To send 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 sending content to .
To send content items to your Kindle, first ensure email@example.com
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 sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent 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.
Hyperbaric oxygen therapy (HBOT) shows promising results in treating radionecrosis (RN) but there is limited evidence for its use in brain RN. The purpose of this study is to report the outcomes of using HBOT for symptomatic brain RN at a single institution.
This was a retrospective review of patients with symptomatic brain RN between 2008 and 2018 and was treated with HBOT. Demographic data, steroid use, clinical response, radiologic response and toxicities were collected. The index time for analysis was the first day of HBOT. The primary endpoint was clinical improvement of a presenting symptom, including steroid dose reduction.
Thirteen patients who received HBOT for symptomatic RN were included. The median time from last brain radiation therapy to presenting symptoms of brain RN was 6 months. Twelve patients (92%) had clinical improvement with median time to symptom improvement of 33 days (range 1–109 days). One patient had transient improvement after HBOT but had recurrent symptomatic RN at 12 months. Of the eight patients with evaluable follow-up MRI, four patients had radiological improvement while four had stable necrosis appearance. Two patients had subsequent deterioration in MRI appearances, one each in the background of initial radiologic improvement and stability. Median survival was 15 months with median follow-up of 10 months. Seven patients reported side effects attributable to HBOT (54%), four of which were otologic in origin.
HBOT is a safe and effective treatment for brain RN. HBOT showed clinical and radiologic improvement or stability in most patients. Prospective studies to further evaluate the effectiveness and side effects of HBOT are needed.
Psychosocial interventions that mitigate psychosocial distress in cancer patients are important. The primary aim of this study was to examine the feasibility and acceptability of an adaptation of the Mindful Self-Compassion (MSC) program among adult cancer patients. A secondary aim was to examine pre–post-program changes in psychosocial wellbeing.
The research design was a feasibility and acceptability study, with an examination of pre- to post-intervention changes in psychosocial measures. A study information pack was posted to 173 adult cancer patients 6 months–5 years post-diagnosis, with an invitation to attend an eight-week group-based adaptation of the MSC program.
Thirty-two (19%) consented to the program, with 30 commencing. Twenty-seven completed the program (mean age: 62.93 years, SD 14.04; 17 [63%] female), attending a mean 6.93 (SD 1.11) group sessions. There were no significant differences in medico-demographic factors between program-completers and those who did not consent. However, there was a trend toward shorter time since diagnosis in the program-completers group. Program-completers rated the program highly regarding content, relevance to the concerns of cancer patients, and the likelihood of recommending the program to other cancer patients. Sixty-three percent perceived that their mental wellbeing had improved from pre- to post-program; none perceived a deterioration in mental wellbeing. Small-to-medium effects were observed for depressive symptoms, fear of cancer recurrence, stress, loneliness, body image satisfaction, mindfulness, and self-compassion.
Significance of results
The MSC program appears feasible and acceptable to adults diagnosed with non-advanced cancer. The preliminary estimates of effect sizes in this sample suggest that participation in the program was associated with improvements in psychosocial wellbeing. Collectively, these findings suggest that there may be value in conducting an adequately powered randomized controlled trial to determine the efficacy of the MSC program in enhancing the psychosocial wellbeing of cancer patients.
It is widely acknowledged that individual moral obligations and responsibility entail shared (or joint) moral obligations and responsibility. However, whether individual epistemic obligations and responsibility entail shared epistemic obligations and responsibility is rarely discussed. Instead, most discussions of doxastic responsibility focus on individuals considered in isolation. In contrast to this standard approach, I maintain that focusing exclusively on individuals in isolation leads to a profoundly incomplete picture of what we're epistemically obligated to do and when we deserve epistemic blame. First, I argue that we have epistemic obligations to perform actions of the sort that can be performed in conjunction with other people, and that consequently, we are often jointly blameworthy when we violate shared epistemic obligations. Second, I argue that shared responsibility is especially important to doxastic responsibility thanks to the fact that we don't have the same kind of direct control over our beliefs that we have over our actions. In particular, I argue that there are many cases in which a particular individual who holds some problematic belief only deserves epistemic blame in virtue of belonging to a group all the members of which are jointly blameworthy for violating some shared epistemic obligation.
Community Orientated and Opportunity Learning (COOL) Music was a 12-month collaborative project between researchers at Glasgow Caledonian University and practitioners at the Edinburgh-based social enterprise Heavy Sound. The project began in October 2017 and involved 16 sessions of participatory music making with 32 ‘hard-to-reach’ young people (aged 12–17) aimed at increasing confidence and self-esteem and improving social skills. Using COOL Music as a case study, this article explores some of the challenges faced by community-based arts organisations tasked with delivering such interventions, contrasting COOL Music’s small-scale, targeted, community-based approach with prevailing top-down music interventions in Scotland. We argue that such programmes are particularly suitable in engaging those at the margins of society, reaching them on their own terms through music that resonates with their own lived experience. However, we acknowledge the short-term and transitory nature of such projects may prove problematic for some hard-to-reach groups who require more stability in their lives and may also lead to staff fatigue and burnout. We call for further research in these areas, and greater policy attention to be paid to the sustainability of such projects.
Synthetic biology combines engineering and biology to produce artificial systems with programmable features. Specifically, engineered microenvironments have advanced immensely over the past few decades, owing in part to the merging of materials with biologic mimetic structures. In this review, the authors adapt a traditional definition of community ecology to describe “cellular ecology,” or the study of the distribution of cell populations and interactions within their microenvironment. The authors discuss two exemplar hydrogel platforms: (1) self-assembling peptide hydrogels and (2) poly(ethylene) glycol hydrogels and describe future opportunities for merging smart material design and synthetic biology within the scope of multicellular platforms.
Schmidt-hammer exposure-age dating (SHD) was applied at 15 sites with glacially-transported granite boulders in parts of northern and western Ireland and southwest Scotland that had been exposed by retreat of the last British-Irish Ice Sheet (BIIS) or Younger Dryas (YD) ice masses. Seven of these surfaces had previously been dated using terrestrial cosmogenic nuclide (TCN) exposure-age dating. Application of the granite calibration equation of Tomkins et al. (2018c) indicated a close correspondence between the SHD ages and the TCN ages (within 1σ or 2σ uncertainties). These findings demonstrate that SHD ages can be of comparable accuracy, precision, and reliability to TCN ages and are a strong argument for the more extensive use of SHD in some Quaternary dating projects. However, surface ages obtained by both SHD and TCN dating should not be accepted uncritically; they must be assessed in relation to the wider geological, geomorphological, and geochronological evidence. Evaluation of eight SHD ages, for which corresponding TCN ages are not available, indicate that most are consistent with current theory and field evidence, but some anomalous age estimates occur.
Professional scientist-geographer Erich von Drygalski led the first German expedition to Antarctica in 1901–1903. The expedition saw itself as purely scientific, which turned out to be at odds with the expectations of Imperial Germany at the time. It was one of the first to use photography extensively and effectively to document and record scientific activities and to shape the public’s image of the work that was being done in this remote and unknown part of the world. Ice was the leitmotif of Drygalski’s life. He had prior experience in the Arctic, and the year spent in Antarctica confirmed his nuanced way of viewing the ice: on the one hand, and foremost, scholarly and objective, while still appreciating its aesthetic qualities; on the other, infused with feelings of human vulnerability. Using discourse analysis, this article examines Drygalski’s published work and photographs he chose to illustrate it, in order to investigate what the ice meant to him. In his writings, it was the scholarly, objective attitude which predominated and this may have contributed to the generally lacklustre reception of his Antarctic achievements. The photographs he chose to illustrate his published work, however, were many and varied, often capturing the awe-inspiring beauty of the ice and contributing to good sales of his narrative of the South Polar Expedition.
Annually dated tree-rings of 509 live and deadwood limber pine (Pinus flexilis) samples from the semi-arid Wassuk Range, Nevada, yielded a 3996-yr record extending from 1983 BC to AD 2013. Correlations of radial growth with climate were positive for water relations and negative for summer temperatures. Long-term trends of ring-width corresponded to climate variability documented from other proxies, including low growth during the Late Holocene Dry Period and Medieval Climate Anomaly (MCA) and elevated growth during cool, wet periods of the Neoglacial and Little Ice Age. Spline fit of the data indicated that growth decrease in the last 20 years was second lowest on record, surpassed by lowest growth at 20 BC—AD 150. Demographics of limber pine by aspect and elevation were not strongly related to long-term climate dynamics, except in the case of extirpations on all but north aspects at the end of the MCA. Pines occurred persistently on north aspects, where a continuous record existed to present. Elevation shifts were not obvious on any aspect, and no evidence existed for migration above current treeline. Non-climatic factors appear to interact with climate to make north slopes refugial for upland pines in semi-arid regions across four millennia.
Over the past two decades, the emphasis on paid work has become one of the defining features of social security policy in the UK. Lone mothers and their families have been one of the key groups affected. In this article we focus on the working and family lives of lone mothers and their children over time, drawing on material from a long-term qualitative research study, and setting this in the context of policy developments. We explore the long-term consequences of trying to sustain work, and manage low-income family life as children grow up and needs change over time. This highlights some of the tensions and limitations in family support and relationships when resources are limited. We reflect on the links between insecurity, legacies and the state.
In contemporary Western, liberal democratic societies, the soldier is frequently regarded as ‘the best of us’, taking on the unlimited liability for the protection and betterment of the whole. In the context of volunteer militaries and distant conflicts, the construction of men (and the universalised masculine citizen) as ‘always-already’ soldiers (or potential soldiers) poses a substantial obstacle to the identification or performance of ‘good’ civilian masculinity – particularly during wartime. The theorisation and articulation of a positive, substantive civilian masculinity, or masculinities, rather than one defined simply by an absence of military service and implication in the collective use of violence, is a central challenge of contemporary politics. As a means of illuminating the complex dynamics of this challenge, this article examines charitable practices of civilian support for the military, and corresponding constructions of masculinity, in the UK during the ‘war on terror’. In doing so, the article demonstrates the ways in which gendered ‘civilian anxiety’, through its connection to citizenship, comes to condition the political possibilities and subjectivities of all those who seek belonging in the liberal political community. The article concludes by arguing for the essentiality of a research programme oriented around ‘civilianness’, and civilian masculinity/ies.
NHS Foundation Trust (FT) hospitals in England have complex internal governance arrangements. They may be considered to exhibit meta-regulatory characteristics to the extent that governors are able to promote deliberative values and steer internal governance processes towards wider regulatory goals. Yet, while recent studies of NHS FT hospital governance have explored FT governors and examined FT hospital boards to consider executive oversight, there is currently no detailed investigation of interactions between these two groups. Drawing on observational and interview data from four case-study sites, we trace interactions between the actors involved; explore their understandings of events; and consider the extent to which the proposed benefits of meta-regulation were realised in practice. Findings show that while governors provided both a conscience and contribution to internal and external governance arrangements, the meta-regulatory role was largely symbolic and limited to compliance and legitimation of executive actions. Thus while the meta-regulatory ‘architecture’ for governor involvement may be considered effective, the soft intelligence gleaned and operationalised may be obscured by ‘hard’ performance metrics which dominate resource-allocation processes and priority-setting. Governors were involved in practices that symbolised deliberative involvement but resulted in further opportunities for legitimising executive decisions.
The Earth is dramatically carbon poor comparing to the interstellar medium and the proto-sun. The carbon to silicon ratios in inner solar system objects show a correlation with heliocentric distance, which suggests that the destruction of carbon grains has occurred before planet formation. To examine this hypothesis, we perform model calculations using a chemical reaction network under the physical conditions typical of protoplanetary disks. Our results show that, when carbonaceous grains are destroyed and converted into the gas phase and the gas becomes carbon-rich, the abundances of carbon-bearing species such as HCN and carbon-chain molecules, increase dramatically near the midplane, while oxygen-bearing species such as H2O and CO2 are depleted. The carbon to silicon ratios obtained by our model calculations qualitatively reproduce the observed gradient with disk radius, but there are some quantitative discrepancies from the observed values of the solar system objects. We adopted the model of a disk around a Herbig Ae star and performed line radiative transfer calculations to examine the effect of carbon grain destruction through observations with ALMA. The results indicate that HCN, H13 CN and c-C3 H2 may be good tracers of this process.
It is thought that protoplanets formed in protoplanetary disks excite the orbital motion of the surrounding planetesimals, and the bow shocks caused by the highly excited planetesimals heat their icy component evaporating into gas. We have performed model calculations to study the evolution of molecular abundances of the evaporated icy component, which suggests sulfur-bearing molecules can be good tracers of icy planetesimal evaporation. Here we report the result of our ALMA observations of sulfur-bearing molecules towards protoplanetary disks. The lines were undetected but the obtained upper limits of the line fluxes and our model calculations give upper limits of the fractional abundances of x(H2S) < 10−11 and x(SO) < 10−10 in the outer disk. These results are consistent with the molecular abundances in comets in our Solar system.
The chemistry within the outflow of an AGB star is determined by its elemental C/O abundance ratio. Thanks to the advent of high angular resolution observations, it is clear that most outflows do not have a smooth density distribution, but are inhomogeneous or “clumpy”. We have developed a chemical model that takes into account the effect of a clumpy outflow on its gas-phase chemistry by using a theoretical porosity formalism. The clumpiness of the model increases the inner wind abundances of all so-called unexpected species, i.e. species that are not predicted to be present assuming an initial thermodynamic equilibrium chemistry. By applying the model to the distribution of cyanopolyynes and hydrocarbon radicals within the outflow of IRC+10216, we find that the chemistry traces the underlying density distribution.
Observationally locating the position of the H2O snowline in protoplanetary disks is crucial for understanding planetesimal and planet formation processes, and the origin of water on the Earth. In our studies, we conducted calculations of chemical reactions and water line profiles in protoplanetary disks, and identified that ortho/para-H216O, H218O lines with small Einstein A coefficients and relatively high upper state energies are dominated by emission from the hot midplane region inside the H2O snowline. Therefore, through analyzing their line profiles the position of the H2O snowline can be located. Moreover, because the number density of the H218O is much smaller than that of H216O, the H218O lines can trace deeper into the disk and thus they are potentially better probes of the exact position of the H2O snowline in disk midplane.
UV radiation plays a critical role in the chemistry of circumstellar envelopes (CSEs) around evolved stars on the asymptotic giant branch (AGB). However, the effects of all potential sources of UV radiation have not been included in models. We present preliminary results of adding an internal source of UV to the CSE chemistry and predict large enhancements of atomic and ionic species arising from photo-destruction of parent species. Observations of atomic carbon towards the UV-bright AGB star o Cet are consistent with the modelling. In addition, we calculate the precise depth dependence of the CO photodissociation rate in an expanding CSE. We incorporate this within a chemical network active in the outflows of AGB stars, which includes 933 species and 15182 reactions. Our results show that the CO envelope size is about 30% smaller at half abundance than the most commonly used radius reported by Mamon et al. (1988).
Purpose: We identified key clinicopathologic features of brain metastasis (BM) patients who are long-term survivors (LTS). Methods: We screened a prospective database of 1892 patients (treated 2006-2017), identified 92 (5%) who lived > 3 years following BM diagnosis, and performed per patient analyses. Results: Median age at diagnosis of BM was 57 years (range 19-77), 77% were women. The most common tumors were lung (50%), breast (26%), thyroid (7%) and skin (5%). 42% had tumors with drug-targetable oncoproteins (e.g. EGFR mutant) and 15% expressed hormonal receptors. ECOG was <2 in 70%. 47% had stage IV disease at diagnosis (75% with brain as the first site). 55% had controlled extracranial disease at the time of BM diagnosis. Median BM diameter was 1.5 cm (range 0.2-7) and 62% had a single lesion. Treatment was with surgery, radiosurgery, whole brain radiation (WBRT), or systemic therapy alone in 38%, 62%, 52%, and 4%, respectively. 53% received targeted- or immuno-therapy. Median follow up was 63 months (range 36-113). 61% failed intracranially at a median 24 months (range 1-99). 5 and 10- year survival (from BM diagnosis) was 82%, and 34%, respectively. Neither upfront WBRT nor other variables tested correlated with improved survival. In patients who died, an MRI was available within 3 months from death in 57%; of those 55% had no active intracranial disease, suggesting that the majority of deaths were non-neurologic. Conclusion: In general, LTS of BM had a limited number of BM, inactive extracranial disease, and drug targetable mutations.
Background: Brain tumors present unique challenges to patient and family quality of life (QOL). Cognitive dysfunction is common and functionally limiting, with no established treatments. These studies evaluate feasibility and preliminary efficacy of behavioral interventions developed for neuro-oncology patients. Study 1: A randomized controlled trial (N=25 primary brain tumor patients) compared an adapted version of Goal Management Training (GMT, a neuroscience-based integration of mindfulness and strategy training) and a newly-designed supportive psychoeducational intervention (Brain Health Program, BHP) to standard of care. Each intervention comprised 8 individual sessions and at-home practice between sessions. GMT patients’ executive functions improved immediately (p=.077, d=1.13), with maintenance at 4-month follow-up (p=.046, d=1.09). Both intervention groups reported improvements in everyday cognitive functioning immediately (p=.049; d’s GMT=0.43, BHP=0.79) and at follow-up (p=.001; d’s GMT=0.22, BHP=1.01). BHP patients also reported improved mood (p’s=.026 & .012, d’s=0.61 & 0.62). Study 2: Following a needs assessment about cognitive concerns and QOL in brain metastases patients (N=109) and caregivers (N=31), we developed a novel, brief (3 sessions + homework) Cognitive Support Program to provide education and strategy-training in key areas of concern: executive functions, memory, and communication. Options include caregiver co-training, and in-person or web-based delivery. Preliminary data from a pilot trial in progress demonstrate objective and subjective improvements. Conclusions: Cognitive rehabilitation may be a feasible and effective option for primary or metastatic brain tumor patients, addressing a need that is largely unmet in standard cancer care. Further development and larger trials appear warranted, with capacity for remote delivery recommended.
Background: Glioblastoma is the most common adult malignant glioma, with poor prognosis and adverse neurological sequelae. Physical activity improves outcomes in patients with other cancers, but has not been evaluated in GBM. This prospective, single-arm intervention trial examines feasibility and preliminary efficacy of exercise on PFS, cognition and QOL in newly diagnosed GBM patients. Method: Participants are English-speaking GBM patients scheduled for concurrent chemoradiation at PMH, 18-65 years old, ECOG ≤ 2. The 3-month home-based exercise program includes aerobic and resistance training, tailored to prior fitness level, current physical status, and individual interests. Assessments of physical and neurocognitive functions, mood, fatigue, sleep, and QOL, occur within 2 weeks of starting chemoradiation, and approximately 3, 6, 12, and 18 months later, or until tumor progression. Feasibility will be assessed by accrual, retention, and adherence rates. Outcomes include PFS (RANO criteria), change in cognition (reliable change index method), physical activity and sleep (actigraphy, self-report questionnaires). Time-to-event outcomes will be estimated (Kaplan-Meier), and mixed modelling will explore individual and disease variables that contribute to outcomes. Results: During the first five months of recruitment, 13 of 19 eligible patients consented. Nine completed the exercise program. One patient died after the intervention and none of the others progressed. No exercise-related serious adverse events occurred. Preliminary results will be presented at the meeting. Discussion: Exercise appears feasible for GBM patients. Effects on survival, performance status, cognition, sleep, mood, and QOL are ongoing. Results may guide physical activity recommendations in GBM and generate avenues for translational research.
The Pediatric Heart Network designed a career development award to train the next generation of clinician scientists in paediatric-cardiology-related research, a historically underfunded area. We sought to identify the strengths/weaknesses of the programme and describe the scholars’ academic achievements and the network’s return on investment.
Survey questions designed to evaluate the programme were sent to applicants – 13 funded and 19 unfunded applicants – and 20 mentors and/or principal investigators. Response distributions were calculated. χ2 tests of association assessed differences in ratings of the application/selection processes among funded scholars, unfunded applicants, and mentors/principal investigators. Scholars reported post-funding academic achievements.
Survey response rates were 88% for applicants and 100% for mentor/principal investigators. Clarity and fairness of the review were rated as “clear/fair” or “very clear/very fair” by 98% of respondents, but the responses varied among funded scholars, unfunded applicants, and mentors/principal investigators (clarity χ2=10.85, p=0.03; fairness χ2=16.97, p=0.002). Nearly half of the unfunded applicants rated feedback as “not useful” (47%). “Expanding their collaborative network” and “increasing publication potential” were the highest-rated benefits for scholars. Mentors/principal investigators found the programme “very” valuable for the scholars (100%) and the network (75%). The 13 scholars were first/senior authors for 97 abstracts and 109 manuscripts, served on 22 Pediatric Heart Network committees, and were awarded $9,673,660 in subsequent extramural funding for a return of ~$10 for every scholar dollar spent.
Overall, patient satisfaction with the Scholar Award was high and scholars met many academic markers of success. Despite this, programme challenges were identified and improvement strategies were developed.