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Anecdotal evidence suggests the use of bolus tube feeding is increasing in the long-term home enteral tube feed (HETF) patients. A cross-sectional survey to assess the prevalence of bolus tube feeding and to characterise these patients was undertaken. Dietitians from ten centres across the UK collected data on all adult HETF patients on the dietetic caseload receiving bolus tube feeding (n 604, 60 % male, age 58 years). Demographic data, reasons for tube and bolus feeding, tube and equipment types, feeding method and patients’ complete tube feeding regimens were recorded. Over a third of patients receiving HETF used bolus feeding (37 %). Patients were long-term tube fed (4·1 years tube feeding, 3·5 years bolus tube feeding), living at home (71 %) and sedentary (70 %). The majority were head and neck cancer patients (22 %) who were significantly more active (79 %) and lived at home (97 %), while those with cerebral palsy (12 %) were typically younger (age 31 years) but sedentary (94 %). Most patients used bolus feeding as their sole feeding method (46 %), because it was quick and easy to use, as a top-up to oral diet or to mimic mealtimes. Importantly, oral nutritional supplements (ONS) were used for bolus feeding in 85 % of patients, with 51 % of these being compact-style ONS (2·4 kcal (10·0 kJ)/ml, 125 ml). This survey shows that bolus tube feeding is common among UK HETF patients, is used by a wide variety of patient groups and can be adapted to meet the needs of a variety of patients, clinical conditions, nutritional requirements and lifestyles.
Evidence synthesis (ES) is often required for economic evaluation (EE) of pharmaceuticals. Commonly used methods are based on the assumption of proportional hazards in trial data, using the hazard ratio (HR). Alternative methods for ES are increasingly used in EE, in situations where the pattern of hazards in the trial data indicates that the proportional hazards assumption may be violated. The impact of these methodological choices on model outcomes is explored.
The model outcomes predicted by each method (HR, FP and AFT) are presented and compared. Both deterministic and probabilistic results are presented, alongside a discussion around how the uncertainty in these structural assumptions may be captured in EE.
Structural assumptions in ES may lead to differences in model outcomes. The impact of these differences may be important in situations where decision uncertainty is high. Methods should be chosen and justified based on patterns of hazard present in the trial data.
This article explores a slice of the careers of two ‘rival’ coloratura singers – the Swedish soprano Christine Nilsson and the French soprano Caroline Miolan Carvalho – during the period 1867 to 1870, and considers the internationalisation of singing careers, women's choices and negotiation of their career paths, and fortunes made and lost. With both singers employed at the Paris Opéra from November 1868 onwards as Gounod's Faust went into rehearsal, the focus falls on the ‘Battle of the Marguerites’ in the Parisian press in spring 1869, which raised heated questions of dramatic and vocal interpretation and style, often linked to cultural stereotypes, as well as artistic legitimacy and stature. Through examination of previously overlooked archival financial and legal records, this article also reveals for the first time that Miolan Carvalho was indentured to the director of the Opéra Emile Perrin during this period.
The subantarctic island of South Georgia provides terrestrial and coastal marine records of climate variability, which are crucial for the understanding of the drivers of Holocene climate changes in the subantarctic region. Here we investigate a sediment core (Co1305) from a coastal inlet on South Georgia using elemental, lipid biomarker, diatom, and stable isotope data to infer changes in environmental conditions and to constrain the timing of late-glacial and Holocene glacier fluctuations. Because of the scarcity of terrestrial macrofossils and the presence of redeposited and relict organic matter in the sediments, age control for the record was obtained by compound-specific radiocarbon dating of mostly marine-derived n-C16 fatty acids. A basal till layer recovered in Little Jason Lagoon was likely deposited during an advance of local glaciers during the Antarctic cold reversal. After glacier retreat, an oligotrophic lake occupied the site, which transitioned to a marine inlet around 8.0±0.9 ka because of relative sea-level rise. From 7.0±0.6 to 4.0±0.4 ka, reduced vegetation coverage in the catchment, as well as high siliciclastic input and deposition of ice-rafted debris, indicates glacier advances in the terrestrial catchment and likely in the adjacent fjord. A second, less extensive period of glacier advances occurred in the late Holocene, after 1.8±0.3 ka.
One of the central claims of Norenzayan et al.’s article is that supernatural monitoring and intergroup competition have facilitated the rise of large-scale prosocial religions. Although the authors outline in detail how social instincts that govern supernatural monitoring are honed by cultural evolution and have given rise to Big Gods, they do not provide a clear explanation for the success of karmic religions. Therefore, to test the real scope of their model, Norenzayan et al. need to seriously engage with questions concerning the evolution of karmic prosocial religions.
We present the results of two 2.3 μm near-infrared (NIR) radial velocity (RV) surveys to detect exoplanets around 36 nearby and young M dwarfs. We use the CSHELL spectrograph (R ~ 46,000) at the NASA InfraRed Telescope Facility (IRTF), combined with an isotopic methane absorption gas cell for common optical path relative wavelength calibration. We have developed a sophisticated RV forward modeling code that accounts for fringing and other instrumental artifacts present in the spectra. With a spectral grasp of only 5 nm, we are able to reach long-term radial velocity dispersions of ~20–30 m s−1 on our survey targets.
We present new imaging data and archival multiwavelength observations of the little-studied emission nebula K 1-6 and its central star. Narrow-band images inHα (+[N II]) and [O III] taken with the Faulkes Telescope North reveal a stratified, asymmetric, elliptical nebula surrounding a central star which has the colours of a late G or early K-type subgiant or giant. GALEX ultraviolet images reveal a very hot subdwarf or white dwarf coincident in position with this star. The cooler, optically dominant star is strongly variable with a period of 21.312± 0.008 days, and is possibly a high-amplitude member of the RS CVn class, although an FK Com classification is also possible. Archival ROSAT data provide good evidence that the cool star has an active corona. We conclude that K 1-6 is most likely an old bona fide planetary nebula at a distance of ∼1.0 kpc, interacting with the interstellar medium, and containing a binary or ternary central star. The observations and data analyses reported in this paper were conducted in conjunction with Year 11 high school students as part of an Australian Research Council Linkage Grant science education project, denoted Space To Grow, conducted jointly by professional astronomers, educational researchers, teachers, and high-school students.
This longitudinal quasi-experimental study examines the effects of Word Generation, a middle-school vocabulary intervention, on the learning, maintenance, and consolidation of academic vocabulary for students from English-speaking homes, proficient English speakers from language-minority homes, and limited English-proficiency students. Using individual growth modeling, we found that students receiving Word Generation improved more on target word knowledge during the instructional period than students in comparison schools did, on average. We found an interaction between instruction and home-language status such that English-proficient students from language-minority homes improved more than English-proficient students from English-speaking homes. Limited English-proficiency students, however, did not realize gains equivalent to those of more proficient students from language-minority homes during the instructional period. We administered follow-up assessments in the fall after the instructional period ended and in the spring of the following year to determine how well students maintained and consolidated target academic words. Students in the intervention group maintained their relative improvements at both follow-up assessments.
This research examines the processes which native Spanish-speaking learners of English and English-only students engage in when inferring meaning for unknown English words that have Spanish cognates. Conducted within the context of a large-scale vocabulary intervention that taught word inferencing strategies, including a cognate strategy, this qualitative study describes cognate strategy use among a small sample of participants. The data suggest that explicit instruction, students' metalinguistic and metacognitive skills, and the structural characteristics of cognate pairs are associated with cognate recognition.
Major depression is an important and costly problem among adolescents, yet evidence to support the provision of cost-effective treatments is lacking.
To assess the short-term cost-effectiveness of combined selective serotonin reuptake inhibitors (SSRIs) and cognitive–behavioural therapy (CBT) together with clinical care compared with SSRIs and clinical care alone in adolescents with major depression.
Pragmatic randomised controlled trial in the UK. Outcomes and costs were assessed at baseline, 12 and 28 weeks.
The trial comprised 208 adolescents, aged 11–17 years, with major or probable major depression who had not responded to a brief initial psychosocial intervention. There were no significant differences in outcome between the groups with and without CBT. Costs were higher in the group with CBT, although not significantly so (P=0.057). Cost-effectiveness analysis and exploration of the associated uncertainty suggest there is less than a 30% probability that CBT plus SSRIs is more cost-effective than SSRIs alone.
A combination of CBT plus SSRIs is not more cost-effective in the short-term than SSRIs alone for treating adolescents with major depression in receipt of routine specialist clinical care.
We have undertaken an adaptive optics imaging survey of extra-solar planetary systems and stars showing interesting radial velocity trends from high precision radial velocity searches. Adaptive Optics increases the resolution and dynamic range of an image, substantially improving the detectability of faint close companions. This survey is sensitive to objects less luminous than the bottom of the main sequence at separations as close as 1″. We have detected stellar companions to the planet bearing stars HD 114762 and Tau Boo. We have also detected a companion to the non-planet bearing star 16 Cyg A.
Clair Gough, Research Associate Research Associate at Manchester School of Management, UMIST and at the Tyndall Centre for Climate Change Research, UK,
Éric Darier, Greenpeace Canada,
Bruna De Marchi, Head of the Mass Emergencies Program (PEM) Institute of International Sociology of Gorizia (ISIG), Italy,
Silvio Funtowicz, Head of the Knowledge Assessment Methodologies Sector European Commission Joint Research Center,
Robin Grove-White, Professor Institute for Environment, Philosophy and Public Policy, Furness College, Lancaster University, UK; Chair Lancaster University's Centre for the Study of Environmental Change (CSEC),
Ângela Guimarães Pereira, Scientific Officer Institute for the Protection and Security of the Citizen,
Simon Shackley, Lecturer in Environmental Management and Policy Environmental Management and Policy, Manchester School of Management, UMIST,
Brian Wynne, Professor of Science Studies Institute for Environment, Philosophy and Public Policy at Furness College, Lancaster University, UK
Climate change represents one of society's most challenging environmental concerns and has been a major factor in changes in the way that environmental policies are debated and informed. Climate change policy faces at least three major challenges: (1) what is known – or not known – about climate change, in particular regarding the relative importance of anthropogenic factors; (2) what can and should be done; and (3) who should do something about it?
Since the 1992 Rio Earth Summit, these challenges have been addressed in several ways: (a) by increasing research and international sharing and integration of expertise on climate change (e.g., the Intergovernmental Panel on Climate Change); (b) by developing international agreements on issues such as the reduction of carbon dioxide emissions; and (c) by promoting national/local strategies to fulfil international agreements (e.g., Local Agenda 21 – community defined strategies for sustainable development arising from the first “Earth Summit” held in Rio in 1992). These challenges all include policy and scientific aspects but also raise questions over the interpretation of Local Agenda 21 (Tuxworth 1996; Selman and Parker 1997; Voisey et al. 1996; Young 1996; Young 1997). How local is “local”? What kind of “agenda” is “Agenda 21”? Whose “agenda” is it? Answers to these questions vary according to the perspectives and purposes of those asking the questions in the first place.
This study is the first to provide direct observations of dyadic interactions with friends for
preschool-aged disruptive children. Forty preschoolers (mean age 52 months) rated by
parents as “hard to manage” on Goodman's (1997) Strengths and Difficulties Questionnaire
(SDQ), as well as 40 control children (matched for age, gender, school, and ethnic
background) were filmed for 20 minutes on two occasions playing with a teacher-nominated
best friend. The videos were transcribed and coded for antisocial behaviour, displays of
negative emotion, and empathic/prosocial responses to friend's distress. Individual
differences in social behaviour were considered in relation to false-belief performance,
affective perspective taking, and executive function skills (planning and inhibitory control).
Compared with controls, the hard-to-manage group showed significantly higher rates of
both antisocial behaviour and displays of negative emotion, as well as significantly lower
rates of emphatic/prosocial responses. Across both groups combined, frequencies of angry
and antisocial behaviours were related to poor executive control. Mental-state understanding
was not significantly correlated with antisocial behaviour, emotion display, or empathy,
suggesting that the interpersonal problems of young disruptive children owe more to failure
of behavioural regulation than to problems in social understanding per se. However, given
the relatively low power of the study, these findings require replication with a larger sample.
It is widely recognised that impaired social relations are
characteristic of school-aged
children with behavioural disorders, and predict a poor long-term outcome
(Parker & Asher,
1987). However, little is known about the early antecedents of social impairment
behaviourally disturbed children. The aim of the present study was to explore
three areas of
potential dysfunction in younger children: theory of mind, emotion understanding,
executive function. Forty preschoolers, rated by their parents on the Strengths
Difficulties Questionnaire (Goodman, 1994) as “hard to manage”
(H2M) were compared
with a control group on a set of: (1) theory of mind tasks (including an
task involving either a nice or a nasty surprise); (2) emotion understanding
required affective perspective-taking skills as well as situational understanding);
simple executive function tasks (adapted for preschoolers, and tapping
attentional set-shifting, and working memory). Small but significant group
found in all three cognitive domains. In particular, hard-to-manage preschoolers
poor understanding of emotion and executive control, poor prediction or
recall of a false
belief, and better understanding of the belief-dependency of emotion in
the context of a trick
than a treat. Moreover, executive function was associated with performance
on the theory of
mind tasks for the hard-to-manage group alone, suggesting both direct and
between executive dysfunction and disruptive behaviour.
Current linguistic theory offers a highly detailed account of what linguistic competence consists of, as well as an indication of how that competence is acquired by L1 learners, via an innate Universal Grammar (UG). In second language (L2) acquisition, a major issue is the nature of the L2 learner’s competence and the degree to which it is similar to or different from the competence attained by native speakers. A theory of linguistic competence is essential to our understanding of what L2 competence might consist of, and should inform L2 acquisition research (Gregg 1989). In this paper, I will adopt certain recent proposals concerning verb movement and the functional categories Agreement and Tense (Chomsky 1989; Pollock 1989), and investigate whether these proposals can provide a suitable explanation of the linguistic behaviour of French learners of English.
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