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.
Fast delivery of intravenous thrombolysis (IVT) and transportation to a comprehensive stroke center (CSC) are paramount for primary stroke centers (PSCs). We investigated outcomes and workflow times of patients treated with IVT at PSCs.
Methodology:
This is a secondary analysis of the AcT trial, a multicenter, phase-3, randomized, controlled, noninferiority trial comparing tenecteplase with alteplase in patients with acute ischemic stroke within 4.5 hours of onset. We compared baseline characteristics, imaging and clinical outcomes at 90 days, and workflow times between PSCs and CSCs.
Results:
Of 1577 patients enrolled in the trial, 99 (6.27%) were treated at PSCs and 1,478 (93.72%) at CSCs. Both groups had similar age, proportion of females, baseline NIHSS and presence of LVO. The proportion of patients achieving excellent functional outcome at 90 days was higher in PSCs compared to CSCs (mRS 0-1: 48.48% versus 35.01%, adjusted IRR, 1.42 [CI 95%, 1.04–1.95]). Patients at PSCs had longer door-to-needle times (median, 56.5 [42–70] versus 35 [27–47] minutes, p < 0.001). In the 24 patients transferred to CSCs, the needle-to-puncture time was more favorable for tenecteplase compared to alteplase (median, 35.5 [21–58] versus 52 [18–74] minutes, p < 0.001).
Conclusions:
Our findings suggest that patients treated at PSCs may achieve outcomes comparable to those treated at CSCs, despite differences in workflow efficiency. These results should be interpreted cautiously, as this is a hypothesis-generating analysis, and observed differences may reflect multiple factors, including site-level practices, referral patterns and workflow characteristics.
Have concerns about equal rights and equal chances crowded out economic equality as a priority of left parties? Despite the increased importance of inequality in political science, this contentiously fought debate has been standing on shaky empirical foundations. While voter's equality preferences are well understood, parties’ equality emphases remain uncharted territory. This research note assesses whether the Left has replaced its emphasis on economic equality with a focus on equal chances and equal rights. Based on a new dataset of 300,000 party statements, we use online crowd‐coding to map the equality trajectories of left parties in 12 OECD countries from 1970 to 2020. We examine if trade‐offs between economic and non‐economic aspects of inequality have come to dominate left parties’ equality profiles. Distinguishing social democratic, green and far‐left parties, we refute a meritocratic or ‘woke’ crowding out of redistribution. Yet, Social Democrats have indeed forsaken the once complementary link between economic equality and equal rights in favour of a weak trade‐off.
Do parties respond to inequality? Despite the relevance of inequality and its consequences, existing studies fail to capture parties’ emphasis on economic equality and redistribution or to differentiate between existing levels of inequality and increases in inequality. Based on 850,000 party statements from 12 (Organisation for Economic Co-operation and Development) countries (1970–2020), we introduce a crowd-coded dataset that allows us to distinguish positive references to economic equality and redistribution from upward-trending equal-rights/anti-discrimination rhetoric. We show that responses found in previous studies do not capture economic equality and redistribution. In reassessing the impact of inequality, we argue that low visibility, status quo bias, and turnout effects discourage party responses to high inequality levels, while rising inequality poses a visible status quo change and a threat that left parties respond to. We find that left parties respond to inequality increases (except less tangible gains among the most affluent) but not to (high) inequality levels. This helps to understand why inequality is not self-correcting.
Background: Recent research has demonstrated that DBS sites in Alzheimer’s (AD) and Parkinson’s (PD) influencing cognition are functionally connected to the subiculum. However, the results are mixed, and it is unclear how or if DBS site-subiculum connectivity can be optimized to improve patient cognition. Methods: We studied how subiculum connectivity influenced cognitive outcomes in both PD (subthalamic nucleus) and AD (fornix) DBS patients (total n = 110). We first confirmed DBS site-subiculum connectivity had opposite cognitive effects in each disease. We next investigated patient factors underlying these opposing effects. Lastly, we related our findings back to clinical practice to guide DBS programming in PD and AD. Results: DBS site-subiculum connectivity correlated with cognitive improvement in AD but decline in PD. This was dependent upon hippocampal atrophy; such that higher subiculum connectivity was beneficial when the hippocampus was atrophic but deleterious when it was intact. Finally, we related our findings back to anatomy with cadaveric dissections and present how DBS stimulation can be optimized to improve patient cognition. Conclusions: DBS site-subiculum connectivity influences cognition but depends on patient factors. Thus, to optimize cognition based on patient factors, DBS electrodes can be programmed to stimulate subregions with higher or lower subiculum connectivity.
Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.
Next generation high-power laser facilities are expected to generate hundreds-of-MeV proton beams and operate at multi-Hz repetition rates, presenting opportunities for medical, industrial and scientific applications requiring bright pulses of energetic ions. Characterizing the spectro-spatial profile of these ions at high repetition rates in the harsh radiation environments created by laser–plasma interactions remains challenging but is paramount for further source development. To address this, we present a compact scintillating fiber imaging spectrometer based on the tomographic reconstruction of proton energy deposition in a layered fiber array. Modeling indicates that spatial resolution of approximately 1 mm and energy resolution of less than 10% at proton energies of more than 20 MeV are readily achievable with existing 100 μm diameter fibers. Measurements with a prototype beam-profile monitor using 500 μm fibers demonstrate active readouts with invulnerability to electromagnetic pulses, and less than 100 Gy sensitivity. The performance of the full instrument concept is explored with Monte Carlo simulations, accurately reconstructing a proton beam with a multiple-component spectro-spatial profile.
Patients’ beliefs and attitudes about medications play a role in whether they adhere to their medications or not. Knowledge on how beliefs and attitudes about medications can be influenced is therefore important.
Objectives
The current study aimed to assess whether patients’ perceived support from their therapists regarding use of medications was associated with their beliefs and attitudes about medications. Because non-adherence in patients with psychosis frequently results in relapses and emergencies, this knowledge may be very useful for therapists and patients.
Methods
This cross-sectional study included 310 patients diagnosed with psychosis from 31 clinical units in Norwegian mental health specialist care. We assessed beliefs about medications using the Beliefs about Medicines Questionnaire (BMQ). BMQ-specific consists of two subscales, BMQ-necessity and BMQ-concerns. Higher score on the necessity subscale indicates stronger beliefs in the necessity of taking the medicine. Higher score on the concern subscale indicates stronger concerns about taking the medicine. We used a newly developed self-report questionnaire, MedSupport, to assess the patients’ perceived support from therapists in dealing with their medications. Higher score on the MedSupport means that the patient experienced more support with decisions related to medications. Linear mixed effect models were used to investigate possible associations of sociodemographic factors, clinical factors and patients’ perceptions of medication support with BMQ.
Results
Patients’ perceptions of medication support from therapists were positively associated with positive beliefs towards medications, β = 0.20, 95% CI [0.04 to 0.35], p=0.012, and negatively associated with concerns about taking the medications, β = -0.31, 95% CI [-0.44 to -0.17], p < 0.001, when other relevant variables were taken into consideration.
Conclusions
The present study shows that therapists may affect patients’ beliefs and concerns about medications. Consequently, medication support may lead to improved adherence to medications prescribed.
The interplay between convective, rotational and magnetic forces defines the dynamics within the electrically conducting regions of planets and stars. Yet their triadic effects are separated from one another in most studies, arguably due to the richness of each subset. In a single laboratory experiment, we apply a fixed heat flux, two different magnetic field strengths and one rotation rate, allowing us to chart a continuous path through Rayleigh–Bénard convection (RBC), two regimes of magnetoconvection, rotating convection and two regimes of rotating magnetoconvection, before finishing back at RBC. Dynamically rapid transitions are determined to exist between jump rope vortex states, thermoelectrically driven magnetoprecessional modes, mixed wall- and oscillatory-mode rotating convection and a novel magnetostrophic wall mode. Thus, our laboratory ‘pub crawl’ provides a coherent intercomparison of the broadly varying responses arising as a function of the magnetorotational forces imposed on a liquid-metal convection system.
Recombinant tissue plasminogen activator improves outcomes in acute ischemic stroke. Alteplase may result in thrombus migration (TM) distally to a critical arterial supply that can worsen perfusion to eloquent brain tissue. Alteplase-related stroke recanalization and clot migration in vertebral artery (VA) occlusion whereby the clot migrates to the basilar artery (BA) may be harmful. We identified seven subjects with isolated symptomatic vertebral occlusion. Two cases suffered early neurologic deterioration due to TM from VA to BA following alteplase. Precautionary transfer to thrombectomy centers may be warranted in alteplase-treated symptomatic VA occlusions in case of migration to basilar occlusion.
The aim of this study was to analyze coronavirus disease 2019 (COVID-19) -related call data at Metro North Public Health Unit, Brisbane Australia, over the 2020 calendar year to assist surge preparedness.
Methods:
Call data were retrieved by call category or reference to “COVID” in summaries from the call management system at a large metropolitan public health service. Under a mixed-methods approach, qualitative data (caller, call purpose, and call outcome) were categorized with categories arising de novo. Resulting variables were numerically analyzed to identify trends by categories and time.
Results:
Of the 3468 calls retrieved, 160 duplicates and 26 irrelevant calls were excluded. Of 3282 included calls, general practitioners, followed by the public, contributed the greatest call volumes. Health-care–related callers and the public made 84.2% of calls. Calls most frequently related to patient testing (40.7%) and isolation/quarantine (23.2%). Education provision accounted for 29.4% of all outcomes. A total of 11.8% of all call outcomes involved applying relevant case definitions, and 49.1% of calls were identified as potentially preventable through effective emergency risk communication and targeted call-handling.
Conclusions:
This study identified key drivers of public health unit phone service use related to the COVID-19 pandemic throughout 2020. The results highlighted where risk perception influenced call volume and provided important insights for future public health preparedness.
We describe here efforts to create and study magnetized electron–positron pair plasmas, the existence of which in astrophysical environments is well-established. Laboratory incarnations of such systems are becoming ever more possible due to novel approaches and techniques in plasma, beam and laser physics. Traditional magnetized plasmas studied to date, both in nature and in the laboratory, exhibit a host of different wave types, many of which are generically unstable and evolve into turbulence or violent instabilities. This complexity and the instability of these waves stem to a large degree from the difference in mass between the positively and the negatively charged species: the ions and the electrons. The mass symmetry of pair plasmas, on the other hand, results in unique behaviour, a topic that has been intensively studied theoretically and numerically for decades, but experimental studies are still in the early stages of development. A levitated dipole device is now under construction to study magnetized low-energy, short-Debye-length electron–positron plasmas; this experiment, as well as a stellarator device that is in the planning stage, will be fuelled by a reactor-based positron source and make use of state-of-the-art positron cooling and storage techniques. Relativistic pair plasmas with very different parameters will be created using pair production resulting from intense laser–matter interactions and will be confined in a high-field mirror configuration. We highlight the differences between and similarities among these approaches, and discuss the unique physics insights that can be gained by these studies.
We describe system verification tests and early science results from the pulsar processor (PTUSE) developed for the newly commissioned 64-dish SARAO MeerKAT radio telescope in South Africa. MeerKAT is a high-gain (${\sim}2.8\,\mbox{K Jy}^{-1}$) low-system temperature (${\sim}18\,\mbox{K at }20\,\mbox{cm}$) radio array that currently operates at 580–1 670 MHz and can produce tied-array beams suitable for pulsar observations. This paper presents results from the MeerTime Large Survey Project and commissioning tests with PTUSE. Highlights include observations of the double pulsar $\mbox{J}0737{-}3039\mbox{A}$, pulse profiles from 34 millisecond pulsars (MSPs) from a single 2.5-h observation of the Globular cluster Terzan 5, the rotation measure of Ter5O, a 420-sigma giant pulse from the Large Magellanic Cloud pulsar PSR $\mbox{J}0540{-}6919$, and nulling identified in the slow pulsar PSR J0633–2015. One of the key design specifications for MeerKAT was absolute timing errors of less than 5 ns using their novel precise time system. Our timing of two bright MSPs confirm that MeerKAT delivers exceptional timing. PSR $\mbox{J}2241{-}5236$ exhibits a jitter limit of $<4\,\mbox{ns h}^{-1}$ whilst timing of PSR $\mbox{J}1909{-}3744$ over almost 11 months yields an rms residual of 66 ns with only 4 min integrations. Our results confirm that the MeerKAT is an exceptional pulsar telescope. The array can be split into four separate sub-arrays to time over 1 000 pulsars per day and the future deployment of S-band (1 750–3 500 MHz) receivers will further enhance its capabilities.
Structural and functional deviations in schizophrenic patients with formal thought disorder (FTD) point towards a dysfunction within left sided language network.
Objectives
Independent component analysis (ICA), a new approach to fMRI analysis, enables to target the question of a network dysfunction directly. Using this method in healthy controls it was possible to identify the language networks separately for the left and the right hemispheres In the present study we use ICA analysis to examine changes of the language network separate for each hemisphere in relation to the severity of FTD.
Aims
We hypothesize increasing disintegration with increasing severity of FTD only in the left sided language network while the right language network should remain unaffected.
Methods
We investigated 16 schizophrenic patients with different severity of FTD and matched healthy controls using ICA decomposition of the BOLD signal. The spatial similarity of the individual language networks was correlated to the severity of FTD.
Results
The integrity of the left language network decrease with increasing severity of FTD (r = -0.79, p < 0.01), while the integrity of the right language network show no significant correlation to the severity of FTD.
Conclusion
For the first time the isolated breakdown of the left sided language network was linked specifically to schizophrenic FTD. This result unites older manly left hemispheric findings of structural and functional abnormalities in schizophrenic FTD.
Motor symptoms are frequent in patients with schizophrenia. Although recent DTI studies point to white matter alterations of the motor system in schizophrenia little is known about specific changes.
Objectives
To date there is a lack of approaches with hypothesis driven quantification of specific anatomical fibre tracts. Therefore, we aimed to compare structural connectivity between specific parts of the motor system such as the pre-supplementary motor area (SMA), the SMA-proper, the primary motor cortex and the basal ganglia in patients with schizophrenia and in healthy controls in a DTI-fibre-tracking study.
Aims
It is the aim of this study to investigate whether fibre tract integrity of the motor system is altered in patients with schizophrenia.
Methods
DTI-data were measured in 21 patients with schizophrenia and in 21 healthy controls. Applying a probabilistic fibre tracking approach the most probable anatomical pathways between key regions of the motor system of each participant have been identified. The resulting probabilistic maps were normalized to obtain values between 0 and 1, normalized into the standard MNI-space and smoothed using an isotropic 3-mm Gaussian kernel. Group comparisons have been calculated using two-sample-t-tests.
Results
First results point to altered fibre tract microstructure of loops including cortical motor areas and the basal ganglia. The data analysis is preliminary. Definite results will be presented at the conference.
Conclusions
Altered motor behaviour might be reflected by altered white matter integrity of loops including cortical motor areas and the basal ganglia.
Habitat avoidance is an anti-parasite behaviour exhibited by at-risk hosts that can minimize exposure to parasites. Because environments are often heterogeneous, host decision-making with regards to habitat use may be affected by the presence of parasites and habitat quality simultaneously. In this study we examine how the ovipositing behaviour of a cactiphilic fruit fly, Drosophila nigrospiracula, is affected by the presence of an ectoparasitic mite, Macrocheles subbadius, in conjunction with other environmental factors – specifically the presence or absence of conspecific eggs and host plant tissue. We hypothesized that the trade-off between site quality and parasite avoidance should favour ovipositing at mite-free sites even if it is of inferior quality. We found that although flies avoided mites in homogeneous environments (86% of eggs at mite-free sites), site quality overwhelmed mite avoidance. Both conspecific eggs (65% of eggs at infested sites with other Drosophila eggs) and host plant tissue (78% of eggs at infested sites with cactus) overpowered mite avoidance. Our results elucidate the context-dependent decision-making of hosts in response to the presence of parasites in variable environments, and suggest how the ecology of fear and associated trade-offs may influence the relative investment in anti-parasite behaviour in susceptible hosts.
The General Structure Analysis System (GSAS-II) package provides materials and crystallographic analysis for all types of diffraction data. It was initially made available with very limited capabilities, but over much of the last decade the features have been expanded, so that GSAS-II is now a comprehensive tool for nearly all types of structural and materials characterization studies. The need to provide materials to teach use of GSAS-II, while the software has been undergoing constant revision and expansion, has required new approaches for documentation. This has included providing tutorials, as each major new capability has been added, and context-sensitive help for each section of the program. Comments in the code are also expanded into a software reference guide. Most recently, video versions of more than half of the tutorials were created and others were provided with animated graphics. All GSAS-II documentation is web-based.
There is a long history of exploitation of the South American river turtle Podocnemis expansa. Conservation efforts for this species started in the 1960s but best practices were not established, and population trends and the number of nesting females protected remained unknown. In 2014 we formed a working group to discuss conservation strategies and to compile population data across the species’ range. We analysed the spatial pattern of its abundance in relation to human and natural factors using multiple regression analyses. We found that > 85 conservation programmes are protecting 147,000 nesting females, primarily in Brazil. The top six sites harbour > 100,000 females and should be prioritized for conservation action. Abundance declines with latitude and we found no evidence of human pressure on current turtle abundance patterns. It is presently not possible to estimate the global population trend because the species is not monitored continuously across the Amazon basin. The number of females is increasing at some localities and decreasing at others. However, the current size of the protected population is well below the historical population size estimated from past levels of human consumption, which demonstrates the need for concerted global conservation action. The data and management recommendations compiled here provide the basis for a regional monitoring programme among South American countries.