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Inspired by laboratory experiments showing internal waves generated by a plume impinging upon a stratified fluid layer (Ansong & Sutherland. 2010 J. Fluid Mech.648, 405–434), we perform large eddy simulations in three dimensions to examine the structure and source of internal waves emanating from the top of a plume that rises vertically into stratification whose strength ranges over two orders of magnitude between different simulations. Provided the plume is sufficiently energetic to penetrate into the stratified layer, internal waves are generated with frequencies in a relatively narrow band moderately smaller than the buoyancy frequency. Through adaptations of ray theory including viscosity and use of dynamic mode decomposition, we show that the waves originate from within the turbulent flow rather than at the turbulent/non-turbulent interface between the fountain top and the surrounding stratified fluid.
England's primary care service for psychological therapy (Improving Access to Psychological Therapies [IAPT]) treats anxiety and depression, with a target recovery rate of 50%. Identifying the characteristics of patients who achieve recovery may assist in optimizing future treatment. This naturalistic cohort study investigated pre-therapy characteristics as predictors of recovery and improvement after IAPT therapy.
Methods
In a cohort of patients attending an IAPT service in South London, we recruited 263 participants and conducted a baseline interview to gather extensive pre-therapy characteristics. Bayesian prediction models and variable selection were used to identify baseline variables prognostic of good clinical outcomes. Recovery (primary outcome) was defined using (IAPT) service-defined score thresholds for both depression (Patient Health Questionnaire [PHQ-9]) and anxiety (Generalized Anxiety Disorder [GAD-7]). Depression and anxiety outcomes were also evaluated as standalone (PHQ-9/GAD-7) scores after therapy. Prediction model performance metrics were estimated using cross-validation.
Results
Predictor variables explained 26% (recovery), 37% (depression), and 31% (anxiety) of the variance in outcomes, respectively. Variables prognostic of recovery were lower pre-treatment depression severity and not meeting criteria for obsessive compulsive disorder. Post-therapy depression and anxiety severity scores were predicted by lower symptom severity and higher ratings of health-related quality of life (EuroQol questionnaire [EQ5D]) at baseline.
Conclusion
Almost a third of the variance in clinical outcomes was explained by pre-treatment symptom severity scores. These constructs benefit from being rapidly accessible in healthcare services. If replicated in external samples, the early identification of patients who are less likely to recover may facilitate earlier triage to alternative interventions.
To evaluate the impact of receptive vocabulary versus years of education on neuropsychological performance of Black and White older adults.
Method:
A community-based prospectively enrolled cohort (n = 1,007; 130 Black, 877 White) in the Emory Healthy Brain Study were administered the NIH Toolbox Picture Vocabulary Test and neuropsychological measures. Group differences were evaluated with age, sex, and education or age, sex, and Toolbox Vocabulary scores as covariates to determine whether performance differences between Black versus White participants were attenuated or eliminated.
Results:
With vocabulary as a covariate, the main effect of race was no longer significant for the MoCA, Phonemic Fluency, Rey Auditory Verbal Learning Test, and Rey Complex Figure Test immediate and delayed recall. Although still significantly different between groups, the effect sizes for Animal Fluency, Trails B-A, Symbol Digit Modalities Test, and Rey Copy were attenuated, with the greatest reductions occurring for the Multilingual Naming Test and Judgment of Line Orientation.
Conclusions:
Findings support the value of using receptive vocabulary as a proxy for premorbid ability level when comparing the cognitive performance of Black and White older adults. The results extend investigations using measures of single word reading to encompass measures assessing word meaning.
We use large-eddy simulations to study the penetration of a buoyant plume carrying a passive tracer into a stably stratified layer with constant buoyancy frequency. Using a buoyancy-tracer volume distribution, we develop a method for objectively partitioning plume fluid in buoyancy-tracer space into three regions, each of which corresponds to a coherent region in physical space. Specifically, we identify a source region where undiluted plume fluid enters the stratified layer, a transport region where much of the transition from undiluted to mixed fluid occurs in the plume cap and an accumulation region corresponding to a radially spreading intrusion. This method enables quantification of different measures of turbulence and mixing within each of the three regions, including potential energy and turbulent kinetic energy dissipation rates, an activity parameter and the instantaneous mixing efficiency. We find that the most intense buoyancy gradients lie in a thin layer at the cap of the penetrating plume. This provides the primary stage of mixing between plume and environment and exhibits a mixing efficiency around 50 %. Newly generated mixtures of environmental and plume fluid join the intrusion and experience relatively weak turbulence and buoyancy gradients. As the intrusion spreads radially, environmental fluid surrounding the intrusion is mixed into the intrusion with moderate mixing efficiency. This dominates the volume of environmental fluid entrained into the region containing plume fluid. However, the ‘strongest’ entrainment, as measured by the specific entrainment rate, is largest in the plume cap, where the most buoyant environmental fluid is entrained.
Anger has been shown to be associated with aggression and violence in adults with intellectual disabilities in both community and secure settings. Emerging evidence has indicated that cognitive behavioural anger treatment can be effective in reducing assessed levels of anger and violent behaviour in these patient populations. However, it has been suggested that the effectiveness of these types of interventions is influenced by the experience and training of the therapists.
Method:
In this service evaluation study, the pre- and post-treatment and 12-month follow-up assessment scores of 88 detained in-patient adults with intellectual disabilities and forensic histories who received cognitive behavioural anger treatment were examined in order to investigate whether participants’ responsiveness to treatment was associated with treatment being delivered by qualified versus unqualified therapists.
Results:
Overall significant reductions in self-reported measures of anger disposition and anger reactivity were found with no significant time × therapist experience interaction effects. However, the patients treated by qualified therapists improved significantly on measures of anger control compared with those allocated to unqualified therapists.
Conclusions:
Male and female detained patients with intellectual disabilities and forensic histories can benefit from an individual cognitive behavioural anger treatment intervention delivered by qualified and unqualified therapists, but therapist experience may be important in supporting patients to develop more complex anger control coping skills.
Individuals with treatment-resistant depression (TRD) experience a high burden of illness. Current guidelines recommend a stepped care approach for treating depression, but the extent to which best-practice care pathways are adhered to is unclear.
Aims
To explore the extent and nature of ‘treatment gaps’ (non-adherence to stepped care pathways) experienced by a sample of patients with established TRD (non-response to two or more adequate treatments in the current depressive episode) across three cities in the UK.
Method
Five treatment gaps were considered and compared with guidelines, in a cross-sectional retrospective analysis: delay to receiving treatment, lack of access to psychological therapies, delays to medication changes, delays to adjunctive (pharmacological augmentation) treatment and lack of access to secondary care. We additionally explored participant characteristics associated with the extent of treatment gaps experienced.
Results
Of 178 patients with TRD, 47% had been in the current depressive episode for >1 year before initiating antidepressants; 53% had received adequate psychological therapy. A total of 47 and 51% had remained on an unsuccessful first and second antidepressant trial respectively for >16 weeks, and 24 and 27% for >1 year before medication switch, respectively. Further, 54% had tried three or more antidepressant medications within their episode, and only 11% had received adjunctive treatment.
Conclusions
There appears to be a considerable difference between treatment guidelines for depression and the reality of care received by people with TRD. Future research examining representative samples of patients could determine recommendations for optimising care pathways, and ultimately outcomes, for individuals with this illness.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
Lewy body dementia, consisting of both dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), is considerably under-recognised clinically compared with its frequency in autopsy series.
Aims
This study investigated the clinical diagnostic pathways of patients with Lewy body dementia to assess if difficulties in diagnosis may be contributing to these differences.
Method
We reviewed the medical notes of 74 people with DLB and 72 with non-DLB dementia matched for age, gender and cognitive performance, together with 38 people with PDD and 35 with Parkinson's disease, matched for age and gender, from two geographically distinct UK regions.
Results
The cases of individuals with DLB took longer to reach a final diagnosis (1.2 v. 0.6 years, P = 0.017), underwent more scans (1.7 v. 1.2, P = 0.002) and had more alternative prior diagnoses (0.8 v. 0.4, P = 0.002), than the cases of those with non-DLB dementia. Individuals diagnosed in one region of the UK had significantly more core features (2.1 v. 1.5, P = 0.007) than those in the other region, and were less likely to have dopamine transporter imaging (P < 0.001). For patients with PDD, more than 1.4 years prior to receiving a dementia diagnosis: 46% (12 of 26) had documented impaired activities of daily living because of cognitive impairment, 57% (16 of 28) had cognitive impairment in multiple domains, with 38% (6 of 16) having both, and 39% (9 of 23) already receiving anti-dementia drugs.
Conclusions
Our results show the pathway to diagnosis of DLB is longer and more complex than for non-DLB dementia. There were also marked differences between regions in the thresholds clinicians adopt for diagnosing DLB and also in the use of dopamine transporter imaging. For PDD, a diagnosis of dementia was delayed well beyond symptom onset and even treatment.
True Colours is an automated symptom monitoring programme used by National Health Service psychiatric services. This study explored whether patients with unipolar treatment-resistant depression (TRD) found this a useful addition to their treatment regimes. Semi-structured qualitative interviews were conducted with 21 patients with TRD, who had engaged in True Colours monitoring as part of the Lithium versus Quetiapine in Depression study. A thematic analysis was used to assess participant experiences of the system.
Results
Six main themes emerged from the data, the most notable indicating that mood monitoring increased patients' insight into their disorder, but that subsequent behaviour change was absent.
Clinical implications
Patients with TRD can benefit from mood monitoring via True Colours, making it a worthwhile addition to treatment. Further development of such systems and additional support may be required for patients with TRD to experience further benefits as reported by other patient groups.
Chinese privet is a major invasive shrub within riparian zones throughout the southeastern United States. We removed privet shrubs from four riparian forests in October 2005 with a Gyrotrac® mulching machine or by hand-felling with chainsaws and machetes to determine how well these treatments controlled privet and how they affected plant community recovery. One year after shrub removal a foliar application of 2% glyphosate was applied to privet remaining in the herbaceous layer. Three “desired-future-condition” plots were also measured to assess how well treatments shifted plant communities toward a desirable outcome. Both methods completely removed privet from the shrub layer without reducing nonprivet shrub cover and diversity below levels on the untreated control plots. Nonprivet plant cover on the mulched plots was > 60% by 2007, similar to the desired-future-condition plots and higher than the hand-felling plots. Both treatments resulted in higher nonprivet plant cover than the untreated controls. Ordination showed that after 2 yr privet removal plots were tightly grouped, suggesting that the two removal techniques resulted in the same plant communities, which were distinctly different from both the untreated controls and the desired-future-condition. Both treatments created open streamside forests usable for recreation and other human activities. However, much longer periods of time or active management of the understory plant communities, or both, will be required to change the forests to typical mature forest plant communities.
Field studies were conducted at Lewiston–Woodville and Rocky Mount, NC in 2001 and 2002 to evaluate weed control and peanut response to POST treatments of diclosulam at various rates and application timings. Diclosulam controlled common ragweed and entireleaf morningglory when applied within 35 d after planting (DAP). Common ragweed 61 cm tall was controlled ≥92% with 4 to 13 g ai/ha diclosulam and larger common ragweed (107 to 137 cm tall) were controlled ≥97% with 27 g/ha diclosulam. Common lambsquarters was controlled 62% or less with all diclosulam POST treatments following metolachlor applied PRE, which provided 48% control. Peanut injury was less than 15% with all diclosulam POST treatments and was transitory. In separate studies, POST diclosulam treatments did not affect peanut yield in a weed-free environment. Peanut yield in weedy environments was reduced as the diclosulam application timing was delayed because of early season weed interference. A linear relationship was observed between yield and application timing with yield decreasing as application timing was delayed. This yield response documents the importance of early season weed management for maximizing peanut yield potential. Virginia peanut varieties were not affected by different POST rates of diclosulam; however, early season peanut injury showed a linear and quadratic relationship with diclosulam rate and was less than 14% at rates as high as 71 g/ha, and was not apparent by late season.
Kudzu is an aggressive, nonnative vine that currently dominates an estimated 810,000 ha of mesic forest communities in the eastern United States. To test an integrated method of weed control, abundances of kudzu and other plant species were compared during 4 yr after six herbicide treatments (clopyralid, triclopyr, metsulfuron, picloram + 2,4-D, tebuthiuron, and a nonsprayed check), in which loblolly pines were planted at three densities (0, 1, and 4 seedlings m−2) to induce competition and potentially delay kudzu recovery. This split-plot design was replicated on each of the four kudzu-dominated sites near Aiken, SC. Relative light intensity (RLI) and soil water content (SWC) were measured periodically to identify mechanisms of interference among plant species. Two years after treatment (1999), crown coverage of kudzu averaged < 2% in herbicide plots compared with 93% in the nonsprayed check, and these differences were maintained through 2001, except in clopyralid plots where kudzu cover increased to 15%. In 2001, pine interference was associated with 33, 56, and 67% reductions in biomass of kudzu, blackberry, and herbaceous vegetation, respectively. RLI in kudzu-dominated plots (4 to 15% of full sun) generally was less than half that of herbicide-treated plots. SWC was greatest in tebuthiuron plots, where total vegetation cover averaged 26% compared with 77 to 111% in other plots. None of the treatments eradicated kudzu, but combinations of herbicides and induced pine competition delayed its recovery.
Clopyralid, picloram, triclopyr, metsulfuron, and tebuthiuron were applied to control kudzu on four loblolly pine forest regeneration sites during July 1997. Spot treatments were applied to recovering kudzu in June 1998 and June 1999. Soil leachate was monitored for these five herbicides from July 1997 to December 2000. All herbicides were detected in shallow (51–58 cm deep) and deep lysimeters (84–109 cm deep). Clopyralid was not persistent and limited leaching occurred, with residue levels of 0.4 to 2.8 μg L−1 in 12 of 102 deep lysimeter samples. Picloram was mobile and persisted at 0.6 to 2.5 μg L−1 in shallow and deep lysimeters for at least 10 mo after the initial application. Triclopyr residues were not persistent in shallow lysimeters and remained < 6 μg L−1 during the study. Metsulfuron persisted at < 0.1 μg L−1 for 182 to 353 d in shallow lysimeters and at < 0.07 μg L−1 for 182 to 300 d in the deep lysimeters in various plots. Tebuthiuron peaks in the deep lysimeters ranged from 69 to 734 μg L−1 34 to 77 d after the first spot treatment. In the soil that was essentially a fill area, tebuthiuron residues remained > 400 μg L−1 (402–1,660 μg L−1) in the shallow lysimeter samples and > 180 μg L−1 (181–734 μg L−1) in the deep lysimeters throughout a 354-d period that followed the first spot application. When used as part of a forest regeneration program, the relative potentials of the herbicides to move into shallow groundwater were: tebuthiuron > picloram > metsulfuron > clopyralid > triclopyr.
A 28-year-old woman presented with a one day history of high fever and partial seizures with secondary generalization. This was preceded by a three week history of headache, ataxia, and fatigue. An initial computed tomogram head scan showed a low density mass lesion in the right frontal operculum without enhancement. On the next day, a repeat scan showed a new frontopolar, expansile, low density cortical lesion (Figure 1A) suggestive of encephalitis. Cerebrospinal fluid showed a pleocytosis of 311 mononuclear white blood cell count per μL and an elevated protein of 1.57 g/L. She received intravenous acyclovir and antibiotics. She remained febrile and became mute. A magnetic resonance (MR) scan under general anesthesia on her fourth hospital day showed frontal and perisylvian lesions with restricted diffusion (Figure 1B - D and Figure 2). A right frontal brain biopsy showed meningoencephalitis and immunohistochemical staining was positive for herpes simplex virus (HSV) antigen (Figure 3). Subsequently, HSV-1 DNA was demonstrated in both cerebrospinal fluid and brain tissue with polymerase chain amplification. She improved after a course of intravenous therapy with acyclovir with residual frontal lobe signs, including marked executive dysfunction, and her speech became normal.
Cultural practices, temperature, and precipitation affect the population fluctuations of Hylobius pales (Herbst) in the piedmont of Georgia. Of the environmental factors, temperature appears to have the most decided influence on the seasonal activity of the weevils. Precipitation may cause some variation but has no effect on general population trends. Cultural practices affect the numbers of weevils collected but not the seasonal trends. Although weevils are long lived and oviposition and larval development occur almost continuously, there are two population peaks during the year.