Quantum Spectral Analysis by Continuous Measurement of Landau-Zener Transitions.

We demonstrate the simultaneous estimation of signal frequency and amplitude by a single quantum sensor in a single experimental shot. Sweeping the qubit splitting linearly across a span of frequencies induces a nonadiabatic Landau-Zener transition as the qubit crosses resonance. The signal frequency determines the time of the transition, and the amplitude its extent. Continuous weak measurement of this unitary evolution informs a parameter estimator retrieving precision measurements of frequency and amplitude. Implemented on radio-frequency-dressed ultracold atoms read out by a Faraday spin-light interface, we sense a magnetic signal with estimated sensitivities to amplitude of 11 pT/sqrt[Hz], frequency 0.026 Hz/Hz^{3/2}, and phase 0.084 rad/sqrt[Hz], in a single 300 ms sweep from 7 to 13 kHz. The protocol realizes a swept-sine quantum spectrum analyzer, potentially sensing hundreds or thousands of channels with a single quantum sensor.

Can evidence drive health equity in the COVID-19 pandemic and beyond?

Using scoping review methods, we systematically searched multiple online databases for publications in the first year of the pandemic that proposed pragmatic population or health system-level solutions to health inequities. We found 77 publications with proposed solutions to pandemic-related health inequities. Most were commentaries, letters, or editorials from the USA, offering untested solutions, and no robust evidence on effectiveness. Some of the proposed solutions could unintentionally exacerbate health inequities. We call on health policymakers to co-create, co-design, and co-produce equity-focussed, evidence-based interventions with communities, focussing on those most at risk to protect the population as a whole. Epidemiologists collaborating with people from other relevant disciplines may provide methodological expertise for these processes. As epidemiologists, we must interrogate our own methods to avoid propagating any unscientific biases we may hold. Epidemiology must be used to address, and never exacerbate, health inequities-in the pandemic and beyond.

Service evaluation of multi-family therapy for anorexia groups between 2013-2021 in a specialist child and adolescent eating disorders service.

The aims of the service evaluation were to examine the effectiveness of multi-family therapy for anorexia nervosa (MFT-AN) on family relationships, as well as to understand families' experiences of MFT in a specialist child and adolescent eating disorders service between 2013-2021. Mixed-methods were used (t-tests and reflexive thematic analysis). Delivery was in-person in 2013-2019, and moved online from 2020 due to COVID-19. Responses from a total of 57 families and 190 people were analysed. MFT improved family functioning from pre-to post MFT as measured by the Systemic Clinical Observation in Routine Evaluation (SCORE-15). Sub-group analysis by family roles showed that at four-month follow-up, the effects were no longer significant among parents. On the contrary, preliminary analysis showed that although young people did not report any improvement at post-intervention, family functioning was reported to increase at follow-up. Four themes were constructed: being together as a family and as a group; individuality: everyone's recovery is different; MFT as an emotion 'hotpot', and in-person versus virtual groups: not a one-size-fits-all. More robust follow-up data are needed to ascertain the effects of online MFT-AN.

Diagnostic yield of a heart failure referral pathway using N-terminal pro-brain natriuretic peptide.

OBJECTIVE: To determine the diagnostic yield of a 'high' N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with suspected heart failure (HF) referred from primary to secondary care. METHODS: In this retrospective study, cardiac diagnoses were quantified in consecutive patients with an NT-proBNP>400 ng/L referred from primary care centres to a specialist HF service. RESULTS: Among 654 consecutive patients (age: 78.5±9.72 years; 45.9% men; left ventricular ejection fraction (LVEF): 55.4±12.5% (mean±SD)), the primary diagnoses were: valvular disease (39.4%), HF (29.2%; 13.3% with LVEF<40%) and atrial fibrillation (AF; 17.3%). In terms of primary or secondary diagnoses, 68% of patients had valve disease, 46.9% had AF and 29.2% had HF. A cardiac diagnosis was made in 85.9%. In multivariable analyses, NT-proBNP predicted HF with LVEF<40% (OR: 10.2, 95% CI: 5.63 to 18.3) and HF with any LVEF (OR: 6.13, 95% CI: 3.79 to 9.93). In canonical linear discriminant analyses, NT-proBNP correctly identified 54.5% of patients with HF. The remainder were misclassified as valvular disease, AF or no cardiac diagnosis. CONCLUSION: Among patients with an NT-proBNP>400 ng/L referred through a primary care HF pathway, most patients had valve disease or AF rather than HF. NT-proBNP cannot discriminate among HF, valve disease and AF. On this basis, NT-proBNP may be best employed in detecting cardiac disease in general rather than HF per se.

Evaluation of the Incremental Value of a Coronary Artery Calcium Score Beyond Traditional Cardiovascular Risk Assessment: A Systematic Review and Meta-analysis.

Importance: Coronary artery calcium scores (CACS) are used to help assess patients' cardiovascular status and risk. However, their best use in risk assessment beyond traditional cardiovascular factors in primary prevention is uncertain. Objective: To find, assess, and synthesize all cohort studies that assessed the incremental gain from the addition of a CACS to a standard cardiovascular disease (CVD) risk calculator (or CVD risk factors for a standard calculator), that is, comparing CVD risk score plus CACS with CVD risk score alone. Evidence Review: Eligible studies needed to be cohort studies in primary prevention populations that used 1 of the CVD risk calculators recommended by national guidelines (Framingham Risk Score, QRISK, pooled cohort equation, NZ PREDICT, NORRISK, or SCORE) and assessed and reported incremental discrimination with CACS for estimating the risk of a future cardiovascular event. Findings: From 2772 records screened, 6 eligible cohort studies were identified (with 1043 CVD events in 17 961 unique participants) from the US (n = 3), the Netherlands (n = 1), Germany (n = 1), and South Korea (n = 1). Studies varied in size from 470 to 5185 participants (range of mean [SD] ages, 50 [10] to 75.1 [7.3] years; 38.4%-59.4% were women). The C statistic for the CVD risk models without CACS ranged from 0.693 (95% CI, 0.661-0.726) to 0.80. The pooled gain in C statistic from adding CACS was 0.036 (95% CI, 0.020-0.052). Among participants classified as being at low risk by the risk score and reclassified as at intermediate or high risk by CACS, 85.5% (65 of 76) to 96.4% (349 of 362) did not have a CVD event during follow-up (range, 5.1-10.0 years). Among participants classified as being at high risk by the risk score and reclassified as being at low risk by CACS, 91.4% (202 of 221) to 99.2% (502 of 506) did not have a CVD event during follow-up. Conclusions and Relevance: This systematic review and meta-analysis found that the CACS appears to add some further discrimination to the traditional CVD risk assessment equations used in these studies, which appears to be relatively consistent across studies. However, the modest gain may often be outweighed by costs, rates of incidental findings, and radiation risks. Although the CACS may have a role for refining risk assessment in selected patients, which patients would benefit remains unclear. At present, no evidence suggests that adding CACS to traditional risk scores provides clinical benefit.

Simulations found within-subject measurement variation in glycaemic measures may cause overdiagnosis of prediabetes and diabetes.

OBJECTIVE: To determine the impact of test measurement variation on misclassification of prediabetes and diabetes in the US adult population. STUDY DESIGN AND SETTING: Data from adults with no prior diagnosis of diabetes in the 2015 to 2016 National Health and Nutrition Examination Survey (NHANES) were used to simulate populations of US adults eligible for screening. Estimates of measurement variation were applied to each simulated individual's true values to generate observed values for up to five repeated screens. RESULTS: UNDERDIAGNOSIS: For 100,000 people assessed according to ADA or USPSTF guidelines, no people with true values in the diabetes range would be underdiagnosed as normal after one screen, and between 64 and 138 people would be misclassified with prediabetes after five re-screens (depending on guideline and test used). OVERDIAGNOSIS: For 100,000 people assessed according to the guidelines, between 1,602 and 2,233 people with true values in the normal range would be over diagnosed with prediabetes after 3 re-screens. A further 627 to 1,672 people with true values in the prediabetes range would be over diagnosed with diabetes after 5 re-screens. CONCLUSION: Measurement variation may cause overdiagnosis of prediabetes and diabetes, as well as apparent "progression" or "regression" of either condition.

Lessons from the past, policies for the future: resilience and sustainability in past crises.

This article surveys some examples of the ways past societies have responded to environmental stressors such as famine, war, and pandemic. We show that people in the past did think about system recovery, but only on a sectoral scale. They did perceive challenges and respond appropriately, but within cultural constraints and resource limitations. Risk mitigation was generally limited in scope, localized, and again determined by cultural logic that may not necessarily have been aware of more than symptoms, rather than actual causes. We also show that risk-managing and risk-mitigating arrangements often favored the vested interests of elites rather than the population more widely, an issue policy makers today still face.

Exploring Public Health and Nursing Students' Perceptions of Each Other's Professional Roles.

Public health education specialists and nurses often work interprofessionally in the public health setting. Using a mixed-methods design, this exploratory study evaluated the effect of an online interprofessional case study activity on nursing and public health education students' perceptions of each other's professional role. For the public health experimental group only, a statistically significant change (p < .05) was found in their perceptions of the professional roles of nurses including large changes in six specific domains. Recommendations for implementing interprofessional education programs include more emphasis on education about professional scopes of practice and roles/responsibilities of the health professions.

The Social Burden of Resilience: A Historical Perspective.

We examine the social burden associated with resilience to environmental shocks in pre-modern societies. We argue that analyses of state-level interventions to mitigate the consequences of catastrophic events tend to isolate these measures from their larger social contexts and thereby overlook the uneven distribution of their burden across different groups. We use three cases of pre-modern societies in the northeastern Mediterranean - the sixth century Roman Empire, the tenth century Byzantine Empire, and the sixteenth century Ottoman Empire. We demonstrate how the adaptive processes that reinforced resilience at the state level incurred different burdens for those at lower levels of the social hierarchy. We found that some groups sustained losses while others gained unexpected benefits in the context of temporary systemic instability. We also found that although elites enjoyed enhanced buffers against the adverse effects in comparison with non-elites, this did not consistently guarantee them a better outcome. We conclude that the differentiated burden of resilience could in some cases entrench existing political or economic configurations, and in other cases, overturn them. Our case studies indirectly address the pressing issue of environmental justice.

Modelling Climate and Societal Resilience in the Eastern Mediterranean in the Last Millennium.

This article analyses high-quality hydroclimate proxy records and spatial reconstructions from the Central and Eastern Mediterranean and compares them with two Earth System Model simulations (CCSM4, MPI-ESM-P) for the Crusader period in the Levant (1095-1290 CE), the Mamluk regime in Transjordan (1260-1516 CE) and the Ottoman crisis and Celâlî Rebellion (1580-1610 CE). During the three time intervals, environmental and climatic stress tested the resilience of complex societies. We find that the multidecadal precipitation and drought variations in the Central and Eastern Mediterranean cannot be explained by external forcings (solar variations, tropical volcanism); rather they were driven by internal climate dynamics. Our research emphasises the challenges, opportunities and limitations of linking proxy records, palaeoreconstructions and model simulations to better understand how climate can affect human history.

Postgraduate Alcohol and Other Drug Practitioner Training in New Zealand: Significant Influences.

OBJECTIVE: The purpose of this article is to present a case study of the evolution of postgraduate-level training programs for alcohol and other drug (AOD) practitioners provided by two universities in New Zealand. METHOD: The case study compiles details on relevant treatment contexts and systems in New Zealand and key milestones and significant developments in postgraduate AOD practitioner programs in two locations over a 30-year period. The details were compiled by the authors, all of whom were closely involved with the development of the training programs. RESULTS: The key ingredients for success that were identified included a focus on specialized learning overlaying generic undergraduate professional training; a core commitment to practice oriented teaching; investment in the training by government bodies; and the parallel emergence of professional bodies, registration systems, and collaborative relationships across agencies. In a small country, the two programs have enabled 345 students to obtain specialist postgraduate qualifications in AOD practice over a 10-year period. CONCLUSIONS: Little could have been achieved without ongoing cooperation between education providers, government agencies, and AOD services. This history may be of interest to those in other locations attempting to establish nation- or statewide approaches to AOD practitioner training.

Unpuzzling American Climate: New World Experience and the Foundations of a New Science.

In the early exploration and colonization of the Americas, Europeans encountered unfamiliar climates that challenged received ideas from classical geography. This experience drove innovative efforts to understand and explain patterns of weather and seasons in the New World. A close examination of three climatic puzzles (the habitability of the tropics, debates on the likelihood of a Northwest Passage, and the unexpectedly harsh weather in the first North American colonies) illustrates how sixteenth- and seventeenth-century observers made three intellectual breakthroughs: conceiving of climates as a distinct subject of inquiry, crossing the hitherto-separated disciplines of geography and meteorology, and developing new theories regarding the influence of prevailing winds on patterns of weather and seasons. While unquantified and unsystematic, these novel approaches promoted a new understanding of climates critical to the emergence of climate science. This study offers new insights into the foundations of climatology and the role of the New World in early modern science.

Facile synthesis of titania nanowires via a hot filament method and conductometric measurement of their response to hydrogen sulfide gas.

Titania nanostructures are of increasing interest for a variety of applications, including photovoltaics, water splitting, and chemical sensing. Because of the photocatalytical properties of TiO2, chemical processes that occur at its surface can be exploited for highly efficient nanodevices. A facile and fast synthesis route has been explored that is free of catalysts or templates. An environmental scanning electron microscopy (ESEM) system was employed to grow titania nanowires (NWs) in a water vapor atmosphere (∼1 mbar) and to monitor the growth in situ. In addition, the growth process was also demonstrated using a simple vacuum chamber. In both processes, a titanium filament was heated via the Joule effect and NWs were found to grow on its surface, as a result of thermal oxidation processes. A variety of nanostructures were observed across the filament, with morphologies changing with the wire temperature from the center to the end points. The longest NWs were obtained for temperatures between ∼730 °C and 810 °C. Typically, they have an approximate thickness of ∼300 nm and lengths of up to a few micrometers. Cross sections prepared by focused-ion-beam milling revealed the presence of a porous layer beneath the NW clusters. This indicates that the growth of NWs is driven by oxidation-induced stresses in the subsurface region of the Ti filament and by enhanced diffusion along grain boundaries. To demonstrate the potential of titania NWs grown via the hot filament method, single NW devices were fabricated and used for conductometric sensing of hydrogen sulfide (H2S) gas. The NW electric resistance was found to decrease in the presence of H2S. Its variation can be explained in terms of the surface depletion model.