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The impact of losing a limb in military service extends well beyond initial recovery and rehabilitation, with long-term consequences and challenges requiring health-care commitments across the lifecourse. This paper presents a systematic review of the current state of knowledge regarding the long-term impact of ageing and limb-loss in military veterans. Key databases were systematically searched including: ASSIA, CINAHL, Cochrane Library, Medline, Web of Science, PsycArticles/PsychInfo, ProQuest Psychology and ProQuest Sociology Journals, and SPORTSDiscus. Empirical studies which focused on the long-term impact of limb-loss and/or health-care requirements in veterans were included. The search process revealed 30 papers relevant for inclusion. These papers focused broadly on four themes: (a) long-term health outcomes, prosthetics use and quality of life; (b) long-term psycho-social adaptation and coping with limb-loss; (c) disability and identity; and (d) estimating the long-term costs of care and prosthetic provision. Findings present a compelling case for ensuring the long-term care needs and costs of rehabilitation for older limbless veterans are met. A dearth of information on the lived experience of limb-loss and the needs of veterans’ families calls for further research to address these important issues.
The relationship between depression and sexual behaviour among men who have sex with men (MSM) is poorly understood.
To investigate prevalence and correlates of depressive symptoms (Patient Health Questionnaire-9 score ≥10) and the relationship between depressive symptoms and sexual behaviour among MSM reporting recent sex.
The Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) is a cross-sectional study of UK genitourinary medicine clinic attendees without diagnosed HIV (2013–2014).
Among 1340 MSM, depressive symptoms (12.4%) were strongly associated with socioeconomic disadvantage and lower supportive network. Adjusted for key sociodemographic factors, depressive symptoms were associated with measures of condomless sex partners in the past 3 months (≥2 (prevalence ratio (PR) 1.42, 95% CI 1.17–1.74; P=0.001), unknown or HIV-positive status (PR 1.43, 95% CI 1.20–1.71; P<0.001)), sexually transmitted infection (STI) diagnosis (PR 1.46, 95% CI 1.19–1.79; P<0.001) and post-exposure prophylaxis use in the past year (PR 1.83, 95% CI 1.33–2.50; P<0.001).
Management of mental health may play a role in HIV and STI prevention.
Issues stemming from differences and similarities in cultural identities affect residents and workforces in care homes in Scotland, as they do across the United Kingdom. Theoretical guidance and policy drivers emphasise the importance of considering cultural diversity when planning or enacting person-centred care processes, regardless of where health or social care takes place. Nevertheless, there is a recognised worldwide dearth of research concerning the intersections of culture, dementia and long-term care. This being so, a recent research study found that inadequate understandings of issues stemming from cultural diversity could be seen to constrain person-centred care in some Scottish care homes. In addition, the study uncovered little-recognised socio-cultural phenomena which were observed to positively enhance person-centre care. This article will focus on that, and will lay out findings from the study which lead to the following broad assertion: there is a broad lack of understanding of the power, and potential utility, of shared identity and community as a bulwark against the erosion of personhood which is often associated with dementia. This article describes these findings in some detail, thereby providing fresh insights into how shared cultural identity, and the sense of community it may bring, bears upon the interactions between workers and residents with dementia in Scottish care homes. It then suggests how the school of ‘person-centred care’ may be developed through further research into these phenomena.
Without a universal Emergency Medical Services (EMS) system in India, data on the epidemiology of patients who utilize EMS are limited. This retrospective chart review aimed to quantify and describe the burden of disease and patient demographics of patients who arrived by EMS to four Indian emergency departments (EDs) in order to inform a national EMS curriculum.
A retrospective chart review was performed on patients transported by EMS over a three-month period in 2014 to four private EDs in India. A total of 17,541 patient records were sampled from the four sites over the study period. Of these records, 1,723 arrived by EMS and so were included for further review.
A range of 1.4%-19.4% of ED patients utilized EMS to get to the ED. The majority of EMS patients were male (59%-64%) and adult or geriatric (93%-99%). The most common chief complaints and ED diagnoses were neurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease.
Neurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease are the most common problems found in patients transported by EMS in India. Adult and geriatric male patients are the most common EMS utilizers. Emergency Medical Services curricula should emphasize these knowledge areas and skills.
WijesekeraO, ReedA, ChastainPS, BiggsS, ClarkEG, KoleT, ChakrapaniAT, AshishN, RajhansP, BreaudAH, JacquetGA. Epidemiology of Emergency Medical Services (EMS) Utilization in Four Indian Emergency Departments. Prehosp Disaster Med. 2016;31(6):675–679.
The fragmented ecosystems along the Niagara Escarpment World Biosphere Reserve provide important habitats for biota including lichens. Nonetheless, the Reserve is disturbed by dense human populations and associated air pollution. Here we investigated patterns of lichen diversity within urban and rural sites at three different locations (Niagara, Hamilton, and Owen Sound) along the Niagara Escarpment in Ontario, Canada. Our results indicate that both lichen species richness and community composition are negatively correlated with increasing human population density and air pollution. However, our quantitative analysis of community composition using canonical correspondence analysis (CCA) indicates that human population density and air pollution is more independent than might be assumed. The CCA analysis suggests that the strongest environmental gradient (CCA1) associated with lichen community composition includes regional pollution load and climatic variables; the second gradient (CCA2) is associated with local pollution load and human population density factors. These results increase the knowledge of lichen biodiversity for the Niagara Escarpment and urban and rural fragmented ecosystems as well as along gradients of human population density and air pollution; they suggest a differential influence of regional and local pollution loads and population density factors. This study provides baseline knowledge for further research and conservation initiatives along the Niagara Escarpment World Biosphere Reserve.
Determining the internal layout of archaeological structures and their uses has always been challenging, particularly in timber-framed or earthen-walled buildings where doorways and divisions are difficult to trace. In temperate conditions, soil-formation processes may hold the key to understanding how buildings were used. The abandoned Roman town of Silchester, UK, provides a case study for testing a new approach that combines experimental archaeology and micromorphology. The results show that this technique can provide clarity to previously uncertain features of urban architecture.
Family-centered care provides family members with basic needs, which includes information, reassurance, and support. Though national guidelines exist, clinical adoption often lags behind in this area. The Geisinger Health System developed and implemented a program for reliable delivery of best practices related to family communication to patients and families admitted to the intensive care unit (ICU).
There was no statistically significant difference noted in family satisfaction as determined by FSICU–24 scores, including the Care and Decision Making constructs between the pre- and post-intervention pilot population. The percentage of families reporting the occurrence of a family conference showed only minimal improvement, from 46.5% before to 52.5% following the intervention (p = 0.565). This was mirrored by low numbers of documented family conferences by providers, suggesting poor uptake despite buy-in, use of electronic checklists, and repeated attempts at education.
Significance of results:
This paper reviews the challenges to and implications for implementing national guidelines in the area of family communication in an ICU coupled with the principles of clinical reengineering.
Vulcanian eruptions are named for the 1888–90 eruptions of Vulcano, Aeolian Islands, Italy (Mercalli, 1907), and are defined here as short-lived, discrete explosions resulting from sudden decompression of a volcanic conduit caused by disruption of a sealing plug or dome. Resulting eruptions characteristically last only seconds to minutes and may produce buoyant columns, pyroclastic density currents, or both. They may occur as single events or in a sequence of discrete explosions. The short duration and unsteady vent conditions of vulcanian eruptions make them distinct from sustained plinian or subplinian eruptions. Pre-eruption pressures can reach 10 MPa, vent velocities may approach 400 m s−1, eruption plumes typically rise to < 10 km, but in some cases may reach nearly 20 km, and the amount of magma erupted is typically < 1011 kg. This chapter reviews mechanisms associated with vulcanian eruptions and discusses several relevant conceptual and quantitative models. Topics include plug formation and disruption, magma fragmentation, calculation of vent flux, the production and propagation of shock waves, the dynamics of pyroclastic jets and plumes ascending from unsteady sources, and ballistic analysis. This chapter also addresses important questions regarding controls on the scale and duration of such short-lived explosions, as well as transitions in eruptive style.
The tension between hierarchy and communalism is a prominent feature of social life in transegalitarian societies. How are hierarchy and communalism combined in these societies? How are they materialized in everyday life? In this paper, we examine the relationship between hierarchy and communalism in the transegalitarian societies of the Northwest Coast of North America. We focus on households, the primary socioeconomic units of the culture area, and on the plank houses that contained them. Despite the apparent contradiction between hierarchy and communalism, we find that in Northwest Coast households with highly developed social hierarchies, communal practices remained deeply entrenched, while in households with weaker hierarchies, communalism was less developed. The relative importance of hierarchy and communalism in daily household life was clearly materialized in the spatial order of plank houses. By simultaneously objectifying both principles, the house may have played an important role in easing the tension between them.
‘Active ageing’ is a key concept in current policy and research on ageing and yet is under-analysed or interpreted largely within an economic framework. This paper explores active ageing in the broader context of older people's lives. Drawing on a series of biographical interviews with 23 people aged 60–96 years, the discussion focuses on the theme of future hopes and concerns. Exhortations for ‘active ageing’ may be challenged by a lifelong unwillingness to look forward or plan ahead. Nevertheless, the findings show that fears for a future of limited resources, decline and dependency can exist alongside not only the desire to live longer but also the positive anticipation of forthcoming events and strong inter-generational relations. ‘Living for now’ and ‘taking a day at a time’ – and by extension the accomplishment of everyday activities rather than the activity-driven goals of earlier years – are common strategies for dealing with the unpredictability of later life. In this respect, even stopping paid work and entering residential care may be actively chosen and empowering even though they are steps towards disengagement and dependency. Similarly, planning for death, such as writing (living) wills and making funeral arrangements, may be positive and proactive responses to beliefs and concerns about dying. ‘Active ageing’ therefore needs to offer choices for life to be lived at all stages whilst recognising that much of the focus for older people is on ordinary needs, deeds and relationships.
Pathophysiological stress from acute illness causes metabolic disturbance, including altered hepatic glucose metabolism, increased peripheral insulin resistance and hyperglycaemia. Acute hyperglycaemia is associated with increased morbidity and mortality in patients in intensive care units and patients with acute respiratory disease. The present review will consider mechanisms underlying this association. In normal lungs the glucose concentration of airway secretions is approximately 10-fold lower than that of plasma. Low airway glucose concentrations are maintained against a concentration gradient by active glucose transport. Airway glucose concentrations become elevated if normal homeostasis is disrupted by a rise in blood glucose concentrations or inflammation of the airway epithelium. Elevated airway glucose concentrations are associated with and precede increased isolation of respiratory pathogens, particularly methicillin-resistant Staphylococcus aureus, from bronchial aspirates of patients intubated on intensive care. Markers of elevated airway glucose are associated with similar patterns of respiratory infection in patients admitted with acute exacerbations of chronic obstructive pulmonary disease. Glucose at airway concentrations stimulates the growth of respiratory pathogens, over and above the effect of other nutrients. Elevated airway glucose concentrations may also worsen respiratory disease by promoting local inflammation. Hyperglycaemia may thus promote pulmonary infection, at least in part, by an effect on airway glucose concentrations. Therapeutic options, including systemic control of blood glucose and local manipulation of airway glucose homeostasis, will be considered.
Following recent study and excavation of the defences, amphitheatre and forum-basilica of Silchester (Calleva Atrebatum), challenging questions about the origins, development, decline and eventual abandonment of the Roman city invited fresh excavation of a representative insula. A well known, but nevertheless major deficiency of the Victorian and Edwardian excavations at Silchester is the almost total absence of chronology, either relative or absolute, such that we have little basis on which to determine the development of the city through time. In making the selection of an appropriate area in which to investigate the larger issues, consideration had to be given to a number of criteria: the chosen insula should have reliable evidence for the presence of buildings not recognised in the Society of Antiquaries' excavations of 1890–1909. In this way it would be possible to assess the extent of the loss of stratigraphie information as a result of the earlier excavation. Equally the selected insula should offer the prospect of investigating apparently blank areas which might, with modern methods of area excavation, yield evidence of timber-framed buildings which the early excavators had failed to recognise. Account also had to be taken of a distinctive element of the town plan of Calleva which includes buildings both aligned with the Roman street grid and oriented at a variety of angles askew to the streets in order to ascertain how far they shared a common history.
The excavations of the Roman town of Silchester, Hampshire, undertaken under the auspices of the Society of Antiquaries between 1890 and 1909, are reconsidered in the light of renewed excavation on the site of insula IX, first explored in 1893. The excavation methodology of trial-trenching followed by area excavation of masonry buildings thus located is reviewed alongside the evidence of policy for the recovery and retention of finds. It is estimated that about 95 per cent of the archaeological resource survives for future research.
Bactrocera Macquart (Diptera: Tephritidae) is a genus of nearly 500 species, the
majority of which are endemic to tropical South-East Asia and Australasia
(Drew 1989). Nearly all Bactrocera have frugivorous larvae that feed on the
fleshy fruit of tropical trees, shrubs, and vines, and some species are major
horticultural pests (White & Elson-Harris 1992). In this paper,where the term
‘fruit fly’ is used, we are referring explicitly to species of Bactrocera.