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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.
Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) prevalence is expected to increase in East Africa as treatment coverage increases, survival improves, and this population ages. This study aimed to better understand the current cognitive phenotype of this newly emergent population of older combination antiretroviral therapy (cART)-treated people living with HIV (PLWH), in which current screening measures lack accuracy. This will facilitate the refinement of HAND cognitive screening tools for this setting.
Method:
This is a secondary analysis of 253 PLWH aged ≥50 years receiving standard government HIV clinic follow-up in Kilimanjaro, Tanzania. They were evaluated with a detailed locally normed low-literacy neuropsychological battery annually on three occasions and a consensus panel diagnosis of HAND by Frascati criteria based on clinical evaluation and collateral history.
Results:
Tests of verbal learning and memory, categorical verbal fluency, visual memory, and visuoconstruction had an area under the receiver operating characteristic curve >0.7 for symptomatic HAND (s-HAND) (0.70–0.72; p < 0.001 for all tests). Tests of visual memory, verbal learning with delayed recall and recognition memory, psychomotor speed, language comprehension, and categorical verbal fluency were independently associated with s-HAND in a logistic mixed effects model (p < 0.01 for all). Neuropsychological impairments varied by educational background.
Conclusions:
A broad range of cognitive domains are affected in older, well-controlled, East African PLWH, including those not captured in widely used screening measures. It is possible that educational background affects the observed cognitive impairments in this setting. Future screening measures for similar populations should consider assessment of visual memory, verbal learning, language comprehension, and executive and motor function.
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.
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.
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.
There are few data on the profile of those with serious mental illness (SMI) admitted to hospital for physical health reasons.
Aims
To compare outcomes for patients with and without an SMI admitted to hospital in England where the primary reason for admission was chronic obstructive pulmonary disease (COPD).
Method
This was a retrospective, observational analysis of the English Hospital Episodes Statistics data-set for the period from 1 April 2018 to 31 March 2019, for patients aged 18–74 years with COPD as the dominant reason for admission. Patient with an SMI (psychosis spectrum disorder, bipolar disorder) were identified.
Results
Data were available for 54 578 patients, of whom 2096 (3.8%) had an SMI. Patients with an SMI were younger, more likely to be female and more likely to live in deprived areas than those without an SMI. The burden of comorbidity was similar between the two groups. After adjusting for covariates, SMI was associated with significantly greater risk of length of stay than the median (odds ratio 1.24, 95% CI 1.12–1.37, P ≤ 0.001) and with 30-day emergency readmission (odds ratio 1.51, 95% confidence interval 1.34–1.69, P ≤ 0.001) but not with in-hospital mortality.
Conclusion
Clinicians should be aware of the potential for poorer outcomes in patients with an SMI even when the SMI is not the primary reason for admission. Collaborative working across mental and physical healthcare provision may facilitate improved outcomes for people with SMI.
In sub-Saharan Africa, there are no validated screening tools for delirium in older adults, despite the known vulnerability of older people to delirium and the associated adverse outcomes. This study aimed to assess the effectiveness of a brief smartphone-based assessment of arousal and attention (DelApp) in the identification of delirium amongst older adults admitted to the medical department of a tertiary referral hospital in Northern Tanzania.
Method:
Consecutive admissions were screened using the DelApp during a larger study of delirium prevalence and risk factors. All participants subsequently underwent detailed clinical assessment for delirium by a research doctor. Delirium and dementia were identified against DSM-5 criteria by consensus.
Results:
Complete data for 66 individuals were collected of whom 15 (22.7%) had delirium, 24.5% had dementia without delirium, and 10.6% had delirium superimposed on dementia. Sensitivity and specificity of the DelApp for delirium were 0.87 and 0.62, respectively (AUROC 0.77) and 0.88 and 0.73 (AUROC 0.85) for major cognitive impairment (dementia and delirium combined). Lower DelApp score was associated with age, significant visual impairment (<6/60 acuity), illness severity, reduced arousal and DSM-5 delirium on univariable analysis, but on multivariable logistic regression only arousal remained significant.
Conclusion:
In this setting, the DelApp performed well in identifying delirium and major cognitive impairment but did not differentiate delirium and dementia. Performance is likely to have been affected by confounders including uncorrected visual impairment and reduced level of arousal without delirium. Negative predictive value was nevertheless high, indicating excellent ‘rule out’ value in this setting.
Chapter 9 introduces the metaphor of a pendulum to characterize the sharp swings in Brandt’s policies toward European integration; the chancellor frequently backed ambitious EC projects that proved premature and unworkable. In 1970, fierce debates arose among the six EC members concerning how to pursue economic and monetary union (EMU). Brandt’s point person on Europe, Katharina Focke, sympathized with the French desire to tighten monetary cooperation among the EC partners right away. Bonn’s economy ministry under Karl Schiller took a more cautious line, insisting that macroeconomic convergence was necessary first. An EC agreement on EMU in early 1971 favored the French line; but soon thereafter a currency crisis prompted Brandt’s cabinet to “float” the mark, putting the EMU project on hold. Bonn’s policies helped the Nixon administration as it sought to stabilize the remnants of the Bretton Woods system – much to the dismay of French president Georges Pompidou. Afterwards Brandt worked to mend fences with France, and at a summit of the newly expanded EC in 1972 they pledged to form a European Union complete with a unified currency by 1980.
Drawing on the diary of Heinrich Krone, Chapter 1 opens by exploring social and cultural changes in West Germany at the end of Konrad Adenauer’s long ascendancy. The Christian Democratic milieu was losing its lock on politics, and the successes of German integration into Atlantic and European communities gave rise to new questions about whether NATO or the EEC had precedence; how German unity could be pursued in the face of détente; and what relationships were possible with the Soviet bloc. Adenauer’s choice was to intensify relations with de Gaulle’s France, with the 1963 Elysée Treaty defining the partnership between France and West Germany as a Cold War bulwark against détente and the USSR. This approach was challenged and significantly modified by the chancellor’s critics in the Bundestag, who feared alienating the United States and pushed for Ludwig Erhard to replace Adenauer. Foreign Minister Gerhard Schröder pushed for a “policy of movement,” intended to represent the cause of German unity more forcefully. Controversies over military aid, relations with Israel, and the Nuclear Test Ban Treaty showed that Adenauer’s long delay in resigning had left a vacuum of leadership.
If West Germany had one unique asset, it was the bedrock stability of its currency, the Deutsche Mark. Chapter 4 introduces the principal defenders of German stability – the economy and finance ministries, the Bundesbank, and the Council of Economic Experts. In fall 1965, Chancellor Erhard identified the maintenance of price stability as the foundation of German policy – with enormous repercussions for foreign relations. In 1965-66, development aid programs, restitution to Israel, and offset purchases from the United States would all be scaled back in order to keep Bonn’s budget balanced and avoid stimulating inflation. German monetary experts worked closely with U.S. officials to uphold the Bretton Woods monetary system; but Lyndon Johnson was furious that Erhard had broken his offset pledges, particularly since West Germany remained reluctant to send personnel to Vietnam. In spring 1966, Erhard’s cabinet tried to unthaw relations with the USSR by issuing a “peace note” calling for mutual renunciation-of-force declarations; but the Soviet bloc rejected the approach as inadequate. When West Germany slipped into recession, Erhard’s coalition collapsed in failure.
Chapter 11 examines the steps needed to rescue Brandt’s Ostpolitik from its near-demise at the hands of a polarized Bundestag. Following a rash of back-channel diplomacy with Egon Bahr at the center, France, Britain, the United States, and the USSR finally reached a Quadripartite Agreement on Berlin; it guaranteed access to the city but failed to clarify West Berlin’s relationship to the Federal Republic, leaving room for future disputes. Brandt’s surprise visit to Brezhnev in Crimea deepened the relationship between these two leaders, but created suspicion in the Western camp that did not ease even with Brandt’s award of the Nobel Peace Prize. Rainer Barzel, leader of the CDU/CSU, insisted that the Warsaw and Moscow treaties must be renegotiated; he maneuvered in the Bundestag to overthrow the Brandt government. Outside observers feared that the entire course of détente was in jeopardy. Barzel’s bid for power failed, but he continued to seek concessions from the Soviets; the GDR did briefly take a softer line. The treaties passed without CDU/CSU support, and Brandt went on to win a decisive victory in the 1972 elections, affirming public backing for Ostpolitik.
The book’s introduction explains why the years 1963 to 1975 were a period of tremendous experimentation in German foreign relations. A succession of relatively weak chancellors gave scope for cabinet members to push in various directions, whether this involved voracious weapons procurement, a single-minded battle against inflation, more generous development aid, or a tighter commitment to European integration. Even in periods of political instability, developments in West Germany had great import for Europe and the world beyond. Historiographically, the introduction stresses the broader historical relevance of German foreign relations: its study reveals the contested values of postwar Germans and how those priorities came to shape the international environment. Methodologically, the chapter presents a brief discussion of constructivism as outlined by political scientists Alexander Wendt and Susan Strange. International relations theory informs the book’s core question – how West Germans shaped and were shaped by the international system.
With the forming of a Grand Coalition, headed by Kurt Kiesinger (CDU/CSU) as chancellor and Willy Brandt (SPD) as foreign minister, West Germany sought equidistance between France and the United States and pursued a new Ostpolitik in parallel with de Gaulle. As Chapter 5 explains, the project proved highly unstable; de Gaulle could do little to aid Bonn vis-à-vis Poland, and Brandt wound up preferring direct contacts with the Soviets. Disputes over Britain’s accession to the EEC further soured Franco-German relations, and Paris was hardly pleased at Bonn’s renewal of its offset promises toward London and Washington. But the U.S.–German relationship also came under strain as the United States and USSR negotiated a non-proliferation treaty (NPT) that would force West Germany to accept a permanently inferior status. Kiesinger and Brandt used their leverage with Washington to force significant changes to the NPT in the areas of nuclear research and commerce; but they also consulted with other nuclear have-nots, such as India and Iran, and contemplated Germany’s future as a middle-sized power. Increasingly, West Germans identified technology exports as a significant source of prestige.
In Chapter 8, focus turns to the handiwork of Brandt’s Ostpolitik – the negotiation of the Moscow and Warsaw Treaties in 1970. Egon Bahr’s bargaining strategy in Moscow was hasty and dilettantish; he did not worry overly about the contents of the treaty with the USSR, since he saw the agreement as only one component of an interlocking series of treaties. When the substance of the “Bahr Paper” was leaked, his secretive approach and his failure to address the Berlin problem further polarized German politics. The CDU/CSU vehemently rejected Brandt’s policies and members of the coalition parties began to defect. The external resonance of German Ostpolitik was nonetheless enormous. Brandt’s meeting with Brezhnev in Moscow alerted the world to the ebbing of Soviet hostility, resulting in greater maneuvering room for Bonn. When the chancellor kneeled in Warsaw, it appeared to signal German acceptance of the moral weight of Nazi crimes. A closer view shows, however, that the Federal Republic was extremely hard-nosed toward Poland; it demanded emigration rights for ethnic Germans while refusing to offer restitution payments. Brandt’s Germany looked forward, not backward.