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.
Due to the high postoperative mortality, tools for an adaequate risk stratification are important to identify high-risk patients undergoing the Norwood procedure. As a marker of ventricular wall stress, NT-proBNP might be of particular interest in these children.
Objectives:
This study evaluated whether NT-proBNP’s age-adjusted z-score (“zlog-NT-proBNP”) predicts outcomes after stage I Norwood procedure.
Methods:
Patients who underwent the Norwood procedure between 1 January 2011 and 31 December 2022, with perioperative NT-proBNP measurements available were enrolled. Since reference intervals of NT-proBNP are highly age-dependent, age-adjusted zlog-NT-proBNP was used. Serial zlog-NT-proBNP values were analysed to predict the occurrence of major adverse cardiovascular events after the Norwood procedure. Major adverse cardiovascular events was defined as death, resuscitation, or mechanical circulatory support. Secondary endpoints were re-operation and re-intervention for shunt.
Results:
A total of 139 patients underwent the Norwood procedure and had at least one NT-proBNP measurement available. Preoperative zlog-NT-proBNP measurements (median 3.7, interquartile range 3.1–4.19) showed no association with the occurrence of major adverse cardiovascular events or mortality. Zlog-NT-proBNP early after ICU admission (3.2, interquartile range 2.4–3.8) was predictive of mortality but showed no association with the occurrence of major adverse cardiovascular events. Zlog-NT-proBNP before ICU discharge (3.2, interquartile range 2.8–3.8) was significantly associated with the occurrence of both major adverse cardiovascular events (hazard ratio 1.83, 95% confidence interval 1.25–2.67, P = 0.002) and death (hazard ratio 2.1, 95% CI 1.4–3.2, P < 0.001).
Conclusions:
High zlog-NT-proBNP levels after the Norwood surgery were strongly associated with the occurrence of major adverse cardiovascular events and death. Therefore, zlog-NT-proBNP has the potential to identify high-risk patients before life-threatening complications occur.
The study of many population growth models is complicated by only partial observation of the underlying stochastic process driving the model. For example, in an epidemic outbreak we might know when individuals show symptoms to a disease and are removed, but not when individuals are infected. Motivated by the above example and the long-established approximation of epidemic processes by branching processes, we explore the number of individuals alive in a time-inhomogeneous branching process with a general phase-type lifetime distribution given only (partial) information on the times of deaths of individuals. Deaths are detected independently with a detection probability that can vary with time and type. We show that the number of individuals alive immediately after the kth detected death can be expressed as the mixture of random variables each of which consists of the sum of k independent zero-modified geometric distributions. Furthermore, in the case of an Erlang lifetime distribution, we derive an easy-to-compute mixture of negative binomial distributions as an approximation of the number of individuals alive immediately after the kth detected death.
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).
This paper presents the results from an investigation of the true probability distributions of the range of rank totals. A procedure for generating an approximation to the true distributions is also given. A comparison of the results of this approximation with an extensive criterion of generated true and sample distributions, and with other approximations is indicated. Accurate estimates of the critical ranges necessary to reach significance at three commonly used alpha levels, where the number of judges and items is less than or equal to sixteen, are presented in tabular form.
Traditional approaches for evaluating the impact of scientific research – mainly scholarship (i.e., publications, presentations) and grant funding – fail to capture the full extent of contributions that come from larger scientific initiatives. The Translational Science Benefits Model (TSBM) was developed to support more comprehensive evaluations of scientific endeavors, especially research designed to translate scientific discoveries into innovations in clinical or public health practice and policy-level changes. Here, we present the domains of the TSBM, including how it was expanded by researchers within the Implementation Science Centers in Cancer Control (ISC3) program supported by the National Cancer Institute. Next, we describe five studies supported by the Penn ISC3, each focused on testing implementation strategies informed by behavioral economics to reduce key practice gaps in the context of cancer care and identify how each study yields broader impacts consistent with TSBM domains. These indicators include Capacity Building, Methods Development (within the Implementation Field) and Rapid Cycle Approaches, implementing Software Technologies, and improving Health Care Delivery and Health Care Accessibility. The examples highlighted here can help guide other similar scientific initiatives to conceive and measure broader scientific impact to fully articulate the translation and effects of their work at the population level.
Mass Casualty Incidents (MCIs) involving high-speed passenger ferries (HSPFs) may result in the dual-wave phenomenon, in which the emergency department (ED) is overwhelmed by an initial wave of minor injuries, followed by a second wave of more seriously injured victims. This study aimed to characterize the time pattern of ED presentation of victims in such accidents in Hong Kong.
Methods
All HSPF MCIs from 2005 to 2015 were reviewed retrospectively, with the time interval from accident to ED registration determined for each victim. Multivariable linear regression was used to identify independent factors associated with the time of ED presentation after the accidents.
Results
Eight MCIs involving 492 victims were identified. Victims with an Injury Severity Score (ISS) ≥ 9 had a significantly shorter median time interval compared to those with minor injuries. An ISS ≥ 9 and evacuation by emergency service vessels were associated with a shorter delay in ED arrival, whereas ship sinking, accident at nighttime, and a longer linear distance between the accident and receiving ED were associated with a longer delay.
Conclusion
The dual-wave phenomenon was not present in HSPF MCIs. Early communication is the key to ensure early resource mobilisation and a well-timed response.
Considering the recently growing number of potentially traumatic events in Europe, the European Psychiatric Association undertook a study to investigate clinicians’ treatment choices for post-traumatic stress disorder (PTSD).
Methods
The case-based analysis included 611 participants, who correctly classified the vignette as a case of PTSD, from Central/ Eastern Europe (CEE) (n = 279), Southern Europe (SE) (n = 92), Northern Europe (NE) (n = 92), and Western Europe (WE) (N = 148).
Results
About 82% woulduse antidepressants (sertraline being the most preferred one). Benzodiazepines and antipsychotics were significantly more frequently recommended by participants from CEE (33 and 4%, respectively), compared to participants from NE (11 and 0%) and SE (9% and 3%). About 52% of clinicians recommended trauma-focused cognitive behavior therapy and 35% psychoeducation, irrespective of their origin. In the latent class analysis, we identified four distinct “profiles” of clinicians. In Class 1 (N = 367), psychiatrists would less often recommend any antidepressants. In Class 2 (N = 51), clinicians would recommend trazodone and prolonged exposure therapy. In Class 3 (N = 65), they propose mirtazapine and eye movement desensitization reprocessing therapy. In Class 4 (N = 128), clinicians propose different types of medications and cognitive processing therapy. About 50.1% of participants in each region stated they do not adhere to recognized treatment guidelines.
Conclusions
Clinicians’ decisions for PTSD are broadly similar among European psychiatrists, but regional differences suggest the need for more dialogue and education to harmonize practice across Europe and promote the use of guidelines.
Clays and clay minerals dissolve over a broad pH range, such as during sediment diagenesis and in a variety of applications, including nuclear waste storage, landfills, and geopolymer binders in the construction industry. The solubility depends on process parameters (pH, temperature, pressure, etc.) and material properties (phase content, clay mineral composition, particle size, etc.). Pretreatments such as calcination or severe grinding change the material properties and could enhance solubility, which is called activation. The aim of the current study was to determine the solubility of three different clay minerals after calcination (metakaolinite, metamontmorillonite, and metaillite) in high molar alkaline solutions (NaOH) up to 10.79 mol/L and pH = 14.73. Furthermore, the solubility of an Al(OH)3 powder in alkaline solution (NaOH) was analyzed, as it can be used to adjust the Si:Al ratio of geopolymer precursors. The residues of the clay minerals after the alkaline treatment were investigated to disclose potential alterations in their phase contents. Based on the results of the thermal and alkaline activation, conclusions about the suitability as geopolymer precursors were made. All clay minerals showed an increase in solubility proportional to the concentration of the alkaline solution. The solubility decreased in the order metakaolinite > metamontmorillonite > metaillite. Thereby, dissolution was incomplete for all three clay minerals (<90%) after 7 days and congruent for metakaolinite and metaillite but incongruent for metamontmorillonite.
Kaolins and clays are important raw materials for production of supplementary cementitious materials and geopolymer precursors through thermal activation by calcination beyond dehydroxylation (DHX). Both types of clay contain different polytypes and disordered structures of kaolinite but little is known about the impact of the layer stacking of dioctahedral 1:1 layer silicates on optimum thermal activation conditions and following reactivity with alkaline solutions. The objective of the present study was to improve understanding of the impact of layer stacking in dioctahedral 1:1 layer silicates on the thermal activation by investigating the atomic structure after dehydroxylation. Heating experiments by simultaneous thermal analysis (STA) followed by characterization of the dehydroxylated materials by nuclear magnetic resonance spectroscopy (NMR) and scanning electron microscopy (SEM) together with first-principles calculations were performed. Density functional theory (DFT) was utilized for correlation of geometry-optimized structures to thermodynamic stability. The resulting volumes of unit cells were compared with data from dilatometry studies. The local structure changes were correlated with experimental results of increasing DHX temperature in the following order: disordered kaolinite, kaolinite, and dickite, whereupon dickite showed two dehydroxylation steps. Intermediate structures were found that were thermodynamically stable and partially dehydroxylated to a degree of DHX of 75% for kaolinite, 25% for disordered kaolinite, and 50% for dickite. These thermodynamically stable, partially dehydroxylated intermediates contained AlV while metakaolinite and metadickite contained only AlIV with a strongly distorted coordination shell. These results indicate strongly the necessity for characterization of the structure of dioctahedral 1:1 layer silicates in kaolins and clays as a key parameter to predict optimized calcination conditions and resulting reactivity.
Sub-micrometer clay particles are of interest in clay-polymer applications, especially when transparency is important. The scattering of light can be reduced by the adjustment of the refractive index (RI) of the clays to that of the matrix. In this study, the RI of sub-micrometer illite particles was changed by treatment with 5 M HCl for treatment times ranging between 2 and 24 h. The dissolution of Fe leads to a decrease in the RI of illite from 1.587 for the unaltered material to 1.502 after 24 h. The layer structure of the illite particles was preserved during the treatment. The RI of the sub-micrometer illite particles was determined by means of a photospectrometer measuring the light intensity passing through suspensions containing the clay particles, with varying refractive indices.
We consider an SIR (susceptible $\to$ infective $\to$ recovered) epidemic in a closed population of size n, in which infection spreads via mixing events, comprising individuals chosen uniformly at random from the population, which occur at the points of a Poisson process. This contrasts sharply with most epidemic models, in which infection is spread purely by pairwise interaction. A sequence of epidemic processes, indexed by n, and an approximating branching process are constructed on a common probability space via embedded random walks. We show that under suitable conditions the process of infectives in the epidemic process converges almost surely to the branching process. This leads to a threshold theorem for the epidemic process, where a major outbreak is defined as one that infects at least $\log n$ individuals. We show further that there exists $\delta \gt 0$, depending on the model parameters, such that the probability that a major outbreak has size at least $\delta n$ tends to one as $n \to \infty$.
Against the background of missing culturally sensitive mental health care services for refugees, we developed a group intervention (Empowerment) for refugees at level 3 within the stratified Stepped and Collaborative Care Model of the project Mental Health in Refugees and Asylum Seekers (MEHIRA). We aim to evaluate the effectiveness of the Empowerment group intervention with its focus on psychoeducation, stress management, and emotion regulation strategies in a culturally sensitive context for refugees with affective disorders compared to treatment-as-usual (TAU).
Method
At level 3 of the MEHIRA project, 149 refugees and asylum seekers with clinically relevant depressive symptoms were randomized to the Empowerment group intervention or TAU. Treatment comprised 16 therapy sessions conducted over 12 weeks. Effects were measured with the Patient Health Questionnaire-9 (PHQ-9) and the Montgomery–Åsberg Depression Rating Scale (MÅDRS). Further scales included assessed emotional distress, self-efficacy, resilience, and quality of life.
Results
Intention-to-treat analyses show significant cross-level interactions on both self-rated depressive symptoms (PHQ-9; F(1,147) = 13.32, p < 0.001) and clinician-rated depressive symptoms (MÅDRS; F(1,147) = 6.91, p = 0.01), indicating an improvement in depressive symptoms from baseline to post-intervention in the treatment group compared to the control group. The effect sizes for both scales were moderate (d = 0.68, 95% CI 0.21–1.15 for PHQ-9 and d = 0.51, 95% CI 0.04–0.99 for MÅDRS).
Conclusion
In the MEHIRA project comparing an SCCM approach versus TAU, the Empowerment group intervention at level 3 showed effectiveness for refugees with moderately severe depressive symptoms.
Refugees and asylum seekers (RAS) in Germany need tailored and resource-oriented mental healthcare interventions.
Aims
To evaluate the cost-effectiveness of group psychotherapy for RAS with moderate depressive symptoms.
Method
This is a post hoc cost-effectiveness analysis of Empowerment group psychotherapy that was embedded in a stratified stepped and collaborative care model (SCCM) from the multicentre randomised controlled MEHIRA trial. One hundred and forty-nine participants were randomly assigned to SCCM or treatment as usual (TAU) and underwent Empowerment (i.e. level 3 of the SCCM for adults) or TAU. Effects were measured with the nine-item Patient Health Questionnaire (PHQ-9) and quality adjusted life-years (QALY) post-intervention. Health service and intervention costs were measured. Incremental cost-effectiveness ratios (ICER) were estimated and net monetary benefit (NMB) regressions with 95% confidence intervals were performed. Cost-effectiveness was ascertained for different values of willingness to pay (WTP) using cost-effectiveness acceptability curves for probable scenarios. Trial registration number: NCT03109028 on ClinicalTrials.gov.
Results
Health service use costs were significantly lower for Empowerment than TAU after 1 year. Intervention costs were on average €409.6. Empowerment led to a significant change in PHQ-9 scores but not QALY. Bootstrapped mean ICER indicated cost-effectiveness according to PHQ-9 and varied considerably for QALY in the base case. NMB for a unit reduction in PHQ-9 score at WTP of €0 was €354.3 (€978.5 to −€269.9). Results were confirmed for different scenarios and varying WTP thresholds.
Conclusions
The Empowerment intervention was cost-effective in refugees with moderate depressive symptoms regarding the clinical outcome and led to a reduction in direct healthcare consumption. Concerning QALYs, there was a lack of confidence that Empowerment differed from TAU.
During an epidemic outbreak, typically only partial information about the outbreak is known. A common scenario is that the infection times of individuals are unknown, but individuals, on displaying symptoms, are identified as infectious and removed from the population. We study the distribution of the number of infectives given only the times of removals in a Markovian susceptible–infectious–removed (SIR) epidemic. Primary interest is in the initial stages of the epidemic process, where a branching (birth–death) process approximation is applicable. We show that the number of individuals alive in a time-inhomogeneous birth–death process at time $t \geq 0$, given only death times up to and including time t, is a mixture of negative binomial distributions, with the number of mixing components depending on the total number of deaths, and the mixing weights depending upon the inter-arrival times of the deaths. We further consider the extension to the case where some deaths are unobserved. We also discuss the application of the results to control measures and statistical inference.
This paper examines conditions that do or do not lead to accurate judgments of frequency (JOF) and judgments of duration (JOD). In three experiments, duration and frequency of visually presented stimuli are varied orthogonally in a within-subjects design. Experiment 1 reveals an asymmetric judgment pattern. JOFs reflected actual presentation frequency quite accurately and were unbiased by exposure duration. Conversely, JODs were almost insensitive to actual exposure duration and were systematically biased by presentation frequency. We show, however, that a tendency towards a symmetric judgment pattern can be obtained by manipulating encoding conditions. Sustaining attention during encoding (Experiment 2) or enhancing richness of the encoded stimuli (Experiment 3) increases judgment sensitivity in JOD and yields biases in both directions (JOF biased by exposure duration, JOD biased by presentation frequency). The implications of these findings for underlying memory mechanisms are discussed.
Shade coffee is a well-studied cultivation strategy that creates habitat for tropical birds while also maintaining agricultural yield. Although there is a general consensus that shade coffee is more “bird-friendly” than a sun coffee monoculture, little work has investigated the effects of specific shade tree species on insectivorous bird diversity. This study involved avian foraging observations, mist-netting data, temperature loggers, and arthropod sampling to investigate bottom-up effects of two shade tree taxa - native Cordia sp. and introduced Grevillea robusta - on insectivorous bird communities in central Kenya. Results indicate that foliage-dwelling arthropod abundance, and the richness and overall abundance of foraging birds were all higher on Cordia than on Grevillea. Furthermore, multivariate analyses of the bird community indicate a significant difference in community composition between the canopies of the two tree species, though the communities of birds using the coffee understorey under these shade trees were similar. In addition, both shade trees buffered temperatures in coffee, and temperatures under Cordia were marginally cooler than under Grevillea. These results suggest that native Cordia trees on East African shade coffee farms may be better at mitigating habitat loss and attracting insectivorous birds that could promote ecosystem services. Identifying differences in prey abundance and preferences in bird foraging behaviour not only fills basic gaps in our understanding of the ecology of East African coffee farms, it also aids in developing region-specific information to optimize functional diversity, ecosystem services, and the conservation of birds in agricultural landscapes.
To examine the association between adherence to plant-based diets and mortality.
Design:
Prospective study. We calculated a plant-based diet index (PDI) by assigning positive scores to plant foods and reverse scores to animal foods. We also created a healthful PDI (hPDI) and an unhealthful PDI (uPDI) by further separating the healthy plant foods from less-healthy plant foods.
Setting:
The VA Million Veteran Program.
Participants:
315 919 men and women aged 19–104 years who completed a FFQ at the baseline.
Results:
We documented 31 136 deaths during the follow-up. A higher PDI was significantly associated with lower total mortality (hazard ratio (HR) comparing extreme deciles = 0·75, 95 % CI: 0·71, 0·79, Ptrend < 0·001]. We observed an inverse association between hPDI and total mortality (HR comparing extreme deciles = 0·64, 95 % CI: 0·61, 0·68, Ptrend < 0·001), whereas uPDI was positively associated with total mortality (HR comparing extreme deciles = 1·41, 95 % CI: 1·33, 1·49, Ptrend < 0·001). Similar significant associations of PDI, hPDI and uPDI were also observed for CVD and cancer mortality. The associations between the PDI and total mortality were consistent among African and European American participants, and participants free from CVD and cancer and those who were diagnosed with major chronic disease at baseline.
Conclusions:
A greater adherence to a plant-based diet was associated with substantially lower total mortality in this large population of veterans. These findings support recommending plant-rich dietary patterns for the prevention of major chronic diseases.