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Dropout from healthcare interventions can negatively affect patients and healthcare providers through impaired trust in the healthcare system and ineffective use of resources. Research on this topic is still largely missing on refugees and asylum seekers. The current study aimed to characterize predictors for dropout in the Mental Health in Refugees and Asylum Seekers (MEHIRA) study, one of the largest multicentered controlled trials investigating the effectiveness and cost-effectiveness of a nationwide stepped and collaborative care model.
Methods
Predictors were multiply imputed and selected for descriptive modelling using backward elimination. The final variable set was entered into logistic regression.
Results
The overall dropout rate was 41,7%. Dropout was higher in participants in group therapy (p = 0.001; OR = 10.7), with larger satisfaction with social relationships (p = 0.017; OR = 1.87), with difficulties in maintaining personal relationships (p = 0.005; OR = 4.27), and with higher depressive symptoms (p = 0.029; OR = 1.05). Participants living in refugee accommodation (p = 0.040; OR = 0.45), with a change in social status (p = 0.008; OR = 0.67) and with conduct (p = 0.020; OR = 0.24) and emotional problems (p = 0.013; OR = 0.31) were significantly less likely to drop out of treatment.
Conclusion
Overall, the outcomes of this study suggest that predictors assessing social relationships, social status, and living conditions should be considered as topics of psychological treatment to increase adherence and as predictors for future research studies (including treatment type).
Although the link between alcohol involvement and behavioral phenotypes (e.g. impulsivity, negative affect, executive function [EF]) is well-established, the directionality of these associations, specificity to stages of alcohol involvement, and extent of shared genetic liability remain unclear. We estimate longitudinal associations between transitions among alcohol milestones, behavioral phenotypes, and indices of genetic risk.
Methods
Data came from the Collaborative Study on the Genetics of Alcoholism (n = 3681; ages 11–36). Alcohol transitions (first: drink, intoxication, alcohol use disorder [AUD] symptom, AUD diagnosis), internalizing, and externalizing phenotypes came from the Semi-Structured Assessment for the Genetics of Alcoholism. EF was measured with the Tower of London and Visual Span Tasks. Polygenic scores (PGS) were computed for alcohol-related and behavioral phenotypes. Cox models estimated associations among PGS, behavior, and alcohol milestones.
Results
Externalizing phenotypes (e.g. conduct disorder symptoms) were associated with future initiation and drinking problems (hazard ratio (HR)⩾1.16). Internalizing (e.g. social anxiety) was associated with hazards for progression from first drink to severe AUD (HR⩾1.55). Initiation and AUD were associated with increased hazards for later depressive symptoms and suicidal ideation (HR⩾1.38), and initiation was associated with increased hazards for future conduct symptoms (HR = 1.60). EF was not associated with alcohol transitions. Drinks per week PGS was linked with increased hazards for alcohol transitions (HR⩾1.06). Problematic alcohol use PGS increased hazards for suicidal ideation (HR = 1.20).
Conclusions
Behavioral markers of addiction vulnerability precede and follow alcohol transitions, highlighting dynamic, bidirectional relationships between behavior and emerging addiction.
To reduce sleep problems in people living with dementia using a multi-component intervention.
Design:
Cluster-randomized controlled study with two parallel groups and a follow-up of 16 weeks.
Setting:
Using external concealed randomization, 24 nursing homes (NH) were allocated either to the intervention group (IG, 12 clusters, 126 participants) or the control group (12 clusters, 116 participants).
Participants:
Participants were eligible if they had dementia or severe cognitive impairment, at least two sleep problems, and residence of at least two weeks in a NH.
Intervention:
The 16-week intervention consists of six components: (1) assessment of sleep-promoting activities and environmental factors in NHs, (2) implementation of two “sleep nurses,” (3) basic education, (4) advanced education for staff, (5) workshops to develop sleep-promoting concepts, and (6) written information and education materials. The control group (CG) received standard care.
Measurements:
Primary outcome was ≥ two sleep problems after 16 weeks assessed with the Sleep Disorders Inventory (SDI).
Results:
Twenty-two clusters (IG = 10, CG = 12) with 191 participants completed the study. At baseline, 90% of people living with dementia in the IG and 93% in the CG had at least two sleep problems. After 16 weeks, rates were 59.3% (IG) vs 83.8% (CG), respectively, a difference of −24.5% (95% CI, −46.3% – −2.7%; cluster-adjusted odds ratio 0.281; 95% CI 0.087–0.909). Secondary outcomes showed a significant difference only for SDI scores after eight and 16 weeks.
Conclusions:
The MoNoPol-Sleep intervention reduced sleep problems of people living with dementia in NH compared to standard care.
Stable water isotope records of six firn cores retrieved from two adjacent plateaus on the northern Antarctic Peninsula between 2014 and 2016 are presented and investigated for their connections with firn-core glacio-chemical data, meteorological records and modelling results. Average annual accumulation rates of 2500 kg m−2 a−1 largely reduce the modification of isotopic signals in the snowpack by post-depositional processes, allowing excellent signal preservation in space and time. Comparison of firn-core and ECHAM6-wiso modelled δ18O and d-excess records reveals a large agreement on annual and sub-annual scales, suggesting firn-core stable water isotopes to be representative of specific synoptic situations. The six firn cores exhibit highly similar isotopic patterns in the overlapping period (2013), which seem to be related to temporal changes in moisture sources rather than local near-surface air temperatures. Backward trajectories calculated with the HYSPLIT model suggest that prominent δ18O minima in 2013 associated with elevated sea salt concentrations are related to long-range moisture transport dominated by westerly winds during positive SAM phases. In contrast, a broad δ18O maximum in the same year accompanied by increased concentrations of black carbon and mineral dust corresponds to the advection of more locally derived moisture with northerly flow components (South America) when the SAM is negative.
An experiment on convective flows induced by the dielectrophoretic force was performed under the microgravity condition provided during a sounding rocket flight. The dielectrophoretic force possesses a non-conservative term that can be seen as resulting from an electric gravity. That gravity can be responsible for an electric Rayleigh–Bénard convection between a hot inner cylinder and a cold outer cylinder when an electric field is applied in the radial direction. Four cells with independent temperature and electric field controls allowed the investigation of eight different values of the electric Rayleigh number relatively close to the onset of the thermo-electric instability. A linear stability analysis is performed to predict the stability threshold and the evolution of the growth rate of the instability. The three-dimensional structure of the flow is captured by simultaneous particle image velocimetry and by shadowgraphy. The amplitude of the instability modes and the time evolution of the flow is analysed, and various methods are proposed to extrapolate the experimental critical value of the electric Rayleigh number for the onset of convection. The measured critical electric Rayleigh number is in agreement with the prediction of the linear stability theory. The comparison of the new experimental results with previous ones from parabolic flight campaigns highlights the importance of long-term microgravity for the achievement of thermal convection at low values of the control parameters.
Alcohol use is influenced by genetic and environmental factors. We examined the interactive effects between genome-wide polygenic risk scores for alcohol use (alc-PRS) and social support in relation to alcohol use among European American (EA) and African American (AA) adults across sex and developmental stages (emerging adulthood, young adulthood, and middle adulthood). Data were drawn from 4,011 EA and 1,274 AA adults from the Collaborative Study on the Genetics of Alcoholism who were between ages 18–65 and had ever used alcohol. Participants completed the Semi-Structured Assessment for the Genetics of Alcoholism and provided saliva or blood samples for genotyping. Results indicated that social support from friends, but not family, moderated the association between alc-PRS and alcohol use among EAs and AAs (only in middle adulthood for AAs); alc-PRS was associated with higher levels of alcohol use when friend support was low, but not when friend support was high. Associations were similar across sex but differed across developmental stages. Findings support the important role of social support from friends in buffering genetic risk for alcohol use among EA and AA adults and highlight the need to consider developmental changes in the role of social support in relation to alcohol use.
Researchers have identified genetic and neural risk factors for externalizing behaviors. However, it has not yet been determined if genetic liability is conferred in part through associations with more proximal neurophysiological risk markers.
Methods
Participants from the Collaborative Study on the Genetics of Alcoholism, a large, family-based study of alcohol use disorders were genotyped and polygenic scores for externalizing (EXT PGS) were calculated. Associations with target P3 amplitude from a visual oddball task (P3) and broad endorsement of externalizing behaviors (indexed via self-report of alcohol and cannabis use, and antisocial behavior) were assessed in participants of European (EA; N = 2851) and African ancestry (AA; N = 1402). Analyses were also stratified by age (adolescents, age 12–17 and young adults, age 18–32).
Results
The EXT PGS was significantly associated with higher levels of externalizing behaviors among EA adolescents and young adults as well as AA young adults. P3 was inversely associated with externalizing behaviors among EA young adults. EXT PGS was not significantly associated with P3 amplitude and therefore, there was no evidence that P3 amplitude indirectly accounted for the association between EXT PGS and externalizing behaviors.
Conclusions
Both the EXT PGS and P3 amplitude were significantly associated with externalizing behaviors among EA young adults. However, these associations with externalizing behaviors appear to be independent of each other, suggesting that they may index different facets of externalizing.
While they usually should, people do not revise their beliefs more to expert (economist) opinion than to lay opinion. The present research sought to better understand the factors that make it more likely for an individual to change their mind when faced with the opinions of expert economists versus the general public. Across five studies we examined the role that overestimation of knowledge plays in this behavior. We replicated the finding that people fail to privilege the opinion of experts over the public across two different (Study 1) and five different (Study 5) economic issues. We further find that undermining an illusion of both topic-relevant (Studies 2–4) and -irrelevant knowledge (Studies 3 and 4) leads to greater normative belief revision in response to expert rather than lay opinion. We suggest one reason that people fail to revise their beliefs more in response to experts is because people think they know more than they really do.
Despite the great progress in data transmission systems using dielectric waveguides (DWGs) in the millimeter-wave (mm-wave) frequency band (30–300 GHz), the signal distortions caused by DWGs have not yet been fully understood. However, such investigations would help to optimize DWGs as a transmission channel in order to further increase data rate and transmission distance of such systems without the need for more complex transceivers. Therefore, this paper presents a detailed study of the expected signal distortions caused by frequency-dependent attenuation and frequency-dependent group delay of circular DWGs at mm-wave frequencies. Based on a low-complexity digital transmission system, the effects of DWGs on the signal-to-noise ratio and the intersymbol interference at the receiver are evaluated. The figures and equations given in this paper allow the reader to easily calculate the channel properties and signal distortions for a wide range of circular DWGs without the need of finite element method solver or other time-consuming numerical simulations. Finally, design recommendations are given to minimize signal distortions for transmitting signals along DWGs.
Candida auris infections continue to occur across the United States and abroad, and healthcare facilities that care for vulnerable populations must improve their readiness to respond to this emerging organism. We aimed to identify and better understand challenges faced and lessons learned by those healthcare facilities who have experienced C. auris cases and outbreaks to better prepare those who have yet to experience or respond to this pathogen.
Design:
Semi-structured qualitative interviews.
Setting:
Health departments, long-term care facilities, acute-care hospitals, and healthcare organizations in New York, Illinois, and California.
Participants:
Infectious disease physicians and nurses, clinical and environmental services, hospital leadership, hospital epidemiology, infection preventionists, emergency management, and laboratory scientists who had experiences either preparing for or responding to C. auris cases or outbreaks.
Methods:
In total, 25 interviews were conducted with 84 participants. Interviews were coded using NVivo qualitative coding software by 2 separate researchers. Emergent themes were then iteratively discussed among the research team.
Results:
Key themes included surveillance and laboratory capacity, inter- and intrafacility communication, infection prevention and control, environmental cleaning and disinfection, clinical management of cases, and media concerns and stigma.
Conclusions:
Many of the operational challenges noted in this research are not unique to C. auris, and the ways in which we address future outbreaks should be informed by previous experiences and lessons learned, including the recent outbreaks of C. auris in the United States.
Despite the strong link between childhood maltreatment and psychopathology, the underlying neurodevelopmental mechanisms are poorly understood and difficult to disentangle from heritable and prenatal factors. This study used a translational macaque model of infant maltreatment in which the adverse experience occurs in the first months of life, during intense maturation of amygdala circuits important for stress and emotional regulation. Thus, we examined the developmental impact of maltreatment on amygdala functional connectivity (FC) longitudinally, from infancy through the juvenile period. Using resting state functional magnetic resonance imaging (MRI) we performed amygdala–prefrontal cortex (PFC) region-of-interest and exploratory whole-brain amygdala FC analyses. The latter showed (a) developmental increases in amygdala FC with many regions, likely supporting increased processing of socioemotional-relevant stimuli with age; and (b) maltreatment effects on amygdala coupling with arousal and stress brain regions (locus coeruleus, laterodorsal tegmental area) that emerged with age. Maltreated juveniles showed weaker FC than controls, which was negatively associated with infant hair cortisol concentrations. Findings from the region-of-interest analysis also showed weaker amygdala FC with PFC regions in maltreated animals than controls since infancy, whereas bilateral amygdala FC was stronger in maltreated animals. These effects on amygdala FC development may underlie the poor behavioral outcomes associated with this adverse experience.
Previous genetic association studies have failed to identify loci robustly associated with sepsis, and there have been no published genetic association studies or polygenic risk score analyses of patients with septic shock, despite evidence suggesting genetic factors may be involved. We systematically collected genotype and clinical outcome data in the context of a randomized controlled trial from patients with septic shock to enrich the presence of disease-associated genetic variants. We performed genomewide association studies of susceptibility and mortality in septic shock using 493 patients with septic shock and 2442 population controls, and polygenic risk score analysis to assess genetic overlap between septic shock risk/mortality with clinically relevant traits. One variant, rs9489328, located in AL589740.1 noncoding RNA, was significantly associated with septic shock (p = 1.05 × 10–10); however, it is likely a false-positive. We were unable to replicate variants previously reported to be associated (p < 1.00 × 10–6 in previous scans) with susceptibility to and mortality from sepsis. Polygenic risk scores for hematocrit and granulocyte count were negatively associated with 28-day mortality (p = 3.04 × 10–3; p = 2.29 × 10–3), and scores for C-reactive protein levels were positively associated with susceptibility to septic shock (p = 1.44 × 10–3). Results suggest that common variants of large effect do not influence septic shock susceptibility, mortality and resolution; however, genetic predispositions to clinically relevant traits are significantly associated with increased susceptibility and mortality in septic individuals.
To understand a sentence, it is crucial to understand who is doing what. The interplay of morphological case marking, argument serialization, and animacy provides linguistic cues for the processing system to rapidly identify the thematic roles of the arguments. The present event-related brain potential (ERP) study investigates on-line brain responses during argument identification in Zurich German, a High Alemannic dialect, and in Fering, a North Frisian variety, which both exhibit reduced case systems as compared to Standard German. Like Standard German, Zurich German and Fering are Continental West Germanic varieties, and indeed argument processing in sentences with an object-before-subject order engenders a qualitatively similar ERP pattern of a scrambling negativity followed by a P600 in all tested varieties. However, the P600 component—a late positive ERP response, which has been linked to the categorization of task-relevant stimuli—is selectively affected by the most prominent cue for argument identification in each variety, which is case marking in Standard German, but animacy in Zurich German and Fering. Thus, even closely related varieties may employ different processing strategies based on the language-specific availability of syntactic and semantic cues for argument identification.*
Dementia guidelines propose the use of nonpharmacological interventions for sleep disturbances for older people. Based on available reviews, it seems most likely that multicomponent interventions have the strongest potential to be effective in improving sleep. However, a detailed description of multicomponent interventions is missing. This systematic review aims to identify, describe, and summarize multicomponent, nonpharmacological interventions to reduce or avoid sleep disturbances in nursing home residents.
Methods:
This review followed established methodological frameworks for systematic evidence syntheses. A computerized search was conducted in December 2018, using the databases PubMed, CINAHL, Scopus, and Cochrane Library. Two independent reviewers assessed all search results to identify eligible studies and assessed studies’ methodological quality following the Cochrane Risk of Bias methodology for randomized controlled trials and the CASP Appraisal Checklist for controlled trials.
Evaluation studies of any design investigating multicomponent interventions were included, except case studies. Components of included intervention programs were analyzed applying the TIDieR and CReDECI 2 criteria.
Results:
A total of 2056 studies were identified through the database search; ten publications about nine interventions met the inclusion criteria and were included in the review. The identified interventions can be summarized assigned to the categories “daytime activities,” “nighttime activities,” “staff training,” and “light exposure.” The approaches showed similarities and differences in procedures, materials, modes of delivery, intervention provider, and intervention period. None of the studies described any intended interactions between components or considered context characteristics in intervention modeling as well as internal and external facilitators or barriers influencing delivery of intervention. We identified positive or mixed positive effects for sleep-related outcomes for the mentioned categories.
Conclusions:
The analysis of included interventions demonstrates somehow promising results, although findings are difficult to interpret as interventions were not well described, and the challenges of developing and evaluating complex interventions were not sufficiently acknowledged.
A growing interest in dielectric waveguides (DWGs) as an alternative to commonly used waveguides (like coaxial or twisted-pair cables) for high data rate interconnects could be observed in the last few years. Especially in the mm-wave frequency range (30–300 GHz) applications with these waveguides benefit from low losses and low dispersion. Moreover, using both polarizations of the fundamental mode in such waveguides could theoretically double the data rate without the need of higher bandwidth or additional fibers. The connection between DWGs and commonly available transceiver chips requires broadband transitions from planar waveguides like microstrip lines to DWGs. In this paper, an overview of the current developments of such transitions is given and a novel low-complexity design is presented that reduces the space consumption by 35% related to recently published works. This allows an easy integration into a printed circuit board layout or a chip package. Furthermore, an extensive sensitivity analysis is presented to prove the robustness toward manufacturing tolerances. The transition is realized at W-band frequencies (75–110 GHz) and achieves a relative 10 dB-bandwidth of more than 25% with a minimum insertion loss of 1.2 dB. It is shown that these properties even hold for manufacturing tolerances of nowadays manufacturing processes.
Pathological gambling is a behavioural addiction with negative economic, social, and psychological consequences. Identification of contributing genes and pathways may improve understanding of aetiology and facilitate therapy and prevention. Here, we report the first genome-wide association study of pathological gambling. Our aims were to identify pathways involved in pathological gambling, and examine whether there is a genetic overlap between pathological gambling and alcohol dependence.
Methods
Four hundred and forty-five individuals with a diagnosis of pathological gambling according to the Diagnostic and Statistical Manual of Mental Disorders were recruited in Germany, and 986 controls were drawn from a German general population sample. A genome-wide association study of pathological gambling comprising single marker, gene-based, and pathway analyses, was performed. Polygenic risk scores were generated using data from a German genome-wide association study of alcohol dependence.
Results
No genome-wide significant association with pathological gambling was found for single markers or genes. Pathways for Huntington's disease (P-value = 6.63 × 10−3); 5′-adenosine monophosphate-activated protein kinase signalling (P-value = 9.57 × 10−3); and apoptosis (P-value = 1.75 × 10−2) were significant. Polygenic risk score analysis of the alcohol dependence dataset yielded a one-sided nominal significant P-value in subjects with pathological gambling, irrespective of comorbid alcohol dependence status.
Conclusions
The present results accord with previous quantitative formal genetic studies which showed genetic overlap between non-substance- and substance-related addictions. Furthermore, pathway analysis suggests shared pathology between Huntington's disease and pathological gambling. This finding is consistent with previous imaging studies.
Evidence linking fasting plasma total homocysteine (tHcy) and methylenetetrahydrofolate reductase (MTHFR) 677C>T genotype with hypertension is inconsistent. Differences in B vitamin status, other lifestyle factors or their consideration in analyses might explain this. We investigated these associations in the absence of mandatory fortification with folic acid and B vitamin supplement use. A cross-sectional study was conducted in 788 adults, aged 18–75 years, randomly selected from three Catalonian town population registers. Fasting plasma folate, cobalamin, tHcy, erythrocyte folate, erythrocyte glutathione reductase activation coefficient (EGRAC, functional riboflavin status indicator; increasing EGRAC indicates worsening riboflavin status), MTHFR 677C>T and solute carrier family 1 (SLC19A1) 80 G>A genotypes were determined. Medical history and lifestyle habits were recorded. Principal tHcy determinants differed between women (age, plasma folate, plasma cobalamin, cigarettes/d) and men (MTHFR 677TT genotype, plasma folate, plasma cobalamin and CT genotype). The MTHFR 677C>T polymorphism–tHcy association (β standardised regression coefficients) was stronger in male smokers (0·52, P < 0·001) compared with non-smokers (0·21, P = 0·001) and weaker in participants aged >50 years (0·19, P = 0·007) compared with ≤50 years (0·31, P < 0·001). Hypertension was more probable in the third tHcy tertile compared with other tertiles (OR 1·9; 95 % CI 1·2, 3·0), and in participants aged ≤50 years, for the MTHFR 677TT genotype compared with the CC genotype (OR 4·1; 95 % CI 1·0, 16·9). EGRAC was associated with increased probability of hypertension in participants aged >50 years (OR 6·2; 95 % CI 1·0, 38·7). In conclusion, moderately elevated tHcy and the MTHFR 677CT genotype were associated with hypertension. The MTHFR 677C>T genotype–hypertension association was confined to adults aged ≤50 years.
Studies suggest that alcohol consumption and alcohol use disorders have distinct genetic backgrounds.
Methods
We examined whether polygenic risk scores (PRS) for consumption and problem subscales of the Alcohol Use Disorders Identification Test (AUDIT-C, AUDIT-P) in the UK Biobank (UKB; N = 121 630) correlate with alcohol outcomes in four independent samples: an ascertained cohort, the Collaborative Study on the Genetics of Alcoholism (COGA; N = 6850), and population-based cohorts: Avon Longitudinal Study of Parents and Children (ALSPAC; N = 5911), Generation Scotland (GS; N = 17 461), and an independent subset of UKB (N = 245 947). Regression models and survival analyses tested whether the PRS were associated with the alcohol-related outcomes.
Results
In COGA, AUDIT-P PRS was associated with alcohol dependence, AUD symptom count, maximum drinks (R2 = 0.47–0.68%, p = 2.0 × 10−8–1.0 × 10−10), and increased likelihood of onset of alcohol dependence (hazard ratio = 1.15, p = 4.7 × 10−8); AUDIT-C PRS was not an independent predictor of any phenotype. In ALSPAC, the AUDIT-C PRS was associated with alcohol dependence (R2 = 0.96%, p = 4.8 × 10−6). In GS, AUDIT-C PRS was a better predictor of weekly alcohol use (R2 = 0.27%, p = 5.5 × 10−11), while AUDIT-P PRS was more associated with problem drinking (R2 = 0.40%, p = 9.0 × 10−7). Lastly, AUDIT-P PRS was associated with ICD-based alcohol-related disorders in the UKB subset (R2 = 0.18%, p < 2.0 × 10−16).
Conclusions
AUDIT-P PRS was associated with a range of alcohol-related phenotypes across population-based and ascertained cohorts, while AUDIT-C PRS showed less utility in the ascertained cohort. We show that AUDIT-P is genetically correlated with both use and misuse and demonstrate the influence of ascertainment schemes on PRS analyses.
The design of government portfolios – that is, the distribution of competencies among government ministries and office holders – has been largely ignored in the study of executive and coalition politics. This article argues that portfolio design is a substantively and theoretically relevant phenomenon that has major implications for the study of institutional design and coalition politics. The authors use comparative data on portfolio design reforms in nine Western European countries since the 1970s to demonstrate how the design of government portfolios changes over time. Specifically, they show that portfolios are changed frequently (on average about once a year) and that such shifts are more likely after changes in the prime ministership or the party composition of the government. These findings suggest a political logic behind these reforms based on the preferences and power of political parties and politicians. They have major implications for the study of institutional design and coalition politics.
The SKA and its pathfinders will enable studies of H i emission at higher redshifts than ever before. In moving beyond the local Universe, this will require the use of cosmologically appropriate formulae that have traditionally been simplified to their low-redshift approximations. In this paper, we summarise some of the most important relations for tracing H i emission in the SKA era, and present an online calculator to assist in the planning and analysis of observations (http://hifi.icrar.org).