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Driving in persons with dementia poses risks that must be counterbalanced with the importance of the care for autonomy and mobility. Physicians often find substantial challenges in the assessment and reporting of driving safety for persons with dementia. This paper describes a driving in dementia decision tool (DD-DT) developed to aid physicians in deciding when to report older drivers with either mild dementia or mild cognitive impairment to local transportation administrators.
A multi-faceted, computerized decision support tool was developed, using a systematic literature and guideline review, expert opinion from an earlier Delphi study, as well as qualitative interviews and focus groups with physicians, caregivers of former drivers with dementia, and transportation administrators. The tool integrates inputs from the physician-user about the patient's clinical and driving history as well as cognitive findings, and it produces a recommendation for reporting to transportation administrators. This recommendation is translated into a customized reporting form for the transportation authority, if applicable, and additional resources are provided for the patient and caregiver.
An innovative approach was needed to develop the DD-DT. The literature and guideline review confirmed the algorithm derived from the earlier Delphi study, and barriers identified in the qualitative research were incorporated into the design of the tool.
The Southern Hemisphere VLBI Experiment (SHEVE) program is aimed at producing high-resolution images of southern radio sources. The radio telescopes of the present SHEVE array are described below and some recent results presented.
We report ultraviolet and optical spectra of IE 0102-7219, the oxygen-rich supernova remnant in the Small Magellanic Cloud. The UV data contain strong lines of oxygen, carbon, neon, and magnesium. OI recombination lines in the optical and UV permit the relative line intensities to be determined from 1200Å to 1 micron. Models assuming shock excitation and X-ray photoionization have been calculated and compared with the observations.
The asphalt deposits of Rancho La Brea are well known for preserving a prolific and diverse Late Pleistocene fauna. However, little taphonomic research has been done on these collections. To better understand the formation of this impressive assemblage, a taphonomic study of the bones of the large mammals from one asphalt deposit, Pit 91, was carried out, and results are presented here. The predominance of carnivore specimens in the Rancho La Brea deposits has long been explained by a scenario in which a prey animal was trapped in asphalt and attracted large numbers of carnivores who became trapped in turn. Hypotheses generated from this scenario were tested by collecting taphonomic data on over 18,000 specimens. Weathering data indicate that elements were deposited fairly rapidly. However, patterns of skeletal part representation for the seven most common species demonstrate that complete skeletons are not present. Water transport is ruled out as the primary process responsible for removing skeletal elements based on abrasion data. Instead, the feeding activity of carnivores (ravaging) appears to have been an important factor in the formation of the assemblage.
The 30 Doradus nebula is the brightest H II region in the local group. Radio continuum and Radio recombination line observations indicate that it is photoionized by the equivalent of ∼100 05 stars. Observations of the central object R136 made at low and high spectral resolution with the IUE reveal a peculiar hot object with a massive stellar wind. An outflow speed of 3500 kilometers per second and a temperature of approximately 60,000 K are indicated by the spectra. The bulk of the observed ultraviolet radiation must come from R136a, the brightest and bluest component of R136. Its absolute visual magnitude and observed temperature imply a luminosity about 108 times that of the sun. Most of the ionizations produced in 30 Doradus are provided by this peculiar object. If R136a is a dense cluster of very hot stars, about 30 stars of classes 03 and WN3 exist in a region estimated to have a diameter of less than 0.1 parsec. This is inconsistent with the ultraviolet line spectrum and the evidence for optical variability. An alternative interpretation of the observations is that the radiation from R136a is dominated by a single super-luminous object with the following approximate properties: luminosity and temperature as given above, a radius 100 times that of the sun, a mass 2500 times that of the sun, and a loss rate of 10−3.5 solar masses per year. Model interior calculations for hydrogen-burning stars are consistent with these parameters. Such stars, however, are expected to be unstable, and this may account for the massive stellar wind.
This chapter reviews evidence concerning the vital role that temporal dynamics can have in the ecology of trees and other long-lived species in the assembly and maintenance of natural communities. The research synthesised here was stimulated by a desire to determine the action of temporal dynamics in nature, and its implications for the nature of competition, community structure and assembly on multiple scales and across a range of climatic conditions. For the most part, the results discussed concern tropical forests, but we think they provide strong support for a more general view that can be applied across biomes. Finally, we ask if there may be a potential role for temporal dynamics in speciation, in light of what we have learned from the tropical trees.
A field programme begun in the late ’90s in the tropical dry forest of México was consciously designed to study the coexistence of closely related species in a very speciose community, but the role of temporal dynamics had not been suspected and its finding was serendipitous. With centuries-long lifespans, decades-long juvenile stages and low population turnover rates, trees are problematic candidates for demographic analyses, either observational or experimental. Unless instant death is involved, the particular hurdle with trees, as with any long-lived organism, is directly connecting any specific response in the early life of the individual with the long-term individual persistence or character of the standing population. However, trees differ from many long-lived organisms in carrying their history in their structure at both the individual and population levels. Thus, a tree population itself documents individual success over the history of the population (Parker et al. 1997, Cole et al. 2011). The distribution of a population with regard to physical conditions, size and age structure and relative to other woody species all contain information on the ecology and interactions of species (e.g. Veblen 1989, 1992, Villalba and Veblen 1998, Kelly et al. 2001) and it was the age structure of populations that revealed the action of temporal dynamics at Chamela Biological Station.
An enormous effort is underway worldwide to attempt to detect gravitational waves. If successful, this will open a new frontier in astronomy. An essential portion of this effort is being carried out in Australia by the Australian Consortium for Interferometric Gravitational Astronomy (ACIGA), with research teams working at the Australia National University, University of Western Australia, and University of Adelaide involving scientists and students representing many more institutions and nations. ACIGA is developing ultrastable high-power continuous-wave lasers for the next generation interferometric gravity wave detectors; researching the problems associated with high optical power in resonant cavities; opening frontiers in advanced interferometry configurations, quantum optics, and signal extraction; and is the world's leader in high-performance vibration isolation and suspension design. ACIGA has also been active in theoretical research and modelling of potential astronomical gravitational wave sources, and in developing data analysis detection algorithms. ACIGA has opened a research facility north of Perth, Western Australia, which will be the culmination of these efforts. This paper briefly reviews ACIGA's research activities and the prospects for gravitational wave astronomy in the southern hemisphere.
The Cygnus Loop supernova remnant serves as an excellent laboratory for the study of radiative and non-radiative shocks with speeds in the 150–450 km s−1 range. We present results on shock-excited emission and dust destruction based on Spitzer Space Telescope observations of two well-studied regions in the remnant, (i) a non-radiative shock filament along the NE limb, and (ii) the XA region, characterized by emission from bright radiative shocks.
Little information exists regarding how accurately emergency physicians (EPs) predict the probability of acute coronary syndrome (ACS). Our objective was to determine if EPs can accurately predict ACS in a prospectively identified cohort of emergency department (ED) patients who met enrolment criteria for a study of coronary computed tomographic angiography (CCTA) and were admitted for a “rule out ACS” protocol.
A prospective observational pilot study in an academic medical centre was carried out. EPs caring for patients with chest pain provided whole-number estimates of the probability of ACS after clinical review. This substudy was part of the now published Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography (ROMICAT) study, a study of CCTA and admission of patients for a rule out ACS protocol after a nondiagnostic evaluation. Predictions were grouped into probability groups based on the validated Goldman criteria. ACS was determined by an adjudication committee using American Heart Association/American College of Cardiology/European Society of Cardiology guidelines.
A total of 334 predictions were obtained for a study population with a mean age of 54 (SD 12) years, 63% of whom were male. There were 35 ACS events. EPs predicted ACS better than by chance, and increasingly higher estimates were associated with a higher incidence of ACS (p = 0.0004). The percentage of patients with ACS was 0%, 6%, 7%, and 17%, respectively, for very low, low, intermediate, and high probability groups. EPs' estimates had a sensitivity of 63% using a > 20% probability of ACS to define a positive test. Lowering this threshold to > 7% to define a test as positive increased the sensitivity of physician estimates to 89% but lowered specificity from 65% to 24%
Our data suggest that for a selected ED cohort meeting eligibility criteria for a study of CCTA, EPs predict ACS better than by chance, with an increasing proportion of patients proving to have ACS with increasing probability estimates. Lowering the estimate threshold does not result in an overall sensitivity level that is sufficient to send patients home from the ED and is associated with a poor specificity.
Background: Proficient delivery of motivational interviewing (MI) is often determined by global rating of relational elements or cumulative tallies of technical elements. Yet limited empirical evidence exists to clarify how relational and technical elements are associated, or if rates of skill indices and their constituent technical elements vary within a clinical encounter. Aims: This study sought to document temporal variance in rates of MI skill indices and their constituent technical elements during brief clinical encounters with a standardized patient wherein delivery was “MI-proficient”, and to distinguish those temporal patterns from those observed in encounters with “MI-inconsistent” delivery. Method: Data were accessed from a large MI training trial wherein relational and technical elements of MI delivery were scored for 503 recordings of a simulated 20-minute clinical encounter. Notably, independent raters tallied technical elements in 5-minute segments, allowing evaluation of potential variance among the encounter's quartile intervals. Global ratings of MI spirit identified subsets of recordings with MI-proficient (n = 49) and MI-inconsistent (n = 43) delivery for stratified analyses. Results: Analyses contrast temporal trajectories of technical aspects of MI-proficient and MI-inconsistent delivery, with the former characterized by: 1) elicitation and reflective listening as primary opening strategies; 2) increased depth of reflective listening as a predominant strategy in subsequent, focused therapeutic discussion; and 3) increased use of elicitation and information provision in change planning as the encounter approached conclusion. Conclusions: Findings are generally consistent with seminal descriptions of MI (Miller and Rollnick, 1991, 2002), and document temporal aspects of skilful MI delivery in brief encounters.
In this study, we used farm-level data from a university feed-out program to evaluate how the value of feeder cattle ultimately realized through finishing and grid pricing differs from their market value at public auction. Consistent with the theory of factor price disparity, results indicate that significant risk premiums exist in the feeder cattle market. Producers of cattle with known feedlot performance, carcass potential, or both might be better off retaining ownership of their calves or marketing them in a way that communicates the information that is known about their potential performance directly to the buyer.
Woody plant herbicide screening techniques were evaluated to expedite the screening process and decrease amounts of herbicide active ingredient required. Rapid greenhouse screening of woody plant seedlings was performed in less than 6 months, and rapid seed screening was performed in less than 20 days. A traditional field screen, requiring 10 months from application to final evaluation, was performed for comparison and regression modeling purposes. Imazapyr and triclopyr were used as test chemicals and linear regressions were generated to predict traditional field screen results from rapid screens. Significant regressions were produced that predicted field responses of loblolly pine, sweetgum, and yellow-poplar with the use of both herbicides and either rapid screening technique. This indicated that rapid screening techniques could determine herbicide efficacy and/or species spectrum in much less time with significantly less herbicide. Rapid greenhouse screens of triclopyr produced more statistically significant regressions than those using imazapyr. Rapid seed screens could estimate species spectrum within 5 days after treatment. These results indicate that rapid greenhouse screen and rapid seed screen techniques can provide woody plant herbicide developers initial efficacy and spectrum of control data in a cost- and-time effective manner.