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Primary health care (PHC) delivered in Austria’s newly established primary health care units (PHCU) is based on interprofessional collaboration (IPC) between health care and social professionals.
Aim:
This study aims to explore the requirements and challenges in IPC in Austrian PHCUs from the perspective of health care and social professionals.
Methods:
15 semi-standardized, online, mono-professional focus group interviews were conducted with a total of 58 professionals with the following backgrounds: biomedical sciences, dietetics, medical training therapy, medicine, midwifery, nursing, occupational therapy, office assistance, orthoptics, pharmacy, physiotherapy, psychotherapy, radiography, social work, and speech therapy. The participants were representatives from PHC practice (especially PHCUs), respective educational institutions, and professional organizations. The data were inductively analysed using qualitative content analysis according to Mayring.
Findings:
The analysis displayed two main fields discussed by the participants, the setting for IPC and the professional relationships. The content analysis revealed three and four topics, respectively, within the main discussion fields. Within the setting for IPC, these topics were elaborated on (1) the operational area where IPC takes place in PHC, (2) the structural and organizational premises for this cooperation in PHCUs, and (3) the observed benefits of PHCUs for patients. Regarding the professional relationships, these topics were discoursed: (1) successful IPC, (2) challenges in IPC, (3) competencies required for IPC, and (4) previous and present corresponding training content.
Conclusion:
Austrian health care and social professionals aim to get more involved in PHC in general and PHCUs specifically. They see opportunities and also challenges for their professional groups. Specific training is desired focusing on the unique requirements of Austrian PHCUs and equipping the workforce for the intensive, necessary, and beneficial collaboration between multiple professional groups in the increasingly important setting.
Learning models predict that the relative speed at which players in a game adjust their behavior has a critical influence on long term behavior. In an ultimatum game, the prediction is that proposers learn not to make small offers faster than responders learn not to reject them. We experimentally test whether relative speed of learning has the predicted effect, by manipulating the amount of experience accumulated by proposers and responders. The experiment allows the predicted learning by responders to be observed, for the first time.
The ʻuaʻu, or Hawaiian Petrel Pterodroma sandwichensis, is an endangered seabird endemic to the Hawaiian Islands. Genetic, morphometric, and behavioural differences have previously been found between different island populations of the species. Understanding the breeding phenology of different populations of ʻuaʻu is therefore vital for conservation actions targeting the species. To assess breeding phenology of ʻuaʻu on the islands of Kauaʻi and Lānaʻi, two main techniques were used over a 12-year period: direct burrow monitoring and burrow cameras. The breeding phenology of the ʻuaʻu is described based on this data. On Kauaʻi, breeding birds arrive in the middle of April, undergo an exodus of approximately one month, and return to lay in the beginning of June. Incubation continues until early August, followed by chick-rearing, which ends on average two weeks before the chick fledges. Fledging starts in mid-October, peaks in mid-November, and ends in the third week of December. Lānaʻi birds arrive two weeks earlier and fledge one week earlier than on Kauaʻi. On both islands breeding was asynchronous with a 68-day (Kauaʻi) and 48-day (Lānaʻi) gap between first and last fledging birds. Considering phenology data across its entire Hawaiian range, ʻuaʻu first arrive on east Maui, then Lānaʻi, Hawaiʻi Island, and Kauaʻi in that order. These differences in timing presumably reflect and/or reinforce genetic differentiation between subpopulations of the species. The utility of this information is discussed in terms of directing management actions towards key periods of vulnerability to introduced predators, including peak incubation, chick emergence, and chick exercise periods. Description of island-specific phenologies is also critical to inform efforts to rescue fledglings disoriented by artificial light, mitigate powerline collisions, and refine existing monitoring and restoration projects. Future work using acoustic monitoring and data collected at social attraction sites is recommended for assessing the phenology of non-breeders at colonies.
Social power establishes and legitimizes actions for individuals within a society who accept the structures that create that power. Differences in power can develop without strict hierarchies, however. Here, we explore the power differences among groups living in the Mimbres Mogollon region of southwestern New Mexico using bioarchaeological data and a case study from the Harris site, a Late Pithouse period village occupied circa AD 550–1000. Aspects of mortuary practices and supporting archaeological data offer nuanced interpretations of individuals with situational power linked to social practices that both solidified and maintained power by particular households. The power differences documented here are not based on coercion; instead, they are tied to cooperation and engagement with the community. For small-scale communities such as Harris, situational power is interpreted for individuals with access to prime agricultural land and/or ritual, or by association with certain land-holding lineages. This system is consistent with a heterarchical structure that embraced flexibility in the use of power.
Maternal vitamin-D and omega-3 fatty acid (DHA) deficiencies during pregnancy have previously been associated with offspring neurodevelopmental traits. However, observational study designs cannot distinguish causal effects from confounding.
Methods
First, we conducted Mendelian randomisation (MR) using genetic instruments for vitamin-D and DHA identified in independent genome-wide association studies (GWAS). Outcomes were (1) GWAS for traits related to autism and ADHD, generated in the Norwegian mother, father, and child cohort study (MoBa) from 3 to 8 years, (2) autism and ADHD diagnoses. Second, we used mother–father–child trio-MR in MoBa (1) to test causal effects through maternal nutrient levels, (2) to test effects of child nutrient levels, and (3) as a paternal negative control.
Results
Associations between higher maternal vitamin-D levels on lower ADHD related traits at age 5 did not remain after controlling for familial genetic predisposition using trio-MR. Furthermore, we did not find evidence for causal maternal effects of vitamin-D/DHA levels on other offspring traits or diagnoses. In the reverse direction, there was evidence for a causal effect of autism genetic predisposition on lower vitamin-D levels and of ADHD genetic predisposition on lower DHA levels.
Conclusions
Triangulating across study designs, we did not find evidence for maternal effects. We add to a growing body of evidence that suggests that previous observational associations are likely biased by genetic confounding. Consequently, maternal supplementation is unlikely to influence these offspring neurodevelopmental traits. Notably, genetic predisposition to ADHD and autism was associated with lower DHA and vitamin-D levels respectively, suggesting previous associations might have been due to reverse causation.
Infrared spectra of nontronite reveal shifts to lower wave, number in peaks located at 3570, 1030, and 821 cm-1, which are assigned to vibrational modes for O-H stretching, Si-Ob (basal oxygens) tetrahedral vibrations, and FeO-H deformation, respectively, as the Fe2+ content increases upon reduction. A pleochroic shoulder at 1110 cm-1 resulting from Si-Oa (apical oxygens) interactions appears to be unchanged with reduction. The absorption band at 848 cm-1 shifts to higher energy with reduction of structural iron, and persists at 840 cm-1 after complete deuteration of structural hydroxyls. The band is assigned to a Fe-OH mode where the OH moves as a unit. The shift in the Si-Ob mode to lower vibrational energy with reduction may indicate a decrease in stress forces between the tetrahedral and octahedral sheets.
Deferration by reduction of free Fe2O3 with Na2S2O4 in the presence of Na citrate and NaHCO3 caused a change in valence state of 10 to 35 per cent of the total structural iron in micaceous vermiculites, soils, nontronite, and muscovite. An increase in Fe2+ on deferration was accompanied by an equivalent decrease in Fe3+. Subsequent treatment with H2O2 reoxidized the structural Fe2+ previously formed.
Sesquioxide coatings on micaceous vermiculites were examined electron microscopically. These coatings were composed predominantly of Fe2O3 with approximately 10 per cent by weight of Al2O3 and small amounts of SiO2, as determined by chemical analysis of the deferration extracts.
The cation exchange capacity (CEC) increased 10–60 per cent as a result of deferration of micaceous vermiculites and soils. Treatment of the deferrated sample with H2O2 restored the Fe3+ content to approximately the original value but the CEC was not affected. Consequently, the increase in CEC on deferration was attributed to the removal of the positively charged sesquioxide coating. The reversible change in valence of structural iron without an equivalent change in CEC was attributed to deprotonation-protonation of the structure (OH− ⇄ O2−) simultaneous with the oxidation-reduction of iron (Fe2+ ⇄ Fe3+) in the phyllosilicate layer.
Montmorillonite clay samples were coated with 16 m-equiv/g of clay or iron plus aluminum as hydrous oxides and aged 1 yr, in suspensions of pH 6 or 8. The magnesium exchange capacity (MgEC) decreased linearly with the amount of non-crystalline aluminum hydrous oxide associated with the clay. Eight to 16 m-equiv of iron per g of clay reduced the MgEC by 20 m-equiv/100g at pH 6, but did not affect the MgEC at pH 8. The quantity of non-crystalline aluminum associated with the clay depended on the suspension pH and aging time, and was unaffected by the coprecipitation of 8–16 m-equiv of iron hydrous oxide/g clay. The crystalline form of aluminum hydrous oxide depended on the suspension pH and was shown by X-ray diffraction to be gibbsite at pH 6 and bayerite at pH 8. Gibbsite and bayerite formed rapidly with a rate dependent on the suspension pH when excess non-crystalline aluminum hydrous oxides were present. The quantity of non-crystalline aluminum hydrous oxides remaining after one year in suspensions of iron hydrous oxides and montmorillonite varied from 2·3 m-equiv/g of montmorillonite at pH 8-4·0 m-equiv/g of montmorillonite at pH 6. Differential thermal analysis and MgEC measurements indicated some regular organization of the iron hydrous oxides, however, crystalline iron minerals were not detected by X-ray diffraction.
Nontronite and biotite were analyzed by Electron Spectroscopy for Chemical Analysis (ESCA). Both minerals yielded ESCA spectra with well-defined peaks and the elements identified by the ESCA spectra were in good agreement with the molecular formulas. High resolution scans were made of the iron (2p3/2) and oxygen (1s) electron binding energies for oxidized and reduced forms of nontronite and biotite. Binding energies for Fe3+ were observed at 711.8 eV in dithionite-reduced nontronite and in oxidized biotite. Peaks for Fe2+ occurred at 710.0 eV for unaltered biotite, at 709 eV for oxidized biotite and at 708.6 eV for hydrazine-reduced and dithionite-reduced nontronite. The oxygen (1s) peak for unaltered nontronite was skewed to the high energy side of the 530.6 eV maximum, but became more symmetrical as the Fe2+ content increased.
The frequency, v, for O-D stretching in D2O films between the superimposed layers of different micas and montmorillonites was measured at several film thicknesses and temperatures of 2° and 25°C by infrared spectroscopy. The molar absorptivity, ε, for O-D stretching in HDO films between the montmorillonite layers was also measured at different film thicknesses and 25°C. It was found that v is related to mw/mm, the mass ratio of D2O to mica or montmorillonite, by the equation v = v0 exp β/(mwmm where v0 is the O-D stretching frequency in pure D2O and ß is a constant. Since mw/mm is proportional to a, the area under the absorption peak, mw/mm can be replaced by a in this equation. It was also found that ε decreased dramatically as the thickness of the water film between the montmorillonite layers decreased. These results were interpreted to mean that the structure of the interlayer water is perturbed by the interlayer cations and/or silicate surfaces.
The specific surface area, S, of a clay is commonly measured by the adsorption of ethylene glycol monoethyl ether (EGME); however, this method can be tedious and time consuming, especially if the clay is saturated with a monovalent, highly hydrated cation. An alternative method for measuring S was developed involving infrared internal reflectance spectroscopy. This method is based on the discovery that the ratio of R1, the reflectance of a clay-HOD mixture at the frequency of O-D stretching, to R2, the reflectance of the mixture at the frequency of H-O-D bending, is linearly related to S. The correlation coefficient between R1/R2 and S, as measured by the adsorption of EGME, was 0.995. Consequently, a calibration curve of R1/R2 versus S was constructed, and the measured values of R1/R2 for any clay-HOD mixture were referred to it for the determination of S. Results were obtained in triplicate in about an hour; hence, this method of determining S is more rapid and convenient than that involving the adsorption of EGME. Moreover, it applies to clays in a natural condition, i.e., swollen in water.
Anterior temporal lobectomy is a common surgical approach for medication-resistant temporal lobe epilepsy (TLE). Prior studies have shown inconsistent findings regarding the utility of presurgical intracarotid sodium amobarbital testing (IAT; also known as Wada test) and neuroimaging in predicting postoperative seizure control. In the present study, we evaluated the predictive utility of IAT, as well as structural magnetic resonance imaging (MRI) and positron emission tomography (PET), on long-term (3-years) seizure outcome following surgery for TLE.
Participants and Methods:
Patients consisted of 107 adults (mean age=38.6, SD=12.2; mean education=13.3 years, SD=2.0; female=47.7%; White=100%) with TLE (mean epilepsy duration =23.0 years, SD=15.7; left TLE surgery=50.5%). We examined whether demographic, clinical (side of resection, resection type [selective vs. non-selective], hemisphere of language dominance, epilepsy duration), and presurgical studies (normal vs. abnormal MRI, normal vs. abnormal PET, correctly lateralizing vs. incorrectly lateralizing IAT) were associated with absolute (cross-sectional) seizure outcome (i.e., freedom vs. recurrence) with a series of chi-squared and t-tests. Additionally, we determined whether presurgical evaluations predicted time to seizure recurrence (longitudinal outcome) over a three-year period with univariate Cox regression models, and we compared survival curves with Mantel-Cox (log rank) tests.
Results:
Demographic and clinical variables (including type [selective vs. whole lobectomy] and side of resection) were not associated with seizure outcome. No associations were found among the presurgical variables. Presurgical MRI was not associated with cross-sectional (OR=1.5, p=.557, 95% CI=0.4-5.7) or longitudinal (HR=1.2, p=.641, 95% CI=0.4-3.9) seizure outcome. Normal PET scan (OR= 4.8, p=.045, 95% CI=1.0-24.3) and IAT incorrectly lateralizing to seizure focus (OR=3.9, p=.018, 95% CI=1.2-12.9) were associated with higher odds of seizure recurrence. Furthermore, normal PET scan (HR=3.6, p=.028, 95% CI =1.0-13.5) and incorrectly lateralized IAT (HR= 2.8, p=.012, 95% CI=1.2-7.0) were presurgical predictors of earlier seizure recurrence within three years of TLE surgery. Log rank tests indicated that survival functions were significantly different between patients with normal vs. abnormal PET and incorrectly vs. correctly lateralizing IAT such that these had seizure relapse five and seven months earlier on average (respectively).
Conclusions:
Presurgical normal PET scan and incorrectly lateralizing IAT were associated with increased risk of post-surgical seizure recurrence and shorter time-to-seizure relapse.
Cognitive tests requiring spoken responses, such as paragraph recall, are rich in cognitive-related information that is not captured using traditional scoring methods. This study aimed to determine if linguistic features embedded in spoken responses may differentiate between individuals who are and are not cognitively impaired.
Participants and Methods:
Participants in the Long Life Family Study completed a neuropsychological assessment which included the WMS-R Logical Memory I paragraph recall. For a subset of participants (N=709), test responses were digitally recorded and manually transcribed. We used Linguistic Inquiry Word Count, a text analysis program, to quantify word counts, grammatical features (e.g, prepositions, verb tenses), and the use of content words related to specific semantic categories (e.g., work-related, numbers) for immediate (IR) and delayed recall (DR). We used regression models with Generalized Estimating Equations adjusted by age, sex, education, and within-family correlation to select features associated with cognitive status (normal cognition [NC] versus cognitive impairment [CI]; Bonferroni-corrected threshold p<0.001). Next, we developed a “polyfeature score” (PFS) for both immediate and delayed recall, each calculated as a weighted sum of the selected linguistic features. We then built a logistic regression model to evaluate the predictive value of each PFS for identifying cognitively impaired individuals. In secondary analyses, we used regression models as above to identify features associated with mild cognitive impairment subtype (amnestic [aMCI] versus nonamnestic [naMCI]; threshold p< .05).
Results:
The sample included 599 participants with NC and 110 with CI (mean age = 72.3 ± 11.0 years, 54% female). The regression identified 8 linguistic features for IR and 7 for DR that significantly predicted cognitive status. Decreased use of content words related to work (e.g., employed, school, police) and biological processes (e.g., cook, cafeteria, eat) and the use of negations (e.g., no, not, can’t) were predictive of cognitive impairment in both recall conditions. In contrast, the use of other content word categories were predictive of cognitive status in only one recall condition (IR: leisure, cognitive processes, space; DR: drives, number). The use of fewer prepositions in IR, more first-person pronouns in DR, and fewer words in the past tense in DR were each associated with cognitive impairment. Word count was not predictive of cognitive status. Both PFSs were highly associated with cognitive status (PFS_IR ß= 0.74, p< 0.001; PFS_DR ß= 0.86, p= 0.001) with high discriminative value (PFS_IR AUC= 0.93, sensitivity = 0.81, specificity= 0.91; PFS_DR AUC= 0.95, sensitivity= 0.77, specificity= 0.88). In the CI subset, linguistic features differed between those classified as aMCI (n= 24) and naMCI (n= 40). Two function word categories predicted aMCI in IR whereas decreased word count, two function word categories, and two content word categories predicted aMCI in DR (all p< .05)
Conclusions:
Linguistic features from paragraph recall provide high predictive value for classifying cognitive status increasing its potential as a cognitive screener in clinical settings. Additionally, each recall condition identified unique linguistic features associated with cognitive impairment which may aid differentiation of cognitive impairment subtypes and elucidate processes underlying deficits in learning and recall.
In the present work, neural networks are applied to formulate parametrized hyperelastic constitutive models. The models fulfill all common mechanical conditions of hyperelasticity by construction. In particular, partially input convex neural network (pICNN) architectures are applied based on feed-forward neural networks. Receiving two different sets of input arguments, pICNNs are convex in one of them, while for the other, they represent arbitrary relationships which are not necessarily convex. In this way, the model can fulfill convexity conditions stemming from mechanical considerations without being too restrictive on the functional relationship in additional parameters, which may not necessarily be convex. Two different models are introduced, where one can represent arbitrary functional relationships in the additional parameters, while the other is monotonic in the additional parameters. As a first proof of concept, the model is calibrated to data generated with two differently parametrized analytical potentials, whereby three different pICNN architectures are investigated. In all cases, the proposed model shows excellent performance.
With the aim of producing a 3D representation of tumors, imaging and molecular annotation of xenografts and tumors (IMAXT) uses a large variety of modalities in order to acquire tumor samples and produce a map of every cell in the tumor and its host environment. With the large volume and variety of data produced in the project, we developed automatic data workflows and analysis pipelines. We introduce a research methodology where scientists connect to a cloud environment to perform analysis close to where data are located, instead of bringing data to their local computers. Here, we present the data and analysis infrastructure, discuss the unique computational challenges and describe the analysis chains developed and deployed to generate molecularly annotated tumor models. Registration is achieved by use of a novel technique involving spherical fiducial marks that are visible in all imaging modalities used within IMAXT. The automatic pipelines are highly optimized and allow to obtain processed datasets several times quicker than current solutions narrowing the gap between data acquisition and scientific exploitation.
Great kivas served as important ritual spaces and played significant roles in community integration throughout the Pithouse period (AD 550–1000) occupation of the Mimbres Mogollon region of southwestern New Mexico. This article uses data from excavations at the Harris site, a large pithouse village located in the Mimbres Valley, to explore the role of great kivas and an associated plaza in community integration as the village grew, extended family households formed, and social distinctions developed. Data from excavations of sequentially used great kivas surrounding the plaza along with household data from domestic structures are used to examine the role of ritual space during the Pithouse period.
Research indicates improvements in negative symptoms and empathy for schizophrenia spectrum disorders (SSD) after mindfulness-based interventions (MBI). Current treatment approaches for SSD remain limited regarding their effectiveness on negative symptoms and sociocognitive deficits. After oxytocin (OXT) administration, especially in a positive social context, an increase in empathy could be shown. The effect of mindfulness in combination with OXT has not yet been examined.
Objectives
This study investigates the additional effect of OXT administration combined with MBI on empathy and negative symptoms in patients with SSD.
Methods
An experimental, randomised, triple-blinded, placebo-controlled study is proposed. Based on power calculations, 140 participants with SSD will be recruited at Charité – Universitätsmedizin Berlin. A dose of intranasal oxytocin with 24 I.U. or placebo will be administered 45 minutes before each session. Following each administration, a total of four MBI interventions will take place for two weeks. Empathy as primary outcome will be measured using validated psychometric questionnaires. Outcomes, including negative symptoms and OXT plasma levels, will be measured at baseline and post-intervention. A 2x2 mixed-model ANCOVA design with time as within- and group as between-subject factor will be calculated to assess empathy and negative symptom changes.
Results
The study hypothesises that applying intranasal oxytocin in combination with MBI will increase empathy and reduce negative symptoms in patients with SSD.
Conclusions
Findings could provide insight into enhancing therapies like MBI by utilising OXT as a possible supplementary treatment option. Findings could therefore pave the way for a personalised psychiatric medicine treatment for individuals with SSD.
Borderline personality disorder (BPD) is a mental health condition characterized by emotion dysregulation, interpersonal impairment, and high suicidality. Dialectical behaviour therapy (DBT) is the most widely studied psychotherapeutic treatment for BPD. To date, the vast majority of DBT research has focused on cisgender women, with a notable lack of systematic investigation of sex and/or gender differences in treatment response. In order to encourage effective, equitable treatment of BPD, further investigation into treatment targets in this population is critical. Here, we employed a systematic strategy to delineate gaps in the DBT literature pertaining to sex and gender differences and propose directions for future research. Findings demonstrate a significant discrepancy in measurement of sex and gender, particularly among gender-diverse individuals. Exploring DBT treatment response across the full spectrum of genders will facilitate the provision of more tailored, impactful care to all individuals who suffer from BPD.
Key learning aims
(1) To date, DBT treatment literature has focused almost exclusively on cisgender women, with only two of 253 DBT studies in current literature accounting for transgender and gender diverse (TGD) individuals.
(2) Recognize how gender minority stress may impact the prevalence of BPD among TGD individuals.
(3) Learn how future research initiatives can be employed to rectify this gap in the DBT literature.