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Advance care planning (ACP) is identified as being an important process for people with dementia. However, its efficacy for improving outcomes relevant for the individual, carers and the health system has yet to be established.
We conducted a systematic review with the aims of testing the efficacy of ACP for people with dementia and describing the settings and population in which it has been evaluated.
A search was completed of electronic databases in August 2016. Articles were included if they described interventions aimed at increasing planning for future care of people with dementia, delivered to the person with dementia, their carers and/or health professionals.
Of 4,772 articles returned by searches, 30 met the inclusion criteria, testing interventions in nursing home (n= 16) community (n = 10) and acute care (n = 4) settings. Only 18 interventions directly involved the person with dementia, with the remainder focusing on surrogate decision-makers. In all settings, interventions were found effective in increasing ACP practice. In nursing homes, ACP was found to influence care and increase the concordance between end of life wishes and care provided. Interventions in the community were found to improve patient quality of life but were not shown to influence concordance.
Future research should focus on ways to involve people with dementia in decision-making through supported means.
This article describes a clinical protocol for supporting those presenting with post-traumatic stress disorder (PTSD) and dissociative symptoms, particularly dissociative flashbacks, based on a cross-culturally applicable model. The protocol is discussed from the perspective of working with a refugee and asylum seeker population, although many of the principles will be applicable to clients from any background presenting with these dissociative symptoms. The protocol addresses the assessment and formulation of a client’s dissociative symptoms. It includes guidance on sharing psycho-education with clients regarding the evolutionary function of dissociation and developing practical strategies to monitor and manage dissociative symptoms. The strengths and limitations of this protocol are also discussed.
Key learning aims
After reading this article people will:
(1)Be able to understand a cross-culturally applicable model of dissociation and how it applies to clinical practice when working with clients presenting with dissociative symptoms, particularly dissociative flashbacks, in the context of a diagnosis of PTSD.
(2)Be able to assess and formulate dissociative symptoms as part of an overall PTSD formulation.
(3)Be able to develop practical strategies for assisting clients in monitoring and managing their dissociative symptoms.
(4)Be familiar with adaptations for using this approach with refugee and asylum seeker populations.
Using a commercial X-ray tomography instrument, we have obtained reconstructions of a graded-index optical fiber with voxels of edge length 1.05 µm at 12 tube voltages. The fiber manufacturer created a graded index in the central region by varying the germanium concentration from a peak value in the center of the core to a very small value at the core-cladding boundary. Operating on 12 tube voltages, we show by a singular value decomposition that there are only two singular vectors with significant weight. Physically, this means scans beyond two tube voltages contain largely redundant information. We concentrate on an analysis of the images associated with these two singular vectors. The first singular vector is dominant and images of the coefficients of the first singular vector at each voxel look are similar to any of the single-energy reconstructions. Images of the coefficients of the second singular vector by itself appear to be noise. However, by averaging the reconstructed voxels in each of several narrow bands of radii, we can obtain values of the second singular vector at each radius. In the core region, where we expect the germanium doping to go from a peak value at the fiber center to zero at the core-cladding boundary, we find that a plot of the two coefficients of the singular vectors forms a line in the two-dimensional space consistent with the dopant decreasing linearly with radial distance from the core center. The coating, made of a polymer rather than silica, is not on this line indicating that the two-dimensional results are sensitive not only to the density but also to the elemental composition.
We present observations of thermonuclear (type-I) X-ray bursts, selected for comparison with numerical models. We provide examples of four distinct cases of ignition: He-ignition in mixed H/He fuel (case 1); He-ignition in pure He fuel, following exhaustion of accreted H by steady burning (case 2); ignition in (almost) pure He accumulated from an evolved donor in an ultracompact system; and a superburst, thought to arise from ignition of carbon fuel produced as a by-product of H/He bursts. For regular bursts, we measured the recurrence time and calculated averaged burst profiles from RXTE observations. We also estimated the recurrence time for pairs of bursts, including those observed during a transient outburst, modelled using a numerical ignition code. For each example we list the burst properties including recurrence time, fluence, peak flux, the persistent flux level (and inferred accretion rate), and the ratio of persistent flux to fluence. In the accompanying material, we provide a bolometric lightcurve for each burst, determined from time-resolved spectral analysis. Along with the inferred or adopted parameters for each burst system, including distance, surface gravity, and redshift, these data are suggested as suitable test cases for ignition models.
The aim of this study was to elucidate the relationship between the urinary metabolic fingerprint and the effects of cocoa and cocoa fibre on body weight, hormone metabolism, intestinal immunity and microbiota composition. To this effect, Wistar rats were fed, for 3 weeks, a diet containing 10 % cocoa (C10) or two other diets with same the proportion of fibres: one based on cocoa fibre (CF) and another containing inulin as a reference (REF) diet. The rats’ 24 h urine samples were analysed by an untargeted 1H NMR spectroscopy-based metabonomic approach. Concentrations of faecal IgA and plasma metabolic hormones were also quantified. The C10 diet decreased the intestinal IgA, plasma glucagon-like peptide-1 and glucagon concentrations and increased ghrelin levels compared with those in the REF group. Clear differences were observed between the metabolic profiles from the C10 group and those from the CF group. Urine metabolites derived from cocoa correlated with the cocoa effects on body weight, immunity and the gut microbiota. Overall, cocoa intake alters the host and bacterial metabolism concerning energy and amino acid pathways, leading to a metabolic signature that can be used as a marker for consumption. This metabolic profile correlates with body weight, metabolic hormones, intestinal immunity and microbiota composition.
Radiocarbon and uranium-series ages of the calcareous deposits of the Plitvice Lakes show that travertines were deposited during three warm, humid, interglacial oxygen isotope stages. According to our measurements, only calcite crystals or crystal aggregates represent reliable material for both 230Th/234U and 234U/238/U dating. Compact old travertine in the form of sandstone is less reliable; it can be dated by both methods provided that its detrital contamination is not significant, demonstrated by very low 14C activity (< 1.5–2.0 pMC) and a high 230Th/232Th ratio. Old porous travertine contaminated with recent carbonates and Th-bearing clay (pMC > 5, 230Th/232Th < 5) gives erroneous results by both methods. Stage 1 (Holocene) deposition is shown primarily by 14C dating corroborated by sedimentological and palynologic studies as well as by both 230Th/234U and 234U/238U disequilibrium methods. The intensive growth of travertine barriers coincided with significant climate warming in the Holocene. Stage 5 deposition is confirmed by the 230Th/234U dating of crystalline calcite aggregates embedded in the travertine matrix and by concordant 230Th/234U and 234U/238U ages, assuming that the 234U/238U activity ratio of 1.88 observed in modern streams and in Holocene deposits can be extended to past epochs. The travertine deposition period was very short, peaking ca. 120 ± 10 ka bp. Stage 11 deposition is indicated by 234U/238U dating only, the period being within the 234U decay range, but not that of 230Th. Stage 11 travertine was deposited ca. 420 ± 50 ka bp. We did not find travertine samples with U-series ages indicating a growth period during relatively warm Stages 7 and 9; due to the scarcity of old travertine outcrops, these and possibly other stages cannot be excluded on the basis of presented data. All of these isotopic dating results concur with the field relation of the travertine complex of the Plitvice Lakes.
We present a detailed depth-sensitive study of the evolution in correlated electron behavior from the surface of the prototypical correlated oxide, SrxCa1-xVO3, to its bulk. Photoemission measurements of varying surface sensitivity are employed to directly compare both the spectral weight and energetics of the correlated electron features, and resonant soft x-ray emission spectroscopy is used as a bulk-sensitive reference. The surface component, which still contributes significantly to photoemission at 2.2 keV, is characterized by a transfer of spectral weight into the incoherent lower Hubbard band and the corresponding shift of these states towards lower binding energy.
Feldman, Radulović, Hegab, and Radulović (2012) established the genus Cooperithyris for an upper Bathonian terebratulid brachiopod from Gebel Engabashi, northern Sinai, based on the type species C. circularis Feldman, Radulović, Hegab, and Radulović, 2012. Recently, Professor Fernando Alvarez, (Departamento de Geologia, Universidad de Oviedo, Oviedo, Spain) informed us of the existence of the homonym Cooperithyris Tchorszevsky, 1988, from the Pliensbachian–Toarcian of the Transcaucasus. In accordance with the International Code of Zoological Nomenclature (ICZN 1999, articles 53 and 60), we herein propose the replacement name, Sinaithyris, for the junior homonym. The new name is in reference to the Sinai Peninsula on which Gebel Engabashi is located and from which the specimens were collected.
Anthracycline chemotherapeutic agents carry the well-recognised risk of cardiotoxicity. Previous methods to evaluate cardiac function are useful, but have significant limitations. We sought to determine the left ventricular strain and strain rate of paediatric cancer patients with normal fractional shortening treated with anthracyclines using the latest ultrasound feature-tracking technology.
Patients and methods
Echocardiograms on cancer patients before anthracycline exposure and following completion of treatment were retrospectively analysed using Velocity Vector Imaging software in the circumferential and longitudinal planes. The same analysis was performed on matched controls. Only patients with a fractional shortening ≥28% were included.
In all, 71 patients were identified with an age at diagnosis of 10.5 ± 4.7 years. The time from diagnosis to follow-up was 3.9 ± 4.0 years and the cumulative anthracycline dose was 356 ± 106 mg/m2. Following anthracycline exposure, paediatric cancer patients had a higher heart rate and a lower longitudinal strain, longitudinal diastolic strain rate, circumferential strain, and circumferential systolic and diastolic strain rate when compared with controls. Diastolic strain rate showed the greatest percent difference following anthracycline exposure versus controls.
Despite having a normal fractional shortening, children exposed to anthracyclines have subclinical derangement of their left ventricular deformation as measured by decreases in strain and strain rate in both the circumferential and longitudinal axis. In particular, there was a profound decrease in diastolic strain rate following anthracycline exposure compared with controls. Whether the decline of strain or strain rate can predict future risk of developing cardiomyopathy requires further investigation.
Cryptosporidium is a zoonotic protozoan parasite with public health importance worldwide. The objectives of this study were to (1) conduct a meta-analysis of published literature for oocyst shedding and diarrhoea outcomes, and (2) develop recommendations for standardization of experimental dose–response studies. Results showed that for the outcome of oocyst shedding in faeces, the covariates ‘experimental species’, ‘immunosuppression’, ‘oocyst dose’ and ‘oocyst dose’ × ‘age’ were all significant (P ⩽ 0·05). This study suggests that exposing mice, piglets, or ruminants, and using immunosuppressed experimental hosts, is more likely to result in oocyst shedding. For the outcome of diarrhoea in experimentally infected animal species, the key covariates ‘experimental species’, ‘age’ and ‘immunosuppression’ were significant (P ⩽ 0·2). Therefore, based on the results of this meta-analysis, these variables should be carefully reported and considered when designing experimental dose–response studies. Additionally, detection of possible publication bias highlights the need to publish additional studies that convey statistically non-significant as well as significant results in the future.
A brachiopod fauna of late Bathonian age recovered from the Kehailia Formation from Gebel Engabashi in northern Sinai consists of six species (two rhynchonellids and four terebratulids) referred to six genera, of which one genus and two species are new: Globirhynchia sphaerica (Cooper, 1989) new combination, Daghanirhynchia angulocostata Cooper, 1989, Ectyphoria sinaiensis new species, Cooperithyris circularis new genus and species, and new material: Avonothyris species A, and Ptyctothyris species A. The brachiopods described herein comprise a fauna located at the northern part of the Indo–African Faunal Realm within the Jurassic Ethiopian Province. They extend the geographic distribution of those taxa that show great affinity with the Jurassic brachiopod fauna of Saudi Arabia described by Cooper (1989). Differentiation of the endemic faunas that is so characteristic of many of these Ethiopian Province faunas is becoming more well-defined.
Nanoindentation was used to assess the mechanical properties of lamellar and interlamellar tissue in dehydrated rabbit cancellous bone. The effects of surface roughness and maximum nanoindentation load on the measured mechanical properties were examined in two samples of differing surface roughness using maximum loads ranging from 250-3000 μN. As the ratio of indentation depth to surface roughness decreased below approximately 3:1, the variability in material properties increased substantially. At low loads, the indentation modulus of the lamellar bone was approximately 20% greater than that of the interlamellar bone, while at high loads the measured properties of both layers converged to an intermediate value. Relatively shallow indentations made on smooth surfaces revealed significant differences in the properties of lamellar and interlamellar bone that are consistent with microstructural observations of lamellar bone as more mineralized than interlamellar bone.
The use of band-edge reflection spectroscopy (BRS) to determine the substrate temperature during MBE is reviewed. Data are presented for Si, GaAs, InP and CdZnTe substrates, and the use of BRS during the growth of ZnTe on Si is demonstrated. We discuss complications that arise due to optical interference in the epitaxial layers, and methods to compensate for the effects of interference are described.
Samples of Alloy 22 were tested in solutions containing various anions in order to determine their effect on the corrosion of the alloy. It was found that Alloy 22 is relatively corrosion resistant in HCl and HNO3 at pH 1 and 160°C (general corrosion rates on the order of 10 μm/year), but more susceptible to phosphoric acid, especially under reducing conditions. The presence of fluoride raised the corrosion rate of Alloy 22 to the order 1 mm/year at pH 1, and fluoride is still active towards Alloy 22 at pH levels as high as 3.5. Samples tested in solutions of 1000xJ13 in which the pH was altered during testing showed an increase in corrosion rate over solutions of constant pH. Preliminary electrochemical tests suggest that nitrate may be an effective corrosion inhibitor in fluoride containing solutions, while sulfate is not.
Both concentrated and dilute simulated solutions of saturated J13 and unsaturated UZ pore water were concentrated through distillation of the solutions under atmospheric pressure. It was observed that condensed vapors from the pH of J13 waters steadily rose during the distillations to a value of 10, while the pH of UZ waters remained steady until 90% of the volume of the solution had been distilled, after which the pH of the condensed vapors dropped precipitously, often below 1. Residual solutions analyzed when most of the solution had been distilled away were also found to be extremely acidic. The temperature of these residual solutions was around 144°C due to their high solute content causing boiling point elevation. All experiments were performed with the condenser open to ambient air at atmospheric pressure. The pH drop during the distillation of UZ water is attributed largely to the presence of large amounts of magnesium. Specimens of Alloy 22 tested in the residual solutions of at their boiling temperature (around 144°C) showed significant rates of general corrosion over a broad range, often approaching 1 mm/year. Similarly high corrosion rates were also observed in tests on Alloy 22 specimens in condensates obtained during the late stages of the distillation. These tests were performed either in situ at 75–80°C using a Soxhlet extractor, or in separate pressure vessels at temperatures between 90 and 130°C.