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Idiopathic subglottic stenosis describes subglottic stenosis where no inflammatory, traumatic, iatrogenic or other causative aetiology can be identified. The present study aimed to outline our institution's experience of patients diagnosed with idiopathic subglottic stenosis and describe a very rarely reported familial association.
Methods
A retrospective review was conducted of prospectively maintained medical records from 2011 to 2020. Patient clinical, radiological and intra-operative data were reviewed to assess for defined endpoints.
Results
Ten patients with idiopathic subglottic stenosis were identified in this series. One familial pairing was identified, with two sisters presenting with the condition. Successful treatment with carbon dioxide laser and dilatation was achieved in most cases.
Conclusion
Idiopathic subglottic stenosis represents a rare, clinically challenging pathology. Management with endoscopic laser and balloon dilatation is an effective treatment. This paper highlights a very rare familial association, and describes our experience in treating idiopathic subglottic stenosis.
The COVID-19 pandemic substantially impacted care of patients with schizophrenia treated with long-acting injectable antipsychotics (LAIs). This study examined how clinics adapted operations to maintain a standard of care for these patients after pandemic onset.
Methods
Online surveys were completed in October-November 2020 by one principal investigator (PI) or PI-appointed designee at 35 clinics participating in OASIS (NCT03919994). Items concerned pandemic impacts on clinic operations, particularly telepsychiatry, and on the care of patients with schizophrenia treated with LAIs.
Results
All 35 clinics reported using telepsychiatry; 20 (57%) implemented telepsychiatry after pandemic onset. Telepsychiatry visits increased from 12%-15% to 45%-69% across outpatient visit types after pandemic onset; frequency of no-show and/or canceled telepsychiatry visits decreased by approximately one-third. Nearly half of clinics increased the frequency of telepsychiatry visits for patients with schizophrenia treated with LAIs. Approximately one-third of participants each reported switching patients treated with LAIs to longer injection interval LAIs or to oral antipsychotics. The most common system/clinic- and patient-related barrier for telepsychiatry visits was lower reimbursement rate and access to technology/reliable internet, respectively. Almost all participants (94%) were satisfied with telepsychiatry for maintaining care of patients with schizophrenia treated with LAIs; most predicted a hybrid of telepsychiatry and office visits post-pandemic.
Conclusions
Changes made by clinics after pandemic onset were viewed by almost all participants as satisfactory for maintaining a standard of care for patients with schizophrenia treated with LAIs. Most participants predicted continuing telepsychiatry to support patient care post-pandemic; equitable access to telepsychiatry will be important in this regard.
This study aimed to determine the awareness, otological symptoms and prevalence of external auditory canal exostoses in Irish cold-water athletes.
Method
An online and in person cross-sectional survey was undertaken with Irish cold-water athletes to explore athletes' awareness, known prevalence of external auditory canal exostoses and attitudes towards preventive measures.
Results
Of the 926 participants surveyed, 67.5 per cent were aware of external auditory canal exostoses. Triathletes reported the lowest awareness (39.9 per cent) among water athletes. A total of 9.7 per cent (n = 90) had previously been diagnosed with external auditory canal exostoses and 46.7 per cent (n = 42) were non-surfers. Ear symptoms were reported in 76 per cent of athletes. Otoscopic examinations showed that 23.7 per cent had external auditory canal exostoses, 3.6 per cent of whom were aware of their diagnosis.
Conclusion
The majority of Irish surfing athletes are aware of external auditory canal exostoses. There is less awareness with regard to Ireland's newly emerging sports such as open water swimming and triathlons. Over 90 per cent of athletes surveyed had no idea they had external auditory canal exostoses, which highlights the need to increase public awareness.
In northern Cambodia, threatened wildlife, livestock and people are being poisoned by pesticides deposited in seasonal waterholes. Addressing this critical conservation threat requires understanding the drivers of poisoning behaviours and the social contexts in which they occur. This study across 10 communities in two protected areas aimed to provide a first assessment of this phenomenon. We used the theory of planned behaviour to measure socio-psychological determinants of behaviour and deepened this understanding using informant interviews and focus group discussions. Informants reported that so-called termite poisons, including powerful carbamates, are deliberately deposited at waterholes to catch wildlife for consumption. This method is perceived to be low effort and high efficacy, and perceptions of the health risks vary. Predominant users are young men and children, but it is unclear whether the practice is related to food insecurity. Threatened wildlife species reported as affected include the giant ibis Pseudibis gigantea and vulture species. Overall, social norms are strongly negative towards poisoning; 75% of survey respondents perceived negative norms because of impacts on human and livestock health, environmental quality, and risks of legal sanctions. This has led to interventions by local authorities in half of the studied villages. We suggest that future interventions should raise the salience of negative norms by providing a non-conflictual mechanism for community members to participate in monitoring and sanctioning, such as a reporting hotline. Regulatory interventions are also required to control the supply of restricted pesticides.
The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.
The Molonglo Observatory Synthesis Telescope (MOST) is an 18000 m2 radio telescope located 40 km from Canberra, Australia. Its operating band (820–851 MHz) is partly allocated to telecommunications, making radio astronomy challenging. We describe how the deployment of new digital receivers, Field Programmable Gate Array-based filterbanks, and server-class computers equipped with 43 Graphics Processing Units, has transformed the telescope into a versatile new instrument (UTMOST) for studying the radio sky on millisecond timescales. UTMOST has 10 times the bandwidth and double the field of view compared to the MOST, and voltage record and playback capability has facilitated rapid implementaton of many new observing modes, most of which operate commensally. UTMOST can simultaneously excise interference, make maps, coherently dedisperse pulsars, and perform real-time searches of coherent fan-beams for dispersed single pulses. UTMOST operates as a robotic facility, deciding how to efficiently target pulsars and how long to stay on source via real-time pulsar folding, while searching for single pulse events. Regular timing of over 300 pulsars has yielded seven pulsar glitches and three Fast Radio Bursts during commissioning. UTMOST demonstrates that if sufficient signal processing is applied to voltage streams, innovative science remains possible even in hostile radio frequency environments.
The class of radio transients called Fast Radio Bursts (FRBs) encompasses enigmatic single pulses, each unique in its own way, hindering a consensus for their origin. The key to demystifying FRBs lies in discovering many of them in order to identity commonalities – and in real time, in order to find potential counterparts at other wavelengths. The recently upgraded UTMOST in Australia, is undergoing a backend transformation to rise as a fast transient detection machine. The first interferometric detections of FRBs with UTMOST, place their origin beyond the near-field region of the telescope thus ruling out local sources of interference as a possible origin. We have localised these bursts to much better than the ones discovered at the Parkes radio telescope and have plans to upgrade UTMOST to be capable of much better localisation still.
The initial results from timing observations of PSR J1141–6545, a relativistic pulsar-white dwarf binary system, are presented. Predictions from the timing baseline hint at the most stringent test of gravity by an asymmetric binary yet. The timing precision has been hindered by the dramatic variations of the pulse profile due to geodetic precession, a pulsar glitch and red timing noise. Methods to overcome such timing irregularities are briefly presented along with preliminary results from the test of the General Theory of Relativity (GR) from this pulsar.
Accommodating cattle indoors during the winter is widely practiced throughout Europe. There is currently no legislation surrounding the space allowance and floor type that should be provided to cattle during this time, however, concerns have been raised regarding the type of housing systems currently in use. The objective of the study was to investigate the effect of space allowance and floor type on performance and welfare of finishing beef heifers. Continental crossbred heifers (n=240: mean initial live; weight, 504 (SD 35.8) kg) were blocked by breed, weight and age and randomly assigned to one of four treatments; (i) 3.0 m2, (ii) 4.5 m2 and (iii) 6.0 m2 space allowance per animal on a fully slatted concrete floor and (iv) 6.0 m2 space allowance per animal on a straw-bedded floor, for 105 days. Heifers were offered a total mixed ration ad libitum. Dry matter intake was recorded on a pen basis and refusals were weighed back twice weekly. Heifers were weighed, dirt scored and blood sampled every 3 weeks. Whole blood was analysed for complete cell counts and serum samples were assayed for metabolite concentrations. Behaviour was recorded continuously using IR cameras from days 70 to 87. Heifers’ hooves were inspected for lesions at the start of the study and again after slaughter. Post-slaughter, carcass weight, conformation and fat scores and hide weight were recorded. Heifers housed at 4.5 m2 had a greater average daily live weight gain (ADG) than those on both of the other concrete slat treatments; however, space allowance had no effect on carcass weight. Heifers accommodated on straw had a greater ADG (0.15 kg) (P<0.05), hide weight (P<0.01) better feed conversion ratio (P<0.05) and had greater dirt scores (P<0.05) at slaughter than heifers accommodated on concrete slats at 6.0 m2. The number of heifers lying at any one time was greater (P<0.001) on straw than on concrete slats. Space allowance and floor type had no effect on the number of hoof lesions gained or on any of the haematological or metabolic variables measured. It was concluded that increasing space allowance above 3.0 m2/animal on concrete slats was of no benefit to animal performance but it did improve animal cleanliness. Housing heifers on straw instead of concrete slats improved ADG and increased lying time; however carcass weight was not affected.
The incidence of thyroid cancer is increasing. There is conflicting evidence as to why. However, studies suggest that it is not an apparent increase resulting from enhanced diagnostic practices, but a true increase with more affected patients. This study aimed to assess racial variation in thyroid cancer.
Method:
A narrative systematic review of the literature was conducted.
Results:
Eight retrospective cohort studies were identified, comprising 611 777 adult patients. Variations exist between racial groups, which are also dependent on gender; white patients have a slightly higher male population when compared to their counterparts. Black and white patients have a higher proportion of follicular cancer. Hispanics were younger at the age of diagnosis. Outcomes are greatly affected by socioeconomic status.
Conclusion:
This study identified many gaps in the way that these types of data are presented. A more concise manner of reporting, with individual-level risk factors, is recommended.
Here, we present a catalogue of known Fast Radio Burst sources in the form of an online catalogue, FRBCAT. The catalogue includes information about the instrumentation used for the observations for each detected burst, the measured quantities from each observation, and model-dependent quantities derived from observed quantities. To aid in consistent comparisons of burst properties such as width and signal-to-noise ratios, we have re-processed all the bursts for which we have access to the raw data, with software which we make available. The originally derived properties are also listed for comparison. The catalogue is hosted online as a Mysql database which can also be downloaded in tabular or plain text format for off-line use. This database will be maintained for use by the community for studies of the Fast Radio Burst population as it grows.
Post-traumatic stress disorder (PTSD) is associated with elevated risk for metabolic syndrome (MetS). However, the direction of this association is not yet established, as most prior studies employed cross-sectional designs. The primary goal of this study was to evaluate bidirectional associations between PTSD and MetS using a longitudinal design.
Method
A total of 1355 male and female veterans of the conflicts in Iraq and Afghanistan underwent PTSD diagnostic assessments and their biometric profiles pertaining to MetS were extracted from the electronic medical record at two time points (spanning ~2.5 years, n = 971 at time 2).
Results
The prevalence of MetS among veterans with PTSD was just under 40% at both time points and was significantly greater than that for veterans without PTSD; the prevalence of MetS among those with PTSD was also elevated relative to age-matched population estimates. Cross-lagged panel models revealed that PTSD severity predicted subsequent increases in MetS severity (β = 0.08, p = 0.002), after controlling for initial MetS severity, but MetS did not predict later PTSD symptoms. Logistic regression results suggested that for every 10 PTSD symptoms endorsed at time 1, the odds of a subsequent MetS diagnosis increased by 56%.
Conclusions
Results highlight the substantial cardiometabolic concerns of young veterans with PTSD and raise the possibility that PTSD may predispose individuals to accelerated aging, in part, manifested clinically as MetS. This demonstrates the need to identify those with PTSD at greatest risk for MetS and to develop interventions that improve both conditions.
Free-form deformation (FFD) is a method first introduced within the graphics industry to enable flexible deformation of geometric models. FFD uses an R3 to R3 mapping of a deformable space to the global Cartesian space to produce the geometry deformation. This method has been extensively used within the design optimisation field as a shape parameterisation technique. Typically it has been used to parameterise analysis meshes, where new design geometries are produced by deforming the original mesh. This method allows a concise set of design variables to be used while maintaining a flexible shape representation. However, if a computer aided design (CAD) model of the resulting geometry is required, reverse engineering techniques would need to be utilised to recreate the model from the deformed mesh. This paper extends the use of FFD within an optimisation routine by using FFD to directly parameterise a CAD geometry. Two methods of linking the FFD methods with the CATIA V5 CAD package are presented. Each CAD integration technique is then critiqued with respect to shape optimisation. Finally the set-up and initialisation of a case study is illustrated. The case study chosen is the aerodynamic optimisation of the wing-fuselage junction of a typical passenger aircraft.
The purpose of this study was to determine whether five subcomponents of children's externalizing behavior showed distinctive patterns of long-term growth and predictive correlates. We examined growth in teachers' ratings of overt aggression, covert aggression, oppositional defiance, impulsivity/inattention, and emotion dysregulation across three developmental periods spanning kindergarten through Grade 8 (ages 5–13 years). We also determined whether three salient background characteristics, family socioeconomic status, child ethnicity, and child gender, differentially predicted growth in discrete categories of child externalizing symptoms across development. Participants were 543 kindergarten-age children (52% male, 81% European American, 17% African American) whose problem behaviors were rated by teachers each successive year of development through Grade 8. Latent growth curve analyses were performed for each component scale, contrasting with overall externalizing, in a piecewise fashion encompassing three developmental periods: kindergarten–Grade 2, Grades 3–5, and Grades 6–8. We found that most subconstructs of externalizing behavior increased significantly across the early school age period relative to middle childhood and early adolescence. However, overt aggression did not show early positive growth, and emotion dysregulation significantly increased across middle childhood. Advantages of using subscales were most clear in relation to illustrating different growth functions between the discrete developmental periods. Moreover, growth in some discrete subcomponents was differentially associated with variations in family socioeconomic status and ethnicity. Our findings strongly affirmed the necessity of adopting a developmental approach to the analysis of growth in children's externalizing behavior and provided unique data concerning similarities and differences in growth between subconstructs of child and adolescent externalizing behavior.
Pulsars are potentially the most remarkable physical laboratories we will ever use. Although in many senses they are extremely clean systems there are a large number of instabilities and variabilities seen in the emission and rotation of pulsars. These need to be recognised in order to both fully understand the nature of pulsars, and to enable their use as precision tools for astrophysical investigations. Here I describe these effects, discuss the wide range of timescales involved, and consider the implications for precision pulsar timing.
Many conservation interventions seek to change resource users' behaviour through the creation and enforcement of rules. Their success depends on changing the incentives of potential rule-breakers and those who monitor and enforce compliance. Project implementers may use payments to encourage monitoring and sanctions to deter rule breaking but there has been little research to examine the effectiveness of such approaches in promoting compliance with conservation rules. The effects of payments and sanctions on poaching in a hypothetical community-based conservation project were investigated using an individual-based model incorporating individual heterogeneity and a realistic range of behaviours. Individuals could choose to poach, monitor others' behaviour, or ‘cheat’ (claim a fee without actually monitoring behaviour). They could also invest in avoidance to reduce their probability of being detected breaking rules. Community-level outcomes emerged from individuals’ choices and strategic interactions. The model demonstrates that payments and sanctions can interact strongly with one another and that their effects depend on the economic context in which they are applied. Sanctions were more reliable than payments in reducing poaching and, in some circumstances, payments produced perverse effects. It is thus important to consider individual-level heterogeneity and strategic decision-making when designing interventions aimed at changing human behaviour.