We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Emergency department (ED) visits for epilepsy are common, costly, and often clinically unnecessary. Configuration of care pathways (CPs) that could divert people away from ED offer an alternative. The aim was to measure patient and carer preferences for alternative CPs and to explore the feasibility of implementing the preferred CPs in the National Health Service (NHS) England with a wider group of stakeholders.
Methods
Formative work (provider survey, service-user interviews, knowledge exchange, and think-aloud piloting) informed a discrete choice experiment (DCE) with six attributes: access to care plan, conveyance, time, epilepsy specialist today, general practitioner (GP) notification, and epilepsy specialist follow-up. This was hosted online with random assignment to two of three scenarios (home, public, or atypical). Logistic regression generated preference weights that were used to calculate the utility of CPs. The highest ranked CPs plus a status quo were discussed at three online knowledge exchange workshops. The nominal group technique was used to ascertain stakeholder views on preference evidence and to seek group consensus on optimal feasible alternatives.
Results
A sample of 427 people with epilepsy and 167 friends or family completed the survey. People with epilepsy preferred paramedics to have access to care plan, non-conveyance, one to three hours, epilepsy specialists today, GP notification, and specialist follow-up within two to three weeks. Family and friends differed when considering atypical seizures, favoring conveyance to urgent treatment centers and shorter time. Optimal configuration of services from service users’ perspectives outranked current practice. Knowledge exchange (n=27 participants) identified the optimal CP as feasible but identified two scenarios for resource reallocation: care plan substitutes specialist advice today and times of strain on NHS resources.
Conclusions
Preferences differed to current practice but had minimal variation by seizure type or stakeholder. This study clearly identified optimal and feasible alternative CPs. The mixed-methods approach allowed for robust measurement of preferences, whilst knowledge exchange examined feasibility to enhance implementation of optimal alternative CPs in the future.
This work investigates the effect of surface roughness on cylinder flows in the postcritical regime and reexamines whether the roughness Reynolds number ($Re_{k_s}$) primarily governs the aerodynamic behaviour. It has been motivated by limitations of many previous investigations, containing occasionally contradictory findings. In particular, many past studies were conducted with relatively high blockage ratios and low cylinder aspect ratios. Both of these factors appear to have non-negligible effects on flow behaviour, and particularly fluctuating quantities such as the standard deviation of the lift coefficient. This study employs a 5 % blockage ratio and a span-to-diameter ratio of 10. Cylinders of different relative surface roughness ratios ($k_s/D$), ranging from $1.1\times 10^{-3}$ to $3\times 10^{-3}$, were investigated at Reynolds numbers up to $6.8 \times 10^5$ and $Re_{k_s}$ up to 2200. It is found that the base pressure coefficient, drag coefficient, Strouhal number, spanwise correlation length of lift and the standard deviation of the lift coefficient are well described by $Re_{k_s}$ in postcritical flows. However, roughness does have an effect on the minimum surface pressure coefficient (near separation) that does not collapse with $Re_{k_s}$. The universal Strouhal number proposed by Bearman (Annu. Rev. Fluid Mech., vol. 16, 1984, pp. 195–222) appears to be nearly constant over the range of $Re_{k_s}$ studied, spanning the subcritical through postcritical regimes. Frequencies in the separating shear layers are found to be an order of magnitude lower than the power law predictions for separating shear layers of smooth cylinders.
Malformed trilobite specimens present important insight into understanding how this extinct arthropod group recovered from developmental or moulting malfunctions, pathologies, and injuries. Previously documented examples of malformed trilobite specimens are often considered in isolation, with few studies reporting on multiple malformations in the same species. Here we report malformed specimens of the ellipsocephaloid trilobite Estaingia bilobata from the Emu Bay Shale Konservat-Lagerstätte (Cambrian Series 2, Stage 4) on Kangaroo Island, South Australia. Ten malformed specimens exhibiting injuries, pathologies, and a range of teratologies are documented. Furthermore, five examples of mangled exoskeletons are presented, indicative of predation on E. bilobata. Considering the position of malformed and normal specimens of E. bilobata in bivariate space, we demonstrate that the majority of malformed specimens cluster among the larger individuals. Such specimens may exemplify larger forms successfully escaping predation attempts, but could equally represent individuals exhibiting old injuries that were made during earlier (smaller) growth stages that have healed through subsequent moulting events. The available evidence from the Emu Bay Shale suggests that this small, extremely abundant trilobite likely played an important role in the structure of the local ecosystem, occupying a low trophic level and being preyed upon by multiple durophagous arthropods. Furthermore, the scarcity of malformed E. bilobata specimens demonstrates how rarely injuries, developmental malfunctions, and pathological infestations occurred within the species.
A terrestrial (lacustrine and fluvial) palaeoclimate record from Hoxne (Suffolk, UK) shows two temperate phases separated by a cold episode, correlated with MIS 11 subdivisions corresponding to isotopic events 11.3 (Hoxnian interglacial period), 11.24 (Stratum C cold interval), and 11.23 (warm interval with evidence of human presence). A robust, reproducible multiproxy consensus approach validates and combines quantitative palaeotemperature reconstructions from three invertebrate groups (beetles, chironomids, and ostracods) and plant indicator taxa with qualitative implications of molluscs and small vertebrates. Compared with the present, interglacial mean monthly air temperatures were similar or up to 4.0°C higher in summer, but similar or as much as 3.0°C lower in winter; the Stratum C cold interval, following prolonged nondeposition or erosion of the lake bed, experienced summers 2.5°C cooler and winters between 5°C and 10°C cooler than at present. Possible reworking of fossils into Stratum C from underlying interglacial assemblages is taken into account. Oxygen and carbon isotopes from ostracod shells indicate evaporatively enriched lake water during Stratum C deposition. Comparative evaluation shows that proxy-based palaeoclimate reconstruction methods are best tested against each other and, if validated, can be used to generate more refined and robust results through multiproxy consensus.
Political event data are widely used in studies of political violence. Recent years have seen notable advances in the automated coding of political event data from international news sources. Yet, the validity of machine-coded event data remains disputed, especially in the context of event geolocation. We analyze the frequencies of human- and machine-geocoded event data agreement in relation to an independent (ground truth) source. The events are human rights violations in Colombia. We perform our evaluation for a key, 8-year period of the Colombian conflict and in three 2-year subperiods as well as for a selected set of (non)journalistically remote municipalities. As a complement to this analysis, we estimate spatial probit models based on the three datasets. These models assume Gaussian Markov Random Field error processes; they are constructed using a stochastic partial differential equation and estimated with integrated nested Laplacian approximation. The estimated models tell us whether the three datasets produce comparable predictions, underreport events in relation to the same covariates, and have similar patterns of prediction error. Together the two analyses show that, for this subnational conflict, the machine- and human-geocoded datasets are comparable in terms of external validity but, according to the geostatistical models, produce prediction errors that differ in important respects.
Morbidities and mortalities caused by malaria are still a serious issue in Nigeria, with the country accounting for 25% of malaria morbidities and 24% of malaria mortalities globally in 2018. Treated bed nets reduce the incidence of malaria, but not all Nigerians use them. This study aimed to examine the factors associated with treated bed net usage, including perceived severity of malaria, and the rural–urban differences in the relationship between socio-demographic factors and use of treated bed nets in Nigeria. The analytic sample size comprised 40,693 women aged 15–49 years. Poisson regression and bivariable and multivariable analyses were used to test the study hypothesis that women who agreed that malaria could potentially lead to death would be more likely to adopt malaria preventive measures, including treated bed net use. About 48% of the women slept under a treated mosquito net the night before the survey. Those who perceived that malaria could lead to death had a higher likelihood of using a treated bed net in the urban, rural and combined samples. However, in the multivariable model, the association between perceived malaria severity and use of a treated bed net was only significant for rural women (APR=0.964, 95% CI: 0.933, 0.996). The results unexpectedly suggest that rural Nigerian women who perceive malaria to be severe have a lower likelihood of using treated bed nets. Also, rural–urban variations in the relationship between the socio-demographic variables and use of treated bed nets were observed. Policies should consider the observed rural–urban dichotomy in the influence of perceived severity of malaria and other socio-demographic factors on women’s use of treated bed nets in Nigeria.
Warfare on the periphery of Europe and across cultural boundaries is a particular focus of this volume. One article, on Castilian seapower, treats the melding of northern and southern naval traditions; another clarifies the military roles of the Ayyubid and Mamluk miners and stoneworkers in siege warfare; a third emphasizes cultural considerations in an Icelandic conflict; a fourth looks at how an Iberian prelate navigated the line between ecclesiastical and military responsibilities; and a fifth analyzes the different roles of early gunpowder weapons in Europe and China, linking technological history with the significance of human geography. Further contributions also consider technology, two dealing with fifteenth-century English artillery and the third with prefabricated mechanical artillery during the Crusades. Another theme of the volume is source criticism, with re-examinations of the sources for Owain Glyndwr's (possible) victory at Hyddgen in 1401, a (possible) Danish attack on England in 1128, and the role of non-milites in Salian warfare. Contributors: Nicolas Agrait, Tonio Andrade, David Bachrach, Oren Falk, Devin Fields, Michael S. Fulton, Thomas K. Heeboll-Holm, Rabei G. Khamisy, Michael Livingstone, Dan Spencer, L.J. Andrew Villalon
Studies that reveal detailed information about trilobite growth, particularly early developmental stages, are crucial for improving our understanding of the phylogenetic relationships within this iconic group of fossil arthropods. Here we document an essentially complete ontogeny of the trilobite Redlichia cf. versabunda from the Cambrian Series 2 (late Stage 4) Ramsay Limestone of Yorke Peninsula in South Australia, including some of the best-preserved protaspides (the earliest biomineralized trilobite larval stage) known for any Cambrian trilobite. These protaspid stages exhibit similar morphological characteristics to many other taxa within the Suborder Redlichiina, especially to closely related species such as Metaredlichia cylindrica from the early Cambrian period of China. Morphological patterns observed across early developmental stages of different groups within the Order Redlichiida are discussed. Although redlichiine protaspides exhibit similar overall morphologies, certain ontogenetic characters within this suborder have potential phylogenetic signal, with different superfamilies characterized by unique trait combinations in these early growth stages.
In order to maximize the utility of future studies of trilobite ontogeny, we propose a set of standard practices that relate to the collection, nomenclature, description, depiction, and interpretation of ontogenetic series inferred from articulated specimens belonging to individual species. In some cases, these suggestions may also apply to ontogenetic studies of other fossilized taxa.
This work investigated the photophysical pathways for light absorption, charge generation, and charge separation in donor–acceptor nanoparticle blends of poly(3-hexylthiophene) and indene-C60-bisadduct. Optical modeling combined with steady-state and time-resolved optoelectronic characterization revealed that the nanoparticle blends experience a photocurrent limited to 60% of a bulk solution mixture. This discrepancy resulted from imperfect free charge generation inside the nanoparticles. High-resolution transmission electron microscopy and chemically resolved X-ray mapping showed that enhanced miscibility of materials did improve the donor–acceptor blending at the center of the nanoparticles; however, a residual shell of almost pure donor still restricted energy generation from these nanoparticles.
The scarcity of Romano-British human remains from north-west England has hindered understanding of burial practice in this region. Here, we report on the excavation of human and non-human animal remains1 and material culture from Dog Hole Cave, Haverbrack. Foetal and neonatal infants had been interred alongside a horse burial and puppies, lambs, calves and piglets in the very latest Iron Age to early Romano-British period, while the mid- to late Roman period is characterised by burials of older individuals with copper-alloy jewellery and beads. This material culture is more characteristic of urban sites, while isotope analysis indicates that the later individuals were largely from the local area. We discuss these results in terms of burial ritual in Cumbria and rural acculturation. Supplementary material is available online (https://doi.org/10.1017/S0068113X20000136), and contains further information about the site and excavations, small finds, zooarchaeology, human osteology, site taphonomy, the palaeoenvironment, isotope methods and analysis, and finds listed in Benson and Bland 1963.
Mutual responsiveness is necessary to sustain a close relationship and, to achieve it, people must protect their overall motivation to act in a caring way against the costs naturally arising from the challenges of maintaining interdependence. These challenges are universal and require solutions that constitute relatively automatic habit structures. The solutions allow people to “keep their eyes on the prize” and sustain their overall rewards without being distracted by the localized costs that occur along the way. For instance, one important challenge involves partners’ behavior that will on occasion interfere with one’s personal goals, by either pursuing their own interests first or failing to coordinate dyadic goals. In a case of motivation cognition, the automatic response to such experiences is to rationalize the negative, costly behavior by exaggerating the partners’ positive features and compensating cognitively for it. However, consistent with the MODE model, if people have the cognitive resources for deliberation, those whose broader goals are more self-protective rather than connective will overturn the pro-relationship impulses, to their ultimate detriment. Research exploring three different automatic procedural rules that illustrate this process of motivated cognition will be described.
Urban areas generate 80 per cent of global GDP (CBD, 1992; Ammann, 2016; Gressel, 2007) and no country has developed without urbanisation, according to Paul Collier (Dobbs et al., 2012; Collier, 2015). Just 2 per cent of the world’s population was urbanised in 1800; the figure passed 50 per cent by 2008, and on current trends it will reach 60 per cent by 2030. Virtually all this urban future growth will take place in developing countries, emulating Western Europe and North America, so that by 2025 it is estimated that 235 million households earning more than US$20,000 pa ppp will live in cities in the emerging economies, compared to 210 million in cities in the developed regions (Department for Business, Innovation and Skills, 2013). Cities are able to harness economies of scale and specialisation through the economies of agglomeration, but they consume 75 per cent of the world’s energy and are responsible for up to 70 per cent of global greenhouse gases (GHGs) (Satterthwaite, 2008).
We propose the concept of the “Fish Revolution” to demarcate the dramatic increase in North Atlantic fisheries after AD 1500, which led to a 15-fold increase of cod (Gadus morhua) catch volumes and likely a tripling of fish protein to the European market. We consider three key questions: (1) What were the environmental parameters of the Fish Revolution? (2) What were the globalising effects of the Fish Revolution? (3) What were the consequences of the Fish Revolution for fishing communities? While these questions would have been considered unknowable a decade or two ago, methodological developments in marine environmental history and historical ecology have moved information about both supply and demand into the realm of the discernible. Although much research remains to be done, we conclude that this was a major event in the history of resource extraction from the sea, mediated by forces of climate change and globalisation, and is likely to provide a fruitful agenda for future multidisciplinary research.
This paper examines retirement saving policy for independent – or contingent – workers, a growing segment of the workforce. Because few of these workers are covered by employer-sponsored retirement plans, they often do not benefit from payroll deduction, employer matching contributions, automatic enrollment, and other provisions that encourage retirement saving. Better use of fintech, judicious changes to tax policy, and expanded Automatic IRAs would help independent workers save for retirement. In addition, we propose the creation of retirement saving accounts that attach to the worker as a supplement to, and possible replacement for, the current system of employer-sponsored accounts.
Background: Despite the global impact of bipolar disorder (BD), treatment success is limited. Challenges include syndromal and subsyndromal mood instability, comorbid anxiety, and uncertainty around mechanisms to target. The Oxford Mood Action Psychology Programme (OxMAPP) offered a novel approach within a cognitive behavioural framework, via mental imagery-focused cognitive therapy (ImCT). Aims: This clinical audit evaluated referral rates, clinical outcomes and patient satisfaction with the OxMAPP service. Method: Eleven outpatients with BD received ImCT in addition to standard psychiatric care. Mood data were collected weekly from 6 months pre-treatment to 6 months post-treatment via routine mood monitoring. Anxiety was measured weekly from start of treatment until 1 month post-treatment. Patient feedback was provided via questionnaire. Results: Referral and treatment uptake rates indicated acceptability to referrers and patients. From pre- to post-treatment, there was (i) a significant reduction in the duration of depressive episode relapses, and (ii) a non-significant trend towards a reduction in the number of episodes, with small to medium effect size. There was a large effect size for the reduction in weekly anxiety symptoms from assessment to 1 month follow-up. Patient feedback indicated high levels of satisfaction with ImCT, and underscored the importance of the mental imagery focus. Conclusions: This clinical audit provides preliminary evidence that ImCT can help improve depressive and anxiety symptoms in BD as part of integrated clinical care, with high patient satisfaction and acceptability. Formal assessment designs are needed to further test the feasibility and efficacy of the new ImCT treatment on anxiety and mood instability.
Textual data are plagued by underreporting bias. For example, news sources often fail to report human rights violations. Cook et al. propose a multi-source estimator to gauge, and to account for, the underreporting of state repression events within human codings of news texts produced by the Agence France-Presse and Associated Press. We evaluate this estimator with Monte Carlo experiments, and then use it to compare the prevalence and seriousness of underreporting when comparable texts are machine coded and recorded in the World-Integrated Crisis Early Warning System dataset. We replicate Cook et al.’s investigation of human-coded state repression events with our machine-coded events, and validate both models against an external measure of human rights protections in Africa. We then use the Cook et al. estimator to gauge the seriousness and prevalence of underreporting in machine and human-coded event data on human rights violations in Colombia. We find in both applications that machine-coded data are as valid as human-coded data.
Over the last thirty years, more and more critics and scholars have come to recognize the importance of science to literature. 'Science in Modern Poetry: New Directions' is the first collection of essays to focus specifically on what poets in the twentieth and twenty-first centuries have made of the scientific developments going on around them. In a collection of twelve essays, leading experts on modern poetry and on literature and science explore how poets have used scientific language in their poems, how poetry can offer new perspectives on science, and how the 'Two Cultures' can and have come together in the work of poets from Britain and Ireland, America and Australia.What does the poetry of a leading immunologist and a Nobel-Prize-winning chemist tell us about how poetry can engage with science? Scientific experiments aim to yield knowledge, but what do the linguistic and formal experiments of contemporary American poets suggest about knowledge in their turn? How can universities help to bring these different experimental cultures and practices together? What questions do literary critics need to ask themselves when looking at poems that respond to science? How did developments in biology between the wars shape modernist poetry? What did William Empson make of science fiction, Ezra Pound of the fourth dimension, Thomas Hardy of anthropology? How did modern poets from W. B. Yeats to Elizabeth Bishop and Judith Wright respond to the legacy of Charles Darwin? This book aims to answer these questions and more, in the process setting out the state of the field and suggesting new directions and approaches for research by students and scholars working on the fertile relationship between science and poetry today.