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The First Large Absorption Survey in H i (FLASH) is a large-area radio survey for neutral hydrogen in and around galaxies in the intermediate redshift range $0.4\lt z\lt1.0$, using the 21-cm H i absorption line as a probe of cold neutral gas. The survey uses the ASKAP radio telescope and will cover 24,000 deg$^2$ of sky over the next five years. FLASH breaks new ground in two ways – it is the first large H i absorption survey to be carried out without any optical preselection of targets, and we use an automated Bayesian line-finding tool to search through large datasets and assign a statistical significance to potential line detections. Two Pilot Surveys, covering around 3000 deg$^2$ of sky, were carried out in 2019-22 to test and verify the strategy for the full FLASH survey. The processed data products from these Pilot Surveys (spectral-line cubes, continuum images, and catalogues) are public and available online. In this paper, we describe the FLASH spectral-line and continuum data products and discuss the quality of the H i spectra and the completeness of our automated line search. Finally, we present a set of 30 new H i absorption lines that were robustly detected in the Pilot Surveys, almost doubling the number of known H i absorption systems at $0.4\lt z\lt1$. The detected lines span a wide range in H i optical depth, including three lines with a peak optical depth $\tau\gt1$, and appear to be a mixture of intervening and associated systems. Interestingly, around two-thirds of the lines found in this untargeted sample are detected against sources with a peaked-spectrum radio continuum, which are only a minor (5–20%) fraction of the overall radio-source population. The detection rate for H i absorption lines in the Pilot Surveys (0.3 to 0.5 lines per 40 deg$^2$ ASKAP field) is a factor of two below the expected value. One possible reason for this is the presence of a range of spectral-line artefacts in the Pilot Survey data that have now been mitigated and are not expected to recur in the full FLASH survey. A future paper in this series will discuss the host galaxies of the H i absorption systems identified here.
Major Depressive Disorder (MDD) is a complex mental health condition characterized by a wide spectrum of symptoms. According to the Diagnostic Statistical Manual 5 (DSM-5) criteria, patients can present with up to 1,497 different symptom combinations, yet all receive the same MDD diagnosis. This diversity in symptom presentation poses a significant challenge to understanding the disorder in the wider population. Subtyping offers a way to unpick this phenotypic diversity and enable improved characterization of the disorder. According to reviews, MDD subtyping work to date has lacked consistency in results due to inadequate statistics, non-transparent reporting, or inappropriate sample choice. By addressing these limitations, the current study aims to extend past phenotypic subtyping studies in MDD.
Objectives
(1) To investigate phenotypic subtypes at baseline in a sample of people with MDD;
(2) To determine if subtypes are consistent between baseline 6- and 12-month follow-ups; and
(3) To examine how participants move between subtypes over time.
Methods
This was a secondary analysis of a one-year longitudinal observational cohort study. We collected data from individuals with a history of recurrent MDD in the United Kingdom, the Netherlands and Spain (N=619). The presence or absence of symptoms was tracked at three-month intervals through the Inventory of Depressive Symptomatology: Self-Report (IDS-SR) assessment. We used latent class and three-step latent transition analysis to identify subtypes at baseline, determined their consistency at 6- and 12-month follow-ups, and examined participants’ transitions over time.
Results
We identified a 4-class solution based on model fit and interpretability, including (Class 1) severe with appetite increase, (Class 2), severe with appetite decrease, (Class 3) moderate, and (Class 4) low severity. The classes mainly differed in terms of severity (the varying likelihood of symptom endorsement) and, for the two more severe classes, the type of neurovegetative symptoms reported (Figure 1). The four classes were stable over time (measurement invariant) and participants tended to remain in the same class over baseline and follow-up (Figure 2).
Image:
Image 2:
Conclusions
We identified four stable subtypes of depression, with individuals most likely to remain in their same class over 1-year follow-up. This suggests a chronic nature of depression, with (for example) individuals in severe classes more likely to remain in the same class throughout follow-up. Despite the vast heterogeneous symptom combinations possible in MDD, our results emphasize differences across severity rather than symptom type. This raises questions about the meaningfulness of these subtypes beyond established measures of depression severity. Implications of these findings and recommendations for future research are made.
Disclosure of Interest
C. Oetzmann Grant / Research support from: C.O. is supported by the UK Medical Research Council (MR/N013700/1) and King’s College London member of the MRC Doctoral Training Partnership in Biomedical Sciences., N. Cummins: None Declared, F. Lamers: None Declared, F. Matcham: None Declared, K. White: None Declared, J. Haro: None Declared, S. Siddi: None Declared, S. Vairavan Employee of: S.V is an employee of Janssen Research & Development, LLC and hold company stocks/stock options., B. Penninx : None Declared, V. Narayan: None Declared, M. Hotopf Grant / Research support from: M.H. is the principal investigator of the RADAR-CNS programme, a precompetitive public–private partnership funded by the Innovative Medicines Initiative and the European Federation of Pharmaceutical Industries and Associations. The programme received support from Janssen, Biogen, MSD, UCB and Lundbeck., E. Carr: None Declared
In a “mixed bag” 2023-2024 session, the U.S. Supreme Court issued a series of decisions both favorable and antithetical to public health and safety. Taking on tough constitutional issues implicating gun control, misinformation, and homelessness, the Court also avoided substantive reviews in favor of procedural dismissals in key cases involving reproductive rights and government censorship.
Prenatal vitamin D deficiency is widely reported and may affect perinatal outcomes. In this secondary analysis of the UK Pregnancies Better Eating and Activity Trial, we examined vitamin D status and its relationship with selected pregnancy outcomes in women with obesity (BMI ≥ 30 kg/m2) from multi-ethnic inner-city settings in the UK. Determinants of vitamin D status at a mean of 17 ± 1 weeks’ gestation were assessed using multivariable linear regression and reported as percent differences in serum 25-hydroxyvitamin D (25(OH)D). Associations between 25(OH)D and clinical outcomes were examined using logistic regression. Among 1089 participants, 67 % had 25(OH)D < 50 nmol/l and 26 % had concentrations < 25 nmol/l. In fully adjusted models accounting for socio-demographic and anthropometric characteristics, 25(OH)D was lower among women of Black (% difference = −33; 95 % CI: −39, −27), Asian (% difference = −43; 95 % CI: −51, −35) and other non-White (% difference = −26; 95 % CI: −35, −14) ethnicity compared with women of White ethnicity (n 1086; P < 0·001 for all). In unadjusted analysis, risk of gestational diabetes was greater in women with 25(OH)D < 25 nmol/l compared with ≥ 50 nmol/l (OR = 1·58; 95 % CI: 1·09, 2·31), but the magnitude of effect estimates was attenuated in the multivariable model (OR = 1·33; 95 % CI: 0·88, 2·00). There were no associations between 25(OH)D and risk of preeclampsia, preterm birth or small for gestational age or large-for-gestational-age delivery. These findings demonstrate low 25(OH)D among pregnant women with obesity and highlight ethnic disparities in vitamin D status in the UK. However, evidence for a greater risk of adverse perinatal outcomes among women with vitamin D deficiency was limited.
A standardless method of energy dispersive X-ray fluorescence in conjunction with scanning electron microscopy was used to analyze selected areas of clay-size particles of talc, pyrophyllite, and kaolinite supported by a carbon planchet. Peak intensity ratios of fluorescing elements relative to silicon were converted directly to weight or mole ratios using conversion factors determined theoretically. The conversion factors depend upon particle thickness and mass adsorption coefficients of the sample for the elements analyzed. The effects of particle thickness become significant above ~0.1 μm. Without using particle thickness corrections, the mean molar ratios of metal to Si agreed to within 6.1,0.5, and 9.7% of the theoretical ratios for kaolinite, pyrophyllite, and talc, respectively.
Nursing home residents may be particularly vulnerable to coronavirus disease 2019 (COVID-19). Therefore, a question is when and how often nursing homes should test staff for COVID-19 and how this may change as severe acute respiratory coronavirus virus 2 (SARS-CoV-2) evolves.
Design:
We developed an agent-based model representing a typical nursing home, COVID-19 spread, and its health and economic outcomes to determine the clinical and economic value of various screening and isolation strategies and how it may change under various circumstances.
Results:
Under winter 2023–2024 SARS-CoV-2 omicron variant conditions, symptom-based antigen testing averted 4.5 COVID-19 cases compared to no testing, saving $191 in direct medical costs. Testing implementation costs far outweighed these savings, resulting in net costs of $990 from the Centers for Medicare & Medicaid Services perspective, $1,545 from the third-party payer perspective, and $57,155 from the societal perspective. Testing did not return sufficient positive health effects to make it cost-effective [$50,000 per quality-adjusted life-year (QALY) threshold], but it exceeded this threshold in ≥59% of simulation trials. Testing remained cost-ineffective when routinely testing staff and varying face mask compliance, vaccine efficacy, and booster coverage. However, all antigen testing strategies became cost-effective (≤$31,906 per QALY) or cost saving (saving ≤$18,372) when the severe outcome risk was ≥3 times higher than that of current omicron variants.
Conclusions:
SARS-CoV-2 testing costs outweighed benefits under winter 2023–2024 conditions; however, testing became cost-effective with increasingly severe clinical outcomes. Cost-effectiveness can change as the epidemic evolves because it depends on clinical severity and other intervention use. Thus, nursing home administrators and policy makers should monitor and evaluate viral virulence and other interventions over time.
We investigate the linear and nonlinear evolution of the current-driven ion-acoustic instability in a collisionless plasma via two-dimensional (2-D) Vlasov–Poisson numerical simulations. We initialise the system in a stable state and gradually drive it towards instability with an imposed, weak external electric field, thus avoiding physically unrealisable super-critical initial conditions. A comprehensive analysis of the nonlinear evolution of ion-acoustic turbulence (IAT) is presented, including the detailed characteristics of the evolution of the particles’ distribution functions, (2-D) wave spectrum and the resulting anomalous resistivity. Our findings reveal the dominance of 2-D quasi-linear effects around saturation, with nonlinear effects, such as particle trapping and nonlinear frequency shifts, becoming pronounced during the later stages of the system's nonlinear evolution. Remarkably, the Kadomtsev–Petviashvili (KP) spectrum is observed immediately after the saturation of the instability. Another crucial and noteworthy result is that no steady saturated nonlinear state is ever reached: strong ion heating suppresses the instability, which implies that the anomalous resistivity associated with IAT is transient and short-lived, challenging earlier theoretical results. Towards the conclusion of the simulation, electron-acoustic waves are triggered by the formation of a double layer and strong modifications to the particle distribution induced by IAT.
We investigated disparities in the clinical management of self-harm following hospital presentation with self-harm according to level of socio-economic deprivation (SED) in England.
Methods
108 092 presentations to hospitals (by 57 306 individuals) after self-harm in the Multicenter Study of Self-harm spanning 17 years. Area-level SED was based on the English Index of Multiple Deprivation. Information about indicators of clinical care was obtained from each hospital's self-harm monitoring systems. We assessed the associations of SED with indicators of care using mixed effect models.
Results
Controlling for confounders, psychosocial assessment and admission to a general medical ward were less likely for presentations by patients living in more deprived areas relative to presentations by patients from the least deprived areas. Referral for outpatient mental health care was less likely for presentations by patients from the two most deprived localities (most deprived: adjusted odd ratio [aOR] 0.77, 95% CI 0.71–0.83, p < 0.0001; 2nd most deprived: aOR 0.80, 95% CI 0.74–0.87, p < 0.0001). Referral to substance use services and ‘other’ services increased with increased SED. Overall, referral for aftercare was less likely following presentations by patients living in the two most deprived areas (most deprived: aOR 0.85, 95% CI 0.78–0.92, p < 0.0001; 2nd most deprived: aOR 0.86, 95% CI 0.79–0.94, p = 0.001).
Conclusions
SED is associated with differential care for patients who self-harm in England. Inequalities in care may exacerbate the risk of adverse outcomes in this disadvantaged population. Further work is needed to understand the reasons for these differences and ways of providing more equitable care.
Front-of-package warning labels introduced in Mexico in 2020 included disclaimers that caution against allowing children to consume products with non-sugary sweeteners and caffeine. We examined the awareness and use of the disclaimers among Mexican adults and youth 1 month after the regulation was implemented. We also investigated their impact on the perceived healthfulness of industrialised beverages designed for children.
Design:
Data on the awareness and use of the disclaimers were analysed. Two between-subjects experiments examined the effect of a sweetener disclaimer (Experiment 1, youth and adults) or a caffeine disclaimer (Experiment 2, only adults) on the perceived healthfulness of industrialised beverages. Interactions between experimental conditions and demographic characteristics were tested.
Setting:
Online survey in 2020.
Participants:
Mexican adults (≥18 years, n 2108) and youth (10–17 years, n 1790).
Results:
Most participants (>80 %) had seen the disclaimers at least rarely, and over 60 % used them sometimes or frequently. The sweetener disclaimer led to a lower perceived healthfulness of a fruit drink (adults: 2·74 ± 1·44; youth: 2·04 ± 0·96) compared with the no-disclaimer condition (adults: 3·17 ± 1·54; youth: 2·32 ± 0·96) (t’s: >4·0, P values: <0·001). This effect was larger among older adults and male youth. The caffeine disclaimer did not affect adult’s perceived healthfulness of a caffeinated drink (t = 0·861, P value = 0·3894).
Conclusions:
There were high awareness and use of the sweeteners and caffeine disclaimers shortly after the warning labels were implemented. The sweetener disclaimer appears to be helping consumers modify their perceptions regarding industrialised beverages for children. Findings may help decision-makers improve the regulation and better target communication strategies.
Three volumes of detailed description of Bedfordshire parish churches, presented with text from five important nineteenth-century sources; Appendices and Index complete the set.
This is to be a series of three volumes covering Bedfordshire churches in the nineteenth century. The volumes will contain descriptions of churches “on the eve of restoration” together with contemporary illustrations –most of which will be published for the first time.
For each church, there will be extracts from original records amplified by a commentary and explanatory footnotes. The main source material consists of:
1. Extracts from church inventories – mainly 1822
2. Antiquarian notes on churches by Archdeacon Bonney, c.1840
4. Articles on churches by W.A. – John Martin, the librarian at Woburn Abbey - 1845-1854
5. Church descriptions by Sir Stephen Glynne 1830-1870
There is considerable value in having these key sources, with illustrations and commentary, in one place. The descriptions by Bonney and Glynne are purely factual, but John Martin’s articles, highlighting abuses and neglect, make colourful and at times controversial reading. Bonney’s visitation notes - and the supporting evidence from contemporary records such as churchwardens’ accounts – give a clear indication that church buildings were far from neglected in the opening decades of the nineteenth century. Together these sources document features that can still be seen today, and provide information on others that have been lost.
The aim has been to present the text of contemporary sources in their original state, to convey a feeling for the times as well as to provide information. It is recognised that most of the sources could have been condensed by editing - for instance the lists of registers in the glebe terriers and the quotations in the articles by W.A. – but the Editorial Group felt that they should nevertheless be published in extenso.
The introductory commentary for each church includes a summary of the history of the building, focusing especially on eighteenth and nineteenth century restoration and alterations. These introductory notes are generally brief, but may be longer where differences between present and past external appearance merit detailed discussion. Detailed footnotes explain and amplify features mentioned in the text of the original sources and so lead the reader to additional research material.
Bedfordshire churches on the eve of restoration are well documented in a number of sources. First, there are a great many pictures of churches by artists such as Thomas Fisher and George Shepherd dating from the early Cl9th. Secondly, there are the manuscript sources which describe the condition of church buildings and ornaments in the years leading up to “the age of restoration”.
These sources are described and discussed in detail below. In outline, however, they include the glebe terriers for 1822 which describe the plan of each church and list the ornaments and furnishings. As Archdeacon of Bedford from 1821 to 1844, Dr. Henry Kaye Bonney compiled two notebooks on the churches in his care. In the one, he made detailed architectural notes on each church and its fittings, and in the other he kept a record of the orders made at his archidiaconal visitations between 1823 and 1839. Another commentator was John Martin, the Librarian at Woburn Abbey, who using the signature W.A. wrote a series of pithy articles on Bedfordshire churches for the Northampton Mercury and Bedfordshire Times between 1845 and 1854. Lastly, there are the notebooks of Sir Stephen Glynne who visited over a third of the churches in the County between 1830 and 1870.
Together these sources provide a colourful image of the appearance, condition and atmosphere of Bedfordshire churches at a time when on the one hand they were nearer their mediaeval state than they are today but when on the other they were arguably in their greatest need of attention.
Glebe Terriers (extracts) 1822
After the Reformation, the ecclesiastical authorities became increasingly aware of the need to keep proper records of church possessions. The documents known as glebe terriers fulfil this purpose, and include terriers (recording property and endowments) and inventories (listing goods and chattels). The existence of such records helped to prevent the loss and misappropriation of church property.
Terriers had been compiled for purely parochial purposes in mediaeval times, but in compliance with an archiepiscopal order or canon of 1571 it became a requirement for copies of these documents to be lodged in diocesan registries for safe-keeping.
Although the present church dates chiefly from the Cl4th and Cl5th, the foundations of the Cl2th church were discovered during excavations in 1975. The later church has a chancel, nave with north and south aisles, south porch and west tower. It retains its Cl5th roof with angels and shields (though the painted decoration is modem) and there is a ceilure above the former rood.
In 1696 a private pew was constructed for Lord Ashbumham of Ampthill Park in the south aisle of the church. Sir Christopher Wren and his pupil Nicholas Hawksmoor were involved in the design, and the pew was built by Alexander Fort, the King’s joiner. There was a heated legal dispute between Lord Ashburnham and Lord Ailesbury of Houghton House about this pew, which was eventually removed in 1847. The entrance through the east wall of the south aisle is shown in Buckler’s drawing dated 1835 (Plate 2). Lord Ailesbury had his own pew in the church, and there are faculties and papers regarding other Cl8th pews. In 1827 Boissier described the church as “crowded with pews & galleries”. Between 1823 and 1839 Bonney ordered several improvements to the pews, and in 1845 W.A. was highly critical of the arrangement of the church interior.
A faculty was obtained in 1728 to replace the pulpit, take down the chancel screen, and alter various windows. It was probably at this date that the pulpit was placed centrally in the chancel arch where it remained until 1847. Other repairs and alterations in the Cl8th and early Cl9th are recorded in the churchwardens’ accounts from 1718, vestry minutes from 1767, and churchwardens bills from 1823 (listed individually by Andrew Underwood) in the parish records.
Restoration came in 1847-8 under James Tacy Wing of Bedford, who provided new seats and galleries in the nave (Plate 3) and renewed the east window, repaired the roof and stonework, and added a small vestry on the north side of the chancel. In 1851-2 the church was lit by gas.
The tracery of the windows in the south aisle was renewed in 1872-3. Further work followed in 1877 when the vestry on the north side of the chancel was enlarged under James Piers St. Aubyn, although not all the work authorised by the faculty was carried out.
The parish churches of England are among the most noble and conspicuous of the nation’s architectural monuments. Their survival, however, owes more to chance than to good stewardship. Neglect, decay, and deliberate destruction are as much a part of their history as the work of dedicated benefactors and parishioners who strove to make our churches worthy for Christian worship.
As the sources selected for inclusion in this series demonstrate all too clearly, many Bedfordshire churches were in a dilapidated state in the opening decades of the nineteenth century. Others, whilst structurally sound and decently furnished for the worship of the day, needed “restoration” – a term meaning much more than just repair. This was the situation facing the Victorians who – far from vandalising our heritage – sought to restore these precious buildings from years of neglect and adapt them to suit the new liturgical arrangements of the time.
The coming of the ecclesiological movement in the 1840s brought a new concern for the ceremonial aspects of worship – the ministry of the sacraments instead of the ministry of the word. This entailed a change in the arrangement of church buildings, the old “preaching boxes” of the Cl8th giving way to churches in which all attention focused on the chancel and the holy table in the sanctuary. The reformers often exaggerated the poor state of church buildings as a means of drawing attention to the need for change, and the Victorians were invariably critical of alterations and repairs carried out in previous centuries when utility had been regarded as more important than sanctity.
Between about 1840 and 1914 virtually every parish church in England was in some measure restored, and vast sums of money were spent on what was seen to be one of the most worthy causes of the Victorian era. Many churches were rescued from the brink of collapse and given a new lease of life. Some were restored to their former glory. Others were mutilated beyond recognition or wholly rebuilt. Churches viewed by the Victorians as “tainted by classical alterations” were gothicised. Sound buildings were “improved” to suit the needs of a new religious age.
Churches remaining “unrestored” in appearance are to be seen at Chaigrave, Dean, Knotting, Odell, Shelton and Wymington (to name a few of the more rewarding examples in the County), but sadly the phrase “over restored” is all too common in the Bedfordshire volume of Dr. Nikolaus Pevsner’s Buildings of England series.
A brief general survey of post-Reformation church work in the County will be useful as an introduction to the subject. It seems sensible to frame the review round the work of architects - the designers of buildings and of furnishing schemes - who worked at different periods and in different styles. In this way, it is possible to view the changes in ecclesiastical taste in the County in their broader national context.
Post-Reformation church building to 1800
In general terms, church building activity came to an abrupt end at the time of the Reformation. There are, however, exceptions and recent studies in the neighbouring county of Huntingdonshire have demonstrated the extent of building work and improvements to churches into the seventeenth century. This may be untypical of the general picture, and Bedfordshire lacks any particularly distinguished examples of churches dating from the period between 1550 and 1800. Those mentioned below are all relatively minor when compared with the treasures in neighbouring counties, such as:
In Bedfordshire, Hulcote church was rebuilt by the Chemocke family in the late sixteenth century. It is gothic in form, but with a distinctly Renaissance feel. The tower at Blunham was rebuilt in 1583. At Odell there is a fine screen and ringing gallery of 1637 in the tower arch. At Campton, the north aisle dates from 1649. Whipsnade church was rebuilt in 1719. Melchboume has a seventeenthcentury porch brought, it is said, from Woodford in Northamptonshire. The body of the church was rebuilt in the classical style in about 1770. Shillington tower, destroyed in a storm in 1701, was rebuilt in brick in 1750. The 1783 black basalt Wedgwood font at Cardington - another formerly existed at Melchboume - is a particularly memorable example of eighteenth-century church furnishing. In every one of these cases the identity of the architect is unknown.