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Edited by
David Mabey, London School of Hygiene and Tropical Medicine,Martin W. Weber, World Health Organization,Moffat Nyirenda, London School of Hygiene and Tropical Medicine,Dorothy Yeboah-Manu, Noguchi Memorial Institute for Medical Research, University of Ghana,Jackson Orem, Uganda Cancer Institute, Kampala,Laura Benjamin, University College London,Michael Marks, London School of Hygiene and Tropical Medicine,Nicholas A. Feasey, Liverpool School of Tropical Medicine
The pattern of thyroid disease in sub-Saharan Africa is changing. Goitre is the commonest thyroid disorder, but is becoming less common because 64% of households now consume adequately iodized salt (UNICEF 2008). Thyrotoxicosis has become more common, with Graves’ disease (a condition once considered very rare) increasing in incidence (Okosieme 2006).
Laueite/stewartite epitaxy was studied using single-crystal diffraction applied to a composite crystal from Hagendorf-Süd, Bavaria. The orientation relationships between the crystals of the two minerals was facilitated by using a non-conventional B$\bar {1}$ space group setting for stewartite, giving unit cells with parallel axes and with as = 2al, bs = bl and cs = 2cl. Face indexing of the crystals of the two minerals confirmed the epitaxial relationship, with the {100} and {010} faces parallel. The plane of epitaxy is {010}. Refinement of laueite and stewartite datasets extracted from the composite-crystal data collection showed a significant decrease in the mean Mn-site bond distances in laueite, consistent with chemical analyses of the crystals that gave site compositions of Mn0.92Fe3+0.08 for stewartite and Mn0.66Mg0.17Fe3+0.17 for laueite. The epitaxial growth of laueite on {010} planes of stewartite appears to have been initiated by a change in solution chemistry. Possible paragenesis of the secondary phosphate minerals from primary triphylite is discussed.
On the upper reaches of the Tigris and Euphrates, archaeologists encounter evidence that challenges conventional understandings of early state formation as a transition from ‘small-scale, egalitarian’ to ‘large-scale, stratified’ societies. One such location is the Early Bronze Age cemetery of Başur Höyük, which presents evidence of grand funerary rituals—including ‘retainer burials’ and spectacular deposits of metallic wealth—in an otherwise small-scale, egalitarian setting. A further, puzzling feature of this cemetery is the preponderance of teenagers in the richest tombs. Here we describe the combined results of archaeological and anthropological analysis at Başur Höyük, including ancient DNA, and consider the challenges they pose to traditional accounts of early state formation.
Functional impairment is a major concern among those presenting to youth mental health services and can have a profound impact on long-term outcomes. Early recognition and prevention for those at risk of functional impairment is essential to guide effective youth mental health care. Yet, identifying those at risk is challenging and impacts the appropriate allocation of indicated prevention and early intervention strategies.
Methods
We developed a prognostic model to predict a young person’s social and occupational functional impairment trajectory over 3 months. The sample included 718 young people (12–25 years) engaged in youth mental health care. A Bayesian random effects model was designed using demographic and clinical factors and model performance was evaluated on held-out test data via 5-fold cross-validation.
Results
Eight factors were identified as the optimal set for prediction: employment, education, or training status; self-harm; psychotic-like experiences; physical health comorbidity; childhood-onset syndrome; illness type; clinical stage; and circadian disturbances. The model had an acceptable area under the curve (AUC) of 0.70 (95% CI, 0.56–0.81) overall, indicating its utility for predicting functional impairment over 3 months. For those with good baseline functioning, it showed excellent performance (AUC = 0.80, 0.67–0.79) for identifying individuals at risk of deterioration.
Conclusions
We developed and validated a prognostic model for youth mental health services to predict functional impairment trajectories over a 3-month period. This model serves as a foundation for further tool development and demonstrates its potential to guide indicated prevention and early intervention for enhancing functional outcomes or preventing functional decline.
Twenty-five essays showcase Malabou's rounded philosophical project: seventeen previously published and eight brand new. In them, Malabou carves a philosophical space between structuralism, deconstruction, cognitive psychology, psychoanalysis and speculative realism.
Self-guided Internet-based cognitive behavior therapy (iCBT) for migraine interventions could improve access to care, but there is poor evidence of their efficacy.
Methods:
A three-arm randomized controlled trial compared: iCBT focused on psychoeducation, self-monitoring and skills training (SPHERE), iCBT focused on identifying and managing personal headache triggers (PRISM) and a waitlist control. The primary treatment outcome was a ≥ 50% reduction in monthly headache days at 4 months post-randomization.
Results:
428 participants were randomized (mean age = 30.1). 240 participants (56.2%) provided outcome data at 4 months. Intention-to-treat (ITT) analysis with missing data imputed demonstrated that the proportion of responders with a ≥ 50% reduction was similar between combined iCBTs and waitlist (48.5/285, 17% vs. 16.6/143, 11.6%, p = 0.20), but analysis of completers showed both iCBT programs to be superior to the waitlist (24/108, 22.2% vs. 13/113, 11.5%, p = 0.047). ITT analysis with missing data imputed showed no difference between the two iCBTs (SPHERE: 24.8/143, 17.3% vs. PRISM: 23.7/142, 16.7%, p = 0.99). Uptake rates of the iCBTs were high (76.9% and 81.69% logged in at least once into SPHERE and PRISM, respectively), but adherence was low (out of those who logged in at least once, 19.01% [21/110] completed at least 50% modules in SPHERE and 7.76% [9/116] set a goal for trying out a given trigger-specific recommendation in PRISM). Acceptability ratings were intermediate.
Conclusions:
Self-guided iCBTs were not found to be superior in our primary ITT analysis. Low adherence could explain the lack of effects as completer analysis showed effects for both interventions. Enhancement of adherence should be a focus of future research.
We present a new model for understanding ice cliff dynamics within a debris-covered glacier ablation zone. This simple energy-balance model incorporates a moving frame of reference, made necessary by the melt of the surrounding debris-covered ice. In so doing, this also formalises how different types of field measurements can be utilised and compared. Our predictions include showing: ice cliffs can endogenously select their own slope angles; that there should be an indifference between illuminated north- and south-facing ice cliff slopes; that ice cliffs grow steeper with thicker debris layers; that ice cliffs cannot stably exist below a certain critical debris thickness and that some modelling of ice cliffs (when not incorporating the moving frame) may incorrectly estimate ice mass losses. All of our results are produced using parametrisations from Baltoro Glacier, Karakoram.
Sperlingite, (H2O)K(Mn2+Fe3+)(Al2Ti)(PO4)4[O(OH)][(H2O)9(OH)]⋅4H2O, is a new monoclinic member of the paulkerrite group, from the Hagendorf-Süd pegmatite, Oberpfalz, Bavaria, Germany. It was found in corrosion pits of altered zwieselite, in association with columbite, hopeite, leucophosphite, mitridatite, scholzite, orange–brown zincoberaunite sprays and tiny green crystals of zincolibethenite. Sperlingite forms colourless prisms with pyramidal terminations, which are predominantly only 5 to 20 μm in size, rarely to 60 μm and frequently are multiply intergrown and are overgrown with smaller crystals. The crystals are flattened on {010} and slightly elongated along [100] with forms {010}, {001} and {111}. Twinning occurs by rotation about c. The calculated density is 2.40 g⋅cm–3. Optically, sperlingite crystals are biaxial (+), α = 1.600(est), β = 1.615(5), γ = 1.635(5) (white light) and 2V (calc.) = 82.7°. The optical orientation is X = b, Y = c and Z = a. Neither dispersion nor pleochroism were observed. The empirical formula from electron microprobe analyses and structure refinement is A1[(H2O)0.96K0.04]Σ1.00A2(K0.52□0.48)Σ1.00M1(Mn2+0.60Mg0.33Zn0.29Fe3+0.77)Σ1.99M2+M3(Al1.05Ti4+1.33Fe3+0.62)Σ3.00(PO4)4X[F0.19(OH)0.94O0.87]Σ2.00[(H2O)9.23(OH)0.77]Σ10.00⋅3.96H2O. Sperlingite has monoclinic symmetry with space group P21/c and unit-cell parameters a = 10.428(2) Å, b = 20.281(4) Å, c = 12.223(2) Å, β = 90.10(3)°, V = 2585.0(8) Å3 and Z = 4. The crystal structure was refined using synchrotron single-crystal data to wRobs = 0.058 for 5608 reflections with I > 3σ(I). Sperlingite is the first paulkerrite-group mineral to have co-dominant divalent and trivalent cations at the M1 sites; All other reported members have Mn2+ or Mg dominant at M1. Local charge balance for Fe3+ at M1 is achieved by H2O → OH– at H2O coordinated to M1.
Hemodynamic collapse in multi-trauma patients with severe traumatic brain injury (TBI) poses both a diagnostic and therapeutic challenge for prehospital clinicians. Brain injury associated shock (BIAS), likely resulting from catecholamine storm, can cause both ventricular dysfunction and vasoplegia but may present clinically in a manner similar to hemorrhagic shock. Despite different treatment strategies, few studies exist describing this phenomenon in the early post-injury phase. This retrospective observational study aimed to describe the frequency of shock in isolated TBI in prehospital trauma patients and to compare their clinical characteristics to those patients with hemorrhagic shock and TBI without shock.
Methods:
All prehospital trauma patients intubated by prehospital medical teams from New South Wales Ambulance Aeromedical Operations (NSWA-AO) with an initial Glasgow Coma Scale (GCS) of 12 or less were investigated. Shock was defined as a pre-intubation systolic blood pressure under 90mmHg and the administration of blood products or vasopressors. Injuries were classified from in-hospital computed tomography (CT) reports. From this, three study groups were derived: BIAS, hemorrhagic shock, and isolated TBI without shock. Descriptive statistics were then produced for clinical and treatment variables.
Results:
Of 1,292 intubated patients, 423 had an initial GCS of 12 or less, 24 patients (5.7% of the original cohort) had shock with an isolated TBI, and 39 patients had hemorrhagic shock. The hemodynamic parameters were similar amongst these groups, including values of tachycardia, hypotension, and elevated shock index. Prehospital clinical interventions including blood transfusion and total fluids administered were also similar, suggesting they were indistinguishable to prehospital clinicians.
Conclusions:
Hemodynamic compromise in the setting of isolated severe TBI is a rare clinical entity. Current prehospital physiological data available to clinicians do not allow for easy delineation between these patients from those with hemorrhagic shock.
Edited by
David Kingdon, University of Southampton,Paul Rowlands, Derbyshire Healthcare NHS foundation Trust,George Stein, Emeritus of the Princess Royal University Hospital
Depressive disorders have been recognised since antiquity, although how they have been described and understood has changed considerably over time. In this chapter, we outline key aspects of the history of depression as well as some of the limitations in its current classification in ICD-11 and DSM-5. We describe the range of symptoms experienced in depressive disorders, together with the recognised variations in clinical presentation and how these are conceptualised and classified. The relationship between depression and related disorders including anxiety disorders, premenstrual dysphoric disorder and grief is discussed, as well as boundary issues with bipolar disorder and primary psychotic disorders. We review current knowledge about depression’s considerable psychiatric and medical comorbidity, along with its epidemiology, natural history and health burden. A brief practical guide to assessing depressive disorders is given, together with rating scales that are useful for clinical assessment and monitoring.
Hydroxylbenyacarite, (H2O)2Mn2(Ti2Fe)(PO4)4[O(OH)](H2O)10⋅4H2O, is a new paulkerrite-group mineral from the El Criollo mine, Cordoba Province, Argentina (IMA2023–079). It was found in specimens of altered triplite, in association with bermanite, phosphosiderite, quartz, strengite and manganese oxides.
Hydroxylbenyacarite occurs as light greenish-yellow rhombic tablets with dimensions of typically 20 to 50 μm, occasionally to 400 μm. The crystals are flattened on {010}, slightly elongated on [001] and bounded by the {111} and {010} forms. The calculated density is 2.32 g cm–3. Optically, hydroxylbenyacarite crystals are biaxial (+), with α = 1.608(3), β = 1.624(3), γ = 1.642(3) (measured in white light) and 2V(meas.) = 88(2)°. The calculated 2V is 87.5°. The empirical formula is Ca0.06A[K0.46(H2O)0.88□0.66]Σ2.00M1(Mn1.52Mg0.02Fe2+0.35□0.11)Σ2.00M2+M3(Fe3+1.21Al0.02Ti1.77)Σ3.00(PO4)4X[F0.16(OH)0.70O1.14]Σ2.00(H2O)10⋅3.77H2O.
The average crystal structure for hydroxylbenyacarite has space group Pbca and unit cell parameters a = 10.5500(3) Å, b =20.7248(5) Å, c = 12.5023(3) Å, V = 2733.58(12) Å3 and Z = 4. It was refined using single-crystal data to wRobs = 0.074 for 2611 reflections with I > 3σ(I). The crystal structure contains corner-connected linear trimers of Ti-centred octahedra that share corners with PO4 tetrahedra to form 10-member rings parallel to (010). K+ cations and water molecules are located in interstitial sites within the rings. Additional corner-sharing of the PO4 tetrahedra with MnO2(H2O)4 octahedra occurs along [010] to complete the 3D framework structure. A new eight-coordinated interstitial site, previously unreported for paulkerrite-group minerals, is occupied by Ca2+ cations. Weak diffuse diffraction spots in reconstructed precession images for hydroxylbenyacarite violate the a and b glide plane extinctions for Pbca and are consistent with local, unit-cell-scale regions of monoclinic, P21/c structure, in which ordering of the interstitial K+ and Ca2+ cations occurs.
The subject of this chapter is Grágás, the compilation of the laws of Iceland in the Commonwealth period. The chapter begins by outlining the court structure of Iceland and the fundamentals of legal procedure, briefly discussing the importance of law to the conversion narrative in Íslendingabók and its account of the first decision to put Iceland’s laws into writing. It describes the distinctive concepts and customs which underlie the legal system of medieval Iceland, looking at the role of the búi (neighbour) in legal procedure, and explaining the key concepts of helgi (the right of inviolability), grið (domicile, or household attachment), vígt (the right to kill or to avenge a wrong with impunity), and the problem of dealing with ómagar (dependants). The chapter argues that the laws and sagas are often mutually informing and demonstrates how fundamental an understanding of law is to the interpretation of the Íslendingasögur. It gives numerous examples of how the laws can be used to help elucidate the sagas, and uses the sagas to reveal the importance of law and legal knowledge in medieval Icelandic society.
The military invasion of Ukraine has destroyed and damaged extensive built cultural heritage, including churches, museums and monuments. Based on site visits conducted since the invasion, we outline damage to the eleventh-century sites of Boldyni Hory, Chernihiv, and the church, citadel and graveyard at Oster, Chernihiv Oblast.
We demonstrate a fast adjoint-based method to optimise tokamak and stellarator equilibria against a pressure-driven instability known as the infinite-$n$ ideal ballooning mode. We present three finite-$\beta$ (the ratio of thermal to magnetic pressure) equilibria: one tokamak equilibrium and two stellarator equilibria that are unstable against the ballooning mode. Using the self-adjoint property of ideal magnetohydrodynamics, we construct a technique to rapidly calculate the change in the eigenvalue, a measure of ideal ballooning instability. Using the SIMSOPT optimisation framework, we then implement our fast adjoint gradient-based optimiser to minimise the eigenvalue and find stable equilibria for each of the three originally unstable equilibria.
The advent of new non-invasive (largely EEG and MRI-based) methods for recording the activity of critical brain circuits (frontotemporal and subcortical) and networks (Default Mode, Salience, Central Executive), cross-sectionally and longitudinally, as well as concurrently (EEG and fMRI), has led to a focus on whether such techniques could be used to guide individual treatment selection. While this work has commenced with specific relevance to depression and other mood disorders (Goldstein-Piekarski et al., 2022; Hack et al., 2023; Scangos et al., 2023), there is still much to be learnt and a great need to replicate findings across different cohorts and different research centres.
White marble sculpture is a cornerstone of Western art history. Archaeological inquiry, however, has demonstrated that Classical sculpture and its associated architecture were once coloured. The authors examine the Parthenon Sculptures at the British Museum to identify traces of colour and carving on their surfaces. Using close examination and archaeometric techniques, the study shows that the sculptors finished surfaces with textures that reflected specific elements (e.g. skin, wool, linen) and these were then enhanced through the application of colour, including a purple colourant and Egyptian blue. The latter was used extensively to paint elaborate figurative designs on the carved textiles. Despite the complexity of the carved drapery, elaborate ornament was applied to the finish. The findings encourage a reconsideration of the appearance of the Parthenon in the fifth century BC.
Rewitzerite, K(H2O)Mn2(Al2Ti)(PO4)4[O(OH)](H2O)10⋅4H2O, is a new monoclinic member of the paulkerrite group, from the Hagendorf-Süd pegmatite, Oberpfalz, Bavaria, Germany. It was found in specimens of altered zwieselite, in association with rockbridgeite. Rewitzerite forms clusters of colourless elongated hexagonal-shaped prisms, up to 0.1 mm long. The crystals are flattened on {010} and elongated along [100], with forms {010}, {001}, {111} and {$\bar{1}$11}. The calculated density is 2.33 g⋅cm–3. Optically, rewitzerite crystals are biaxial (+), with α = 1.585(2), β = 1.586(2), γ = 1.615(2) (measured in white light) and 2V(meas) = 25(2)°. The empirical formula from electron microprobe analyses and structure refinement is A1[K0.77(H2O)0.23]A2[H2O] M1(Mn2+0.82Mg0.64Fe3+0.43□0.11)Σ2.00M2+M3(Al1.51Ti4+1.06Fe3+0.43)Σ3.00(PO4)4X[(OH)0.54F0.42O1.04]Σ2.00(H2O)10⋅4H2O, where □ = vacancy.
Rewitzerite has monoclinic symmetry with space group P21/c and unit-cell parameters a = 10.444(2) Å, b = 20.445(2) Å, c = 12.2690(10)Å, β = 90.17(3)°, V = 2619.8(6) Å3 and Z = 4. The crystal structure was refined using synchrotron single-crystal data to wRobs = 0.068 for 5894 reflections with I > 3σ(I). The crystal structure has the same topology as that for orthorhombic paulkerrite-group minerals but differs primarily in having an ordering of K+ and H2O molecules in different A sites, whereas they are disordered at a single A site in the orthorhombic members of the group.
Brain in Hand (BIH) is a UK-based digital self-support system for managing anxiety and social functioning.
Aims
To identify the impact of BIH on the psychological and social functioning of adults with autism.
Method
Adults with diagnosed or suspected DSM-5 (level 1) autism, identified by seven NHS autism services in England and Wales, were recruited for a 12-week prospective mixed-methods cohort study. The primary quantitative outcome measures were the Health of the Nation Outcome Scales for People with Learning Disabilities (HONOS-LD) and the Hospital Anxiety and Depression Scale (HADS). Fisher's exact test explored sociodemographic associations. Paired t-test was utilised for pre–post analysis of overall effectiveness of BIH. Multivariable linear regression models, univariable pre–post analysis, Wilcoxon signed-rank test, logistic regression analysis, Bonferroni correction and normative analysis were used to give confidence in changes identified. A thematic analysis of semi-structured exist interviews following Braun and Clarke's six-step process of 10% of participants who completed the study was undertaken.
Results
Sixty-six of 99 participants completed the study. There was significant reduction in mean HONOS-LD scores, with 0.65 s.d. decrease in those who used BIH for 12 weeks. Significant positive changes were identified in HONOS-LD subdomains of ‘self-injurious behaviours’, ‘memory and orientation’, ‘communication problems in understanding’, ‘occupation and activities’ and ‘problems with relationship’. A significant reduction in the anxiety, but not depression, component of the HADS scores was identified. Thematic analysis showed high confidence in BIH.
Conclusions
BIH improved anxiety and other clinical, social and functioning outcomes of adults with autism.
Protection of Antarctica's biodiversity and ecosystem values is enshrined in the Protocol on Environmental Protection to the Antarctic Treaty, which provides for the designation of Antarctic Specially Protected Areas (ASPAs) to areas with outstanding values. Concern has been raised that existing ASPAs fail to prioritize areas to maximize the likelihood of ensuring the long-term conservation of Antarctic ecosystems and biodiversity. The absence of systematic and representative protection is particularly acute for inland aquatic ecosystems, which support a disproportionate amount of inland biodiversity. This paper promotes the case for overt inclusion of inland waters as a critical component of a representative protected area framework for Antarctica, thereby addressing their current underrepresentation. We set out a structured approach to enable the selection of representative freshwater systems for inclusion in the ASPA framework that, with modification, could also be applied across other Antarctic habitats. We acknowledge an overall lack of information on the biogeography of inland aquatic diversity and recommend increased use of remote data collection along with classification tools to mitigate this, as well as the need for the consideration of catchment-scale processes. Changes that accompany contemporary and anticipated climate change make the need for the conservation of representative biodiversity increasingly urgent.