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This systematic review aimed to analyze studies assessing the extent to which General Practitioners (GPs) engage patients in the decision-making process during consultations.
Background:
Shared Decision Making (SDM) stands at the core of patient-centred care, particularly in primary healthcare, where a diverse array of medical decisions transpires. In a 2015 systematic review summarizing studies on the Observing Patient Involvement in Decision Making (OPTION) instrument to assess SDM objectively across healthcare settings, a notable dearth of patient involvement was observed.
Methods:
A comprehensive literature search encompassing three digital databases was conducted up to November 2023. Inclusion criteria focused on studies employing a comparative study design, centric to primary healthcare, and utilizing the OPTION-5 or -12 instrument to gauge SDM levels. Two investigators independently performed study selection, risk of bias assessment, and data extraction using a list of predefined variables, with discrepancies resolved by a third reviewer. PROSPERO registration-ID: CRD42023475419.
Findings:
Initially, harvesting 447 articles, our review retained 29 studies published between 2003 and 2022. Mean age of GPs was 45.5 (range 33–53) years. Reported baseline OPTION scores varied between 1.5 and 57.2 on a 0–100-point scale, with a median score of 16. Following SDM interventions, OPTION-scores increased significantly to a median of 28.5, range 16–83.
Conclusion:
The overall level of SDM among GPs remains relatively low and has shown minimal improvement over the past decade. However, interventions promoting SDM appear to enhance patient involvement levels. This underscores the necessity for increased education and tools, directed at GPs and patients, to foster and elevate the practice of SDM.
There is growing evidence that smoking increases the risk of developing psychiatric disorders, but the underlying mechanisms are largely unknown. We examine brain structure as a potential pathway between smoking and psychiatric disease liability.
Methods
We test associations between smoking (initiation, cigarettes per day, cessation, lifetime use) and depression, bipolar disorder, and schizophrenia, with and without correcting for volume of the amygdala, hippocampus, lateral and medial orbitofrontal cortex, superior frontal context, and cortical thickness and surface area. We use three methods that use summary statistics of genome-wide association studies to investigate genome-wide and local genetic overlap (genomic structural equation modeling, local analysis of (co)variant association), as well as causal associations (Mendelian randomization).
Results
While we find causal effects of smoking on brain volume in different brain areas, and with psychiatric disorders, brain volume did not seem to mediate the effect of smoking on psychiatric disorders.
Conclusions
While these findings are limited by characteristics of the included summary statistics (e.g. sample size), we conclude that brain volume of these areas is unlikely to explain a substantial part of any effect of smoking on psychiatric disorders. Nevertheless, genetic methods are valuable tools for exploring other potential mechanisms, such as brain functional connectivity, foregoing the need to collect all phenotypes in one dataset.
It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.
Aims
To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.
Method
Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.
Results
IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).
Conclusions
Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.
Mental health problems are the major cause of disability among adolescents. Personalized prevention may help to mitigate the development of mental health problems, but no tools are available to identify individuals at risk before they require mental health care.
Methods
We identified children without mental health problems at baseline but with six different clinically relevant problems at 1- or 2-year follow-up in the Adolescent Brain Cognitive Development (ABCD) study. We used machine learning analysis to predict the development of these mental health problems with the use of demographic, symptom and neuroimaging data in a discovery (N = 3236) and validation (N = 3851) sample. The discovery sample (N = 168–513 per group) consisted of participants with MRI data and were matched with healthy controls on age, sex, IQ, and parental education level. The validation sample (N = 84–231) consisted of participants without MRI data.
Results
Subclinical symptoms at 9–10 years of age could accurately predict the development of six different mental health problems before the age of 12 in the discovery and validation sample (AUCs = 0.71–0.90). The additive value of neuroimaging in the discovery sample was limited. Multiclass prediction of the six groups showed considerable misclassification, but subclinical symptoms could accurately differentiate between the development of externalizing and internalizing problems (AUC = 0.79).
Conclusions
These results suggest that machine learning models can predict conversion to mental health problems during a critical period in childhood using subclinical symptoms. These models enable the personalization of preventative interventions for children at increased risk, which may reduce the incidence of mental health problems.
For a smooth projective surface $X$ satisfying $H_1(X,\mathbb{Z}) = 0$ and $w \in H^2(X,\mu _r)$, we study deformation invariants of the pair $(X,w)$. Choosing a Brauer–Severi variety $Y$ (or, equivalently, Azumaya algebra $\mathcal{A}$) over $X$ with Stiefel–Whitney class $w$, the invariants are defined as virtual intersection numbers on suitable moduli spaces of stable twisted sheaves on $Y$ constructed by Yoshioka (or, equivalently, moduli spaces of $\mathcal{A}$-modules of Hoffmann–Stuhler).
We show that the invariants do not depend on the choice of $Y$. Using a result of de Jong, we observe that they are deformation invariants of the pair $(X,w)$. For surfaces with $h^{2,0}(X) \gt 0$, we show that the invariants can often be expressed as virtual intersection numbers on Gieseker–Maruyama–Simpson moduli spaces of stable sheaves on $X$. This can be seen as a ${\rm PGL}_r$–${\rm SL}_r$ correspondence.
As an application, we express ${\rm SU}(r) / \mu _r$ Vafa–Witten invariants of $X$ in terms of ${\rm SU}(r)$ Vafa–Witten invariants of $X$. We also show how formulae from Donaldson theory can be used to obtain upper bounds for the minimal second Chern class of Azumaya algebras on $X$ with given division algebra at the generic point.
The wide adoption of occupational shoulder exoskeletons in industrial settings remains limited. Passive exoskeletons were proved effective in a limited amount of application scenarios, such as (quasi-)static overhead handling tasks. Quasi-active devices, albeit representing an improved version of their passive predecessors, do not allow full modulation of the amount of assistance delivered to the user, lacking versatility and adaptability in assisting various dynamic tasks. Active occupational shoulder exoskeletons could overcome these limitations by controlling the shape of the delivered torque profile according to the task they aim to assist. However, most existing active devices lack compactness and wearability. This prevents their implementation in working environments. In this work, we present a new active shoulder exoskeleton, named Active Exo4Work (AE4W). It features a new flexible shaft-driven remote actuation unit that allows the positioning of the motors close to the wearer’s center of mass while it maintains a kinematic structure that is compatible with the biological motion of the shoulder joint. in vitro and in vivo experiments have been conducted to investigate the performance of AE4W. Experimental results show that the exoskeleton is kinematically compatible with the user’s workspace since it does not constrain the natural range of motion of the shoulder joint. Moreover, this device can effectively provide different types of assistance while the user executes various dynamic tasks, without altering perceived comfort.
We analyze the disclosures of sustainable investing by Dutch pension funds in their annual reports by introducing a novel textual analysis approach using state-of-the-art natural language processing techniques to measure the awareness and implementation of sustainable investing. We find that a pension fund's size increases both the awareness and implementation of sustainable investing. Moreover, we analyze the role of signing a sustainable investment initiative. Although signing this initiative increases the specificity of pension fund statements about sustainable investing, we do not find an effect on the implementation of sustainable investing.
A detailed exploration is presented of the integration of human–machine collaboration in governance and policy decision-making, against the backdrop of increasing reliance on artificial intelligence (AI) and automation. This exploration focuses on the transformative potential of combining human cognitive strengths with machine computational capabilities, particularly emphasizing the varying levels of automation within this collaboration and their interaction with human cognitive biases. Central to the discussion is the concept of dual-process models, namely Type I and II thinking, and how these cognitive processes are influenced by the integration of AI systems in decision-making. An examination of the implications of these biases at different levels of automation is conducted, ranging from systems offering decision support to those operating fully autonomously. Challenges and opportunities presented by human–machine collaboration in governance are reviewed, with a focus on developing strategies to mitigate cognitive biases. Ultimately, a balanced approach to human–machine collaboration in governance is advocated, leveraging the strengths of both humans and machines while consciously addressing their respective limitations. This approach is vital for the development of governance systems that are both technologically advanced and cognitively attuned, leading to more informed and responsible decision-making.
At high elevations on the Greenland ice sheet meltwater percolates and refreezes in place, and hence does not contribute to mass loss. However, meltwater generation and associated surface runoff is occurring from increasingly higher altitudes, causing changes in firn stratigraphy that have led to the presence of near-surface ice slabs. These ice slabs force meltwater to flow laterally instead of percolating downwards. Here we present a simple, physics-based quasi-2-D model to simulate lateral meltwater runoff and superimposed ice (SI) formation on top of ice slabs. Using an Eulerian Darcy flow scheme, the model calculates how far meltwater can travel within a melt season and when it appears at the snow surface. Results show that lateral flow is a highly efficient runoff mechanism, as lateral outflow exceeds locally generated meltwater in all model gridcells, with total meltwater discharge sometimes reaching more than 30 times the average amount of in situ generated melt. SI formation, an important process in the formation and thickening of the ice slabs, can retain up to 40% of the available meltwater, and generally delays the appearance of visible runoff. Validating the model against field- or remote-sensing data remains challenging, but the results presented here are a first step towards a more comprehensive understanding and description of the hydrological system in the accumulation zone of the southwestern Greenland ice sheet.
Accurately quantifying all the components of the surface energy balance (SEB) is a prerequisite for the reliable estimation of surface melt and the surface mass balance over ice and snow. This study quantifies the SEB closure by comparing the energy available for surface melt, determined from continuous measurements of radiative fluxes and turbulent heat fluxes, to the surface ablation measured on the Greenland ice sheet between 2003 and 2023. We find that the measured daily energy available for surface melt exceeds the observed surface melt by on average 18 ± 30 W m−2 for snow and 12 ± 54 W m−2 for ice conditions (mean ± SD), which corresponds to 46 and 10% of the average energy available for surface melt, respectively. When the surface is not melting, the daily SEB is on average closed within 5 W m−2. Based on the inter-comparison of different ablation sensors and radiometers installed on different stations, and on the evaluation of modelled turbulent heat fluxes, we conclude that measurement uncertainties prevent a better daily to sub-daily SEB closure. These results highlight the need and challenges in obtaining accurate long-term in situ SEB observations for the proper evaluation of climate models and for the validation of remote sensing products.
This paper explores the role of integrating behavioral science to refine human-AI interaction, essential for ensuring safety and efficiency. Advocating for empathetic, user-centric design, the paper illustrates how behavioral insights can effectively inform AI-integrated designs, making AI applications more intuitive and ethically aligned with diverse human needs. This approach can ultimately enrich interaction across systems, fostering a more harmonious human-AI synergy.
The comprehensive overview of Neogene lithostratigraphy in the eastern Netherlands dates back to the mid-1970s. In the present study, continuous gamma-ray logs and in situ sediment core samples from six boreholes in the area allowed palynological and mollusc analyses and wireline log-based correlation. These investigations were aimed at updating and revising the existing Neogene lithostratigraphy within the Stratigraphic Nomenclature of the Netherlands by integrating litho-, bio-, and sequence-stratigraphic approaches. The analytical results yielded the establishment of new holo- and lectostratotype sections, together with cross-border interregional correlation. The lithostratigraphic revision resulted in the modified definition of the Aalten, Eibergen and Delden members and the definition of two new proposed members: the Dale and Doetinchem members. The Ticheloven bed, removed in earlier studies, is proposed to be reinstated, and the Stemerdink Bed is upgraded in its hierarchical status to the Stemerdink member. All lithostratigraphic units are included in the present Miocene subdivision of the Groote Heide and Diessen formations, which include three recognisable unconformities: the Early-Miocene Unconformity (EMU), Mid-Miocene Unconformity (MMU) and Late-Miocene Unconformity (LMU). The new, revised, reintroduced and existing local lithostratigraphic units and sequences are discussed with their counterparts in the south and southeast of the Netherlands, in Germany and Belgium, and from this a regionally consistent framework has emerged of the regional Neogene lithostratigraphy.
Extensive research has focused on the potential benefits of education on various mental and physical health outcomes. However, whether the associations reflect a causal effect is harder to establish.
Methods
To examine associations between educational duration and specific aspects of well-being, anxiety and mood disorders, and cardiovascular health in a sample of European Ancestry UK Biobank participants born in England and Wales, we apply four different causal inference methods (a natural policy experiment leveraging the minimum school-leaving age, a sibling-control design, Mendelian randomization [MR], and within-family MR), and assess if the methods converge on the same conclusion.
Results
A comparison of results across the four methods reveals that associations between educational duration and these outcomes appears predominantly to be the result of confounding or bias rather than a true causal effect of education on well-being and health outcomes. Although we do consistently find no associations between educational duration and happiness, family satisfaction, work satisfaction, meaning in life, anxiety, and bipolar disorder, we do not find consistent significant associations across all methods for the other phenotypes (health satisfaction, depression, financial satisfaction, friendship satisfaction, neuroticism, and cardiovascular outcomes).
Conclusions
We discuss inconsistencies in results across methods considering their respective limitations and biases, and additionally discuss the generalizability of our findings in light of the sample and phenotype limitations. Overall, this study strengthens the idea that triangulation across different methods is necessary to enhance our understanding of the causal consequences of educational duration.
We recently reported on the radio-frequency attenuation length of cold polar ice at Summit Station, Greenland, based on bi-static radar measurements of radio-frequency bedrock echo strengths taken during the summer of 2021. Those data also allow studies of (a) the relative contributions of coherent (such as discrete internal conducting layers with sub-centimeter transverse scale) vs incoherent (e.g. bulk volumetric) scattering, (b) the magnitude of internal layer reflection coefficients, (c) limits on signal propagation velocity asymmetries (‘birefringence’) and (d) limits on signal dispersion in-ice over a bandwidth of ~100 MHz. We find that (1) attenuation lengths approach 1 km in our band, (2) after averaging 10 000 echo triggers, reflected signals observable over the thermal floor (to depths of ~1500 m) are consistent with being entirely coherent, (3) internal layer reflectivities are ≈–60$\to$–70 dB, (4) birefringent effects for vertically propagating signals are smaller by an order of magnitude relative to South Pole and (5) within our experimental limits, glacial ice is non-dispersive over the frequency band relevant for neutrino detection experiments.
A wide variety of language skills has been shown to be compromised in children from low socioeconomic status (SES). However, few studies have investigated the effect of SES on language development in infants. The aim of this study is two-fold: to investigate when the first SES-effects on language can be observed and to explore the effects of three variables often claimed to be linked to SES – gestational duration, stress and parent-child interaction – on language development. Parents/caregivers of 539 Dutch-acquiring infants aged 8-13 months from mid to high SES backgrounds completed a questionnaire including the LENA Developmental Snapshot (Gilkerson et al., 2017a) and the Brigance Parent-Child Interaction Scale (Glascoe & Brigance, 2002). No association was found between SES and language development. However, the results suggest that corrected age and parent-child interaction positively influence language development at this early age.
Ground penetrating radar (GPR) has been extensively used in glaciology to infer glacier's ice thickness, liquid water content, water drainage pathways, and other properties. The interpretation of such GPR data is not always straightforward and for temperate glaciers, the signal is often affected by strong scattering and attenuation. It has often been suggested that such effects originate from englacial water inclusions, since water and ice have a large contrast in their di-electric permittivity. To investigate such effects quantitatively, we perform an extensive numerical modeling study of GPR signals. By exploring how different liquid water contents (LWC) and water-inclusions size affect the GPR signal, we show that their effects are much larger than the potential presence of a wet snowpack or a heterogeneous distribution of ice permittivity. In particularly, we show that the presence of such water inclusions is a necessary and sufficient condition for reproducing the typical characteristics of GPR data acquired in the field. Further, we find that for 25 MHz GPR antennas, a bulk LWC $\gtrsim$ 0.2%, associated with decimeters-scale water inclusions already limits bedrock detectability for ice thicknesses $\gtrsim 100$ m. Since these values are typical for Alpine glaciers, they clarify why the quality of GPR data is often poor in such environments.
Edited by
Alik Ismail-Zadeh, Karlsruhe Institute of Technology, Germany,Fabio Castelli, Università degli Studi, Florence,Dylan Jones, University of Toronto,Sabrina Sanchez, Max Planck Institute for Solar System Research, Germany
Abstract: The continuously increasing quantity and quality of seismic waveform data carry the potential to provide images of the Earth’s internal structure with unprecedented detail. Harnessing this rapidly growing wealth of information, however, constitutes a formidable challenge. While the emergence of faster supercomputers helps to accelerate existing algorithms, the daunting scaling properties of seismic inverse problems still demand the development of more efficient solutions. The diversity of seismic inverse problems – in terms of scientific scope, spatial scale, nature of the data, and available resources – precludes the existence of a silver bullet. Instead, efficiency derives from problem adaptation. Within this context, this chapter describes a collection of methods that are smart in the sense of exploiting specific properties of seismic inverse problems, thereby increasing computational efficiency and usable data volumes, sometimes by orders of magnitude. These methods improve different aspects of a seismic inverse problem, for instance, by harnessing data redundancies, adapting numerical simulation meshes to prior knowledge of wavefield geometry, or permitting long-distance moves through model space for Monte Carlo sampling.
We introduce a conjecture on Virasoro constraints for the moduli space of stable sheaves on a smooth projective surface. These generalise the Virasoro constraints on the Hilbert scheme of a surface found by Moreira and Moreira, Oblomkov, Okounkov and Pandharipande. We verify the conjecture in many nontrivial cases by using a combinatorial description of equivariant sheaves found by Klyachko.
Belgium – as most other Western European countries – has become an immigration country in the last decades. One in five Belgian citizens has or was born with a non-Belgian nationality. On a yearly basis, around 140,000 immigrants arrive in Belgium (Myria, 2020). Refugees granted international protection represent about 10 per cent of these immigrants. The increasing numbers of refugees Belgium has been confronted with from 2015 onwards – due to wars in the Middle East and the persecution of people by authoritarian states – have mainly led to policy initiatives aimed at asylum reception and integration, while support for maintaining family ties across borders and support during the process of family reunification has received far less political attention. Family reunification is for refugees and other migrants, however, the most important legal ground for migration to Belgium: 42 per cent of migrants from non-EU countries and 27 per cent of EU citizens migrating to Belgium obtained their first residence permit on the basis of family reunification. In total this concerned 35,169 people in 2018 (Myria, 2019). Within the group of non-Europeans, 2,722 people had received an approval for family reunification with someone with refugee status (Myria, 2018).
Family reunification is a unique process within the migration processes, as it concerns ‘not only “outsiders knocking at a state's doors and requesting entry” but also the “moral claim of insiders”, people living within state borders who ask to be united with their family’ (Block, 2012: 37). Notwithstanding the right to family life inscribed in Article 16 of the Universal Declaration of Human Rights, in Article 8 of the European Convention on Human Rights and in Article 22 of the Belgian Constitution, family reunification is subject to a policy of problematisation and suspicion. The association with ‘fraudulent marriages’ and possible fraud involving papers, ages or relational ties has become standard. Wray (2006: 303) calls this ‘moral gatekeeping’, which contributes to the image of ‘the undesirable family migrant’.
In general, the political discourse on migration is often very negative. Migration is framed by some as a danger; a threat from the outside for the ‘body of the nation’ (Schrooten et al, 2016). Numbers are thereby enlarged and exaggerated to create an image of massive influx. Moreover, refugee immigration is coupled with unprecedented problematisations of Islam – including an association with terrorism – and widespread populism (Lucassen, 2018).
In Beckett’s poem ‘what is the word’, he seems to ask a more fundamental question than in the French original, ‘Comment dire’. Rather than a – crucially unsuccessful – search for ‘le mot juste’, ‘what is the word’ is also a linguistic quest for the ontology of the word.1 What is the word? Is it just a vehicle to bring across a message, or does it have a materiality of its own? Can it be a ‘thing’? And what if this ‘thing’ is crossed out? This essay tries to approach Beckett’s late poetry from a ‘materialist’ perspective in the sense that it takes the materiality of its inscription (ink on paper) as a starting point. It suggests a reading of Beckett’s late poems as he preserved them (in line with the edition of Emily Dickinson’s envelope poems in The Gorgeous Nothings)2; a reading that takes the deliberate ‘scrappiness’ of their drafts into account as an extra dimension and as an integral part of the poetic experience; a reading that helps us refine our notion of presence, find out more about its relation to absence, and perhaps understand how certain forms of absence can also have agency. This materialist perspective does not imply a strictly bibliographical approach, without any relation to the content of these late poems. The profound connection between content and form that Beckett discovered in Joyce’s ‘Work in Progress’ (‘His writing is not about something; it is that something itself’3), became a fundamental characteristic of his own ‘oeuvre in gress’,4 ending in the middle of a sentence (in ‘what is the word’). To the extent that this enactment is a crucial aspect of what H. Porter Abbott has called ‘autography’, I would like to take this autography more literally than Abbott probably intended it: the ‘form’ enacting the ‘content’ of the late poetry also encompasses the autographs (the drafts and notes).