with a view to planning clinical programs, ensuring safety and governance, procuring resources and embedding service evaluation.
The service went live in May 2023. Clinical data was gained from data entry to the service Electronic Patient Record.
Qualitative feedback was gained from service users using post-discharge questionnaires and from clinicians using semi-structured interview.
Results
1. Between May and December 2023 the Hub received 61 referrals and accepted 35.
2. 27 of those accepted were new referrals to the service.
3. Patients received an average of 27.1 hours of clinical intervention during their admission.
4. Shortest admission was 10 hrs, the longest 66.5 hrs.
5. 6 young people were seen at home, totalling 41 visits.
6. 24 young people were discharged to CAMHS, 2 to GP, 2 to the clinic's Day Program, 3 required in-patient admission.
Service user feedback was positive with families highlighting ease of access to the service, intensity of intervention and a friendly environment as positives.
One parent remarked that they did not feel the Hub was the right setting for their child's care.
Clinician feedback highlighted the Hub as a positive support for community CAMHS with rapid access to intervention and communication from the Hub team mentioned as positives. One drawback identified was the intensity of intervention setting an unrealistic expectation for ongoing care.
Conclusion
The Hub appears a welcome addition to CAMHS with positive feedback from service users and clinicians. Ongoing development phase and evaluation is required.
Behavioural treatments are recommended first-line for insomnia, but long-term benzodiazepine receptor agonist (BZRA) use remains common and engaging patients in a deprescribing consultation is challenging. Few deprescribing interventions directly target patients. Prescribers’ support of patient-targeted interventions may facilitate their uptake. Recently assessed in the Your Answers When Needing Sleep in New Brunswick (YAWNS NB) study, Sleepwell (mysleepwell.ca) was developed as a direct-to-patient behaviour change intervention promoting BZRA deprescribing and non-pharmacological insomnia management. BZRA prescribers of YAWNS NB participants were invited to complete an online survey assessing the acceptability of Sleepwell as a direct-to-patient intervention. The survey was developed using the seven construct components of the theoretical framework of acceptability (TFA) framework. Respondents (40/250, 17.2%) indicated high acceptability, with positive responses per TFA construct averaging 32.3/40 (80.7%). Perceived as an ethical, credible, and useful tool, Sleepwell also promoted prescriber–patient BZRA deprescribing engagements (11/19, 58%). Prescribers were accepting of Sleepwell and supported its application as a direct-to-patient intervention.
Differentiating clay minerals that formed in a supergene environment during deep chemical weathering from those that formed during hydrothermal alteration at higher temperatures associated with a mineralizing event is important in the exploration for epithermal Au deposits. The purpose of this study was to further elucidate this topic by comparing morphological and chemical properties of clay minerals in saprolite overlying epithermally altered bedrock at the Vera Au deposit, Queensland, Australia, with those of clay minerals in saprolite overlying bedrock adjacent to the epithermal alteration zone. X-ray diffraction (XRD) and analytical transmission electron microscopy (ATEM) investigations identified kaolinite, illite, and interstratified illite-smectite, together with quartz, Fe and Ti oxide minerals, and the sulfate minerals jarosite, gypsum, alunite, and natroalunite. Kaolinite crystals within the weathered argillic alteration zone proximal to the epithermal quartz vein are generally larger (up to 3 μm in diameter) and better formed (subhedral to euhedral) than crystals in saprolite distal to the hydrothermal alteration zone, in which smaller (mostly <1 μm), subhedral to anhedral crystals dominate. Energy-dispersive spectrometry (EDS) analysis of single crystals indicated that kaolinite within the alteration zone has an Al/Si ratio indistinguishable from reference kaolinite and has small Fe concentrations, whereas distal saprolitic kaolinite has smaller Al/Si and greater Fe/Si ratios, consistent with the formation of low-Fe kaolinite during hydrothermal alteration and higher-Fe kaolinite during weathering. Illite and interstratified illitesmectite (I-S) were distinguished from kaolinite by their morphology and greater K/Si and smaller Al/Si ratios. The Illite and I-S morphology ranged from thin irregular masses through lath-like crystals in hydrothermal samples to larger, irregularly shaped crystals. The Ca/Si and K/Si ratios of single crystals in Ca-saturated clay minerals were consistent with the I-S interstratification parameters determined from XRD patterns.
The Australian SKA Pathfinder (ASKAP) has surveyed the sky at multiple frequencies as part of the Rapid ASKAP Continuum Survey (RACS). The first two RACS observing epochs, at 887.5 (RACS-low) and 1 367.5 (RACS-mid) MHz, have been released (McConnell, et al. 2020, PASA, 37, e048; Duchesne, et al. 2023, PASA, 40, e034). A catalogue of radio sources from RACS-low has also been released, covering the sky south of declination $+30^{\circ}$ (Hale, et al., 2021, PASA, 38, e058). With this paper, we describe and release the first set of catalogues from RACS-mid, covering the sky below declination $+49^{\circ}$. The catalogues are created in a similar manner to the RACS-low catalogue, and we discuss this process and highlight additional changes. The general purpose primary catalogue covering 36 200 deg$^2$ features a variable angular resolution to maximise sensitivity and sky coverage across the catalogued area, with a median angular resolution of $11.2^{\prime\prime} \times 9.3^{\prime\prime}$. The primary catalogue comprises 3 105 668 radio sources, including those in the Galactic Plane (2 861 923 excluding Galactic latitudes of $|b|<5^{\circ}$), and we estimate the catalogue to be 95% complete for sources above 2 mJy. With the primary catalogue, we also provide two auxiliary catalogues. The first is a fixed-resolution, 25-arcsec catalogue approximately matching the sky coverage of the RACS-low catalogue. This 25-arcsec catalogue is constructed identically to the primary catalogue, except images are convolved to a less-sensitive 25-arcsec angular resolution. The second auxiliary catalogue is designed for time-domain science and is the concatenation of source lists from the original RACS-mid images with no additional convolution, mosaicking, or de-duplication of source entries to avoid losing time-variable signals. All three RACS-mid catalogues, and all RACS data products, are available through the CSIRO ASKAP Science Data Archive (https://research.csiro.au/casda/).
The present work is devoted to the analysis of drop impact on a deep liquid pool, focusing on the high-energy splashing regimes caused by large raindrops at high velocities. Such cases are characterized by short time scales and complex mechanisms, thus they have received very little attention until now. The BASILISK open-source solver is used to perform three-dimensional direct numerical simulations. The capabilities of octree adaptive mesh refinement techniques enable capturing of the small-scale features of the flow, while the volume of fluid approach combined with a balanced-force surface-tension calculation is applied to advect the volume fraction of the liquids and reconstruct the interfaces. The numerical results compare well with experimental visualizations: both the evolution of crown and cavity, the emanation of ligaments, the formation of bubble canopy and the growth of a downward-moving spiral jet that pierces through the cavity bottom, are correctly reproduced. Reliable quantitative agreements are also obtained regarding the time evolution of rim positions, cavity dimensions and droplet distributions through an observation window. Furthermore, simulation gives access to various aspects of the internal flows, which allows us to better explain the observed physical phenomena. Details of the early-time dynamics of bubble ring entrapment and splashing performance, the formation/collapse of bubble canopy and the spreading of drop liquid are discussed. The statistics of droplet size show the bimodal distribution in time, corroborating distinct primary mechanisms of droplet production at different stages.
The Australian SKA Pathfinder (ASKAP) radio telescope has carried out a survey of the entire Southern Sky at 887.5 MHz. The wide area, high angular resolution, and broad bandwidth provided by the low-band Rapid ASKAP Continuum Survey (RACS-low) allow the production of a next-generation rotation measure (RM) grid across the entire Southern Sky. Here we introduce this project as Spectral and Polarisation in Cutouts of Extragalactic sources from RACS (SPICE-RACS). In our first data release, we image 30 RACS-low fields in Stokes I, Q, U at 25$^{\prime\prime}$ angular resolution, across 744–1032 MHz with 1 MHz spectral resolution. Using a bespoke, highly parallelised, software pipeline we are able to rapidly process wide-area spectro-polarimetric ASKAP observations. Notably, we use ‘postage stamp’ cutouts to assess the polarisation properties of 105912 radio components detected in total intensity. We find that our Stokes Q and U images have an rms noise of $\sim$80 $\unicode{x03BC}$Jy PSF$^{-1}$, and our correction for instrumental polarisation leakage allows us to characterise components with $\gtrsim$1% polarisation fraction over most of the field of view. We produce a broadband polarised radio component catalogue that contains 5818 RM measurements over an area of $\sim$1300 deg$^{2}$ with an average error in RM of $1.6^{+1.1}_{-1.0}$ rad m$^{-2}$, and an average linear polarisation fraction $3.4^{+3.0}_{-1.6}$ %. We determine this subset of components using the conditions that the polarised signal-to-noise ratio is $>$8, the polarisation fraction is above our estimated polarised leakage, and the Stokes I spectrum has a reliable model. Our catalogue provides an areal density of $4\pm2$ RMs deg$^{-2}$; an increase of $\sim$4 times over the previous state-of-the-art (Taylor, Stil, Sunstrum 2009, ApJ, 702, 1230). Meaning that, having used just 3% of the RACS-low sky area, we have produced the 3rd largest RM catalogue to date. This catalogue has broad applications for studying astrophysical magnetic fields; notably revealing remarkable structure in the Galactic RM sky. We will explore this Galactic structure in a follow-up paper. We will also apply the techniques described here to produce an all-Southern-sky RM catalogue from RACS observations. Finally, we make our catalogue, spectra, images, and processing pipeline publicly available.
Psilocybin Therapy (PT) is being increasingly studied as a psychiatric intervention. Personality relates to mental health and can be used to probe the nature of PT's therapeutic action.
Methods
In a phase 2, double-blind, randomized, active comparator controlled trial involving patients with moderate-to-severe major depressive disorder, we compared psilocybin with escitalopram, over a core 6-week trial period. Five-Factor model personality domains, Big Five Aspect Scale Openness aspects, Absorption, and Impulsivity were measured at Baseline, Week 6, and Month 6 follow-up.
Results
PT was associated with decreases in neuroticism (B = −0.63), introversion (B = −0.38), disagreeableness (B = −0.47), impulsivity (B = −0.40), and increases in absorption (B = 0.32), conscientiousness (B = 0.30), and openness (B = 0.23) at week 6, with neuroticism (B = −0.47) and disagreeableness (B = −0.41) remaining decreased at month 6. Escitalopram Treatment (ET) was associated with decreases in neuroticism (B = −0.38), disagreeableness (B = −0.26), impulsivity (B = −0.35), and increases in openness (B = 0.28) at week 6, with neuroticism (B = −0.46) remaining decreased at month 6. No significant between-condition differences were observed.
Conclusions
Personality changes across both conditions were in a direction consistent with improved mental health. With the possible exception of trait absorption, there were no compelling between-condition differences warranting conclusions regarding a selective action of PT (v. ET) on personality; however, post-ET changes in personality were significantly moderated by pre-trial positive expectancy for escitalopram, whereas expectancy did not moderate response to PT.
Whilst representing a relatively small proportion of the overall offender population, individuals with autism spectrum disorder (ASD) present with diverse needs and issues that can challenge mainstream forensic services. The specific topics discussed in this chapter focus on those related to the assessment of individuals withASD in forensic settings, notably obtaining a diagnosis of ASD, completing a forensic risk formulation and therapeutic needs profile, the assessment of psychopathy in ASD and presence of any co-occurring neurodevelopmental and/or psychiatric disorders. Therapeutic approaches within forensic settings in the form of psychological and pharmacological interventions are also reviewed, including the role of organisational and staff training in ASD. A case example is also provided. The potential additional needs that women with ASD who offend present with are discussed. A final summary is provided including potential research targets to inform the future direction of assessments and therapeutic approaches for people with ASD within forensic settings.
While individuals with autism spectrum disorder (ASD) represent a small proportion of the overall offender population, clinical experience and research evidence suggest they are a diverse group who present with specific difficulties, risk management issues and needs that can challenge the criminal justice system. Although methodological limitations mean that an exact figure of how many individuals with ASD enter this system is unknown, within secure forensic settings, the consensus view suggests that offenders with ASD are likely to be over-represented compared to the prevalence in the general population. This chapter touches on why some individuals with ASD offend, how the media views such individuals, opinions of culpability and the impact this may have on their involvement with the criminal justice system. The influence of government legislation is also discussed and how this is shaping services. While progress continues in the assessment and management of individuals with ASD in the criminal justice system, there remains a need for a more informed and unified approach to how individual difficulties and needs are best addressed.
Although individuals with an Autism Spectrum Disorder (ASD) have been associated with many types of offences, some appear to be particularly problematic such as those involving cybercrime, interpersonal violence, arson and firesetting, terrorism, stalking, as well as some sexual offences. Clinical experience and research suggest that whilst individual motivations for offending may vary, an understanding of why these offences occur among individuals with an ASD should be informed by the associated difficulties and vulnerabilities. However, an understanding of ASD and the associated difficulties within the courts remains varied, raising questions around the important role experts play in trials involving individuals with an ASD.