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.
This article addresses questions surrounding the minimally conscious state (MCS) from the perspective of adult clinical ethics. It describes the background of the MCS diagnosis, analyzes phenomenological ambiguities inherent in the nature of MCS, and raises epistemological concerns surrounding its diagnosis. It argues that in many cases, the burdens of prolonging treatment for people who have sustained certain severe brain injuries (SBI) outweigh the benefits, even if they are in or have the prospect of entering into MCS. It also argues that often such long-term measures are problematic from the perspective of patient preferences and stewardship of resources. Consequently, it suggests that the delineation of MCS as a distinct neurological state, along with research that seeks to expand how MCS is diagnosed, poses ethical difficulties for families and providers making decisions for affected patients.
Multisomatoform disorder is characterised by severe and disabling bodily symptoms, and pain is one of the most common and impairing of these. Furthermore, these bodily symptoms cannot be explained by an underlying organic disorder. Patients with multisomatoform disorder are commonly found at all levels of healthcare and are typically difficult to treat for physicians as well as for mental health specialists.
To test whether brief psychodynamic interpersonal therapy (PIT) effectively improves the physical quality of life in patients who have had multisomatoform disorder for at least 2 years.
We recruited 211 patients (from six German academic out-patient centres) who met the criteria for multisomatoform disorder for a randomised, controlled, 12-week, parallel-group trial from 1 July 2006 to 1 January 2009 (International Standard Randomised Controlled Trial Number ISRCTN23215121). We randomly assigned the patients to receive either 12 weekly sessions of PIT (n = 107) or three sessions of enhanced medical care (EMC, n = 104). The physical component summary of the Short Form Health Survey (SF-36) was the pre-specified primary outcome at a 9-month follow-up.
Psychodynamic interpersonal therapy improved patients' physical quality of life at follow-up better than EMC (mean improvement in SF-36 score: PIT 5.3, EMC 2.2), with a small to medium between-group effect size (d = 0.42, 95% CI 0.15–0.69, P = 0.001). We also observed a significant improvement in somatisation but not in depression, health anxiety or healthcare utilisation.
This trial documents the long-term efficacy of brief PIT for improving the physical quality of life in patients with multiple, difficult-to-treat, medically unexplained symptoms.
This article analyzes a number of yearly reports from the World Bank's Doing Business project, an ambitious international effort to measure various aspects of law and development, analyze their interrelationship, develop benchmarks for assessment of legal systems, and suggest legal reforms. After describing the methodology used, we analyze the strengths and limitations of the project, both as a scholarly enterprise and as a set of proposals for legal reform. Our analysis highlights the challenges associated with measuring legal variables in the face of legal complexity and uncertainty, measuring development when the concept of development is contested, tracing causal connections between law and development, and using scholarly research as a basis for legal reform.
Foix–Chavany–Marie syndrome (FCMS) is a distinct clinical picture of suprabulbar (pseudobulbar) palsy due to bilateral anterior opercular lesions. Symptoms include anarthria/severe dysarthria and loss of voluntary muscular functions of the face and tongue, and problems with mastication and swallowing with preservation of reflex and autonomic functions. FCMS may be congenital or acquired as well as persistent or intermittent. The aetiology is heterogeneous; vascular events in adulthood, nearly exclusively affecting adults who experience multiple subsequent strokes; CNS infections; bilateral dysgenesis of the perisylvian region; and epileptic disorders. Of the six cases reported here, three children had FCMS as the result of meningoencephalitis, two children had FCMS due to a congenital bilateral perisylvian syndrome, and one child had intermittent FCMS due to an atypical benign partial epilepsy with partial status epilepticus. The congenital dysgenetic type of FCMS and its functional epileptogenic variant share clinical and EEG features suggesting a common pathogenesis. Consequently, an increased vulnerability of the perisylvian region to adverse events in utero is discussed. In honour of Worster-Drought, who described the clinical entity in children 40 years ago, the term Worster-Drought syndrome is proposed for this unique disorder in children.
A study of 56 patients was undertaken to determine whether there is a difference in the effect of the laryngeal mask airway and the endotracheal tube on the vocal tract after short-duration anaesthesia. All the patients were interviewed pre- and post-operatively.In 43 patients, it was possible to assess the larynx using videoendoscopy and videostrobolaryngoscopy both pre- and post-operatively. Selected acoustic characteristics were investigated in 51 patients pre- and 18–24 h post-operatively. Thirty-four patients that did not have anaesthesia were used as an age-matched control.
The interview showed, that patients in the LMA group complained less frequently of having post-operative complained less frequently of having post-operative demonstrated minor lesions of the vocal tract in six patients in the ETT group and in one patient in the LMA group. Of the 12 voice variables evaluated, there was no significant difference in any parameter between the two groups. Both groups had a higher fundamental frequency post-operatively.
To investigate if there is a reservoir of Escherichia
coli O157 in Norwegian cattle, faecal
samples from 197 cattle herds were screened for E.
coli O157 by the use of immunomagnetic
separation (IMS) and PCR during the 1995 grazing season. Six
E. coli O157[ratio ]H-isolates were
detected in two herds, one isolate in one and five in the other.
The isolates carried the stx1,
stx2, and eae genes, and a 90 MDa
virulence plasmid. They were toxinogenic in a Vero cell
assay. From 57 other herds, 137 faecal samples were positive
for stx1 and/or stx2
genes detected by PCR run directly on IMS-isolated material.
Among these samples, stx2 were the
most widely distributed toxin encoding genes. No difference was
found among milking cows
and heifers in the rate of stx1 and/or
stx2 in positive samples.
Thin films, 0.2 μm to 2 μm thick, of ferroelectric PbTiO3 have been deposit ed on Pt coated Si wafers using a novel dual target ion beam sputtering technique. The sputtering targets of PbO and Ti are shuttled back and forth into a Xe ion beam, depositing very thin (10 - 15 Å) alternating layers of PbO and TiO2. The substrate is heated in situ, allowing interdiffusion of the thin layers into a homogeneous PbTiO3 film. Film composition can be controlled accurately and repeatably by controlling the ratio of the sputtering times from each target. Structural characteristics were analyzed by x-ray diffraction, Rutherford backscattering as a function of the sputtering time ratio and the deposition temperature on Pt and Si3N4 coated Si substrates. The stoichiometric PbTiO3 films have a tetragonal perovskite structure with a slight c-axis preference. Capacitor structures show ferroelectric hysterisis loops, dielectric constants of 100-250, loss tangents between 0.002 and 0.04 and a pyroelectric coefficient greater than 5 x 10−8 C/cm2 °C.
The absolute time of growth of a floating tree-ring series is determined by computer, by first fitting a curve to the 14C ages of tree-ring dated wood and then by matching the 14C ages of the floating tree-ring series to that curve. The results obtained by this matching procedure are given here for five floating European oak chronologies for which 14C dates have been published previously by Suess (1978). Three of these five floating series have been linked together dendrochronologically. There now remain three floating series covering a 4000-year time span from 4820 BC to 830 BC. Their 14C dates, matched by computer to the bristlecone pine chronology, provide a possibility of obtaining precise ages of oak wood series from Neolithic sites in Switzerland and South Germany by dendrochronologically cross-dating with the calibrated master chronologies.
Email your librarian or administrator to recommend adding this to your organisation's collection.