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Anecdotal evidence suggests the use of bolus tube feeding is increasing in 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 10 centres across the UK collected data on all adult HETF patients on the dietetic caseload receiving bolus tube feeding, (n=604, 60% male, age 58years). 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 (4.1years tube feeding, 3.5years 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 31years) 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 meal times. Importantly, oral nutritional supplements (ONS) were used for bolus feeding in 85% of patients, with 51% of these being compact-style ONS (2.4kcal/ml, 125ml). This survey shows that bolus tube feeding is common amongst 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.
This article reanalyzes petroglyphs from the Red Bird River Shelter (15CY52), a small sandstone shelter in Kentucky. In 2009–2013, it was claimed that some of the carvings at the site represented the earliest known examples of Cherokee Syllabary writing, dating to the first two decades of the nineteenth century. It was also suggested that Sequoyah, the Cherokee artist and intellectual who invented the Cherokee Syllabary in the early nineteenth century, had made these petroglyph versions during a visit to see his white paternal family living in Kentucky. Our reanalysis categorically contests this interpretation. We do not see Cherokee Syllabary writing at Red Bird River Shelter. We do not believe that historical evidence supports the notion that Sequoyah had white relatives in Kentucky whom he visited there at the time required for him to have authored those petroglyphs. We also believe that this account misrepresents Sequoyah's Cherokee identity by tying him to white relatives for whom there is no historical warrant. We argue that the Red Bird River Shelter is a significant precontact petroglyph site with several panels of line-and-groove petroglyphs overlain by numerous examples of modern graffiti, but there is no Sequoyan Syllabary inscription there.
Focused electron beam-induced deposition (FEBID) is capable of producing metal-containing nanostructures with lateral resolution on the sub-nanometer scale. Practical application of this nanofabrication technique has been hindered by ligand-derived contamination from precursors developed for thermal deposition methods. Mechanistic insight into FEBID through surface science studies and gas-phase electron–molecule interactions has begun to enable the design of custom FEBID precursors. These studies have shown that precursors designed to decompose under electron irradiation can produce high-purity FEBID deposits. Herein, we highlight the progress in FEBID precursor development with several examples that incorporate this mechanism-based design approach.
Medically unexplained symptoms (MUS) are not only common and distressing, but are also typically poorly managed in general medical settings. Those suffering from these problems tend to incur significantly higher health costs than the general population. There are many effective treatments for different MUS; these are almost entirely based on cognitive-behavioural approaches. However, the wide range of treatment protocols tend to be ‘syndrome specific’. As such, they do not generalise well in terms of training and application, making them expensive and difficult to disseminate, suggesting the desirability of developing a transdiagnostic approach. The general basis of such a CBT grounded transdiagnostic approach is considered, and the particular need to incorporate cognitive elements of both anxiety or health anxiety (threat) and depression (loss) is highlighted. Key empirically grounded and evidence-based processes (both specific and general) previously identified as underpinning the maintenance of MUS are delineated. The way in which these can be combined in a transdiagnostic model that accounts for most MUS presentations is presented and linked to a formulation-driven transdiagnostic treatment strategy, which is described. However, the need to take more syndrome-specific issues into account in treatment is identified, suggesting that the optimum treatment may be a hybrid transdiagnostic/specific approach with formulation, shared understanding, belief change strategies, and behavioural experiments at its heart. The generalisation of such approaches to psychological problems occurring in the context of ‘long-term conditions’ is identified as a further important development that is now within reach.
Do street-level bureaucrats discriminate in the services they provide to constituents? We use a field experiment to measure differential information provision about voting by local election administrators in the United States. We contact over 7,000 election officials in 48 states who are responsible for providing information to voters and implementing voter ID laws. We find that officials provide different information to potential voters of different putative ethnicities. Emails sent from Latino aliases are significantly less likely to receive any response from local election officials than non-Latino white aliases and receive responses of lower quality. This raises concerns about the effect of voter ID laws on access to the franchise and about bias in the provision of services by local bureaucrats more generally.
There is increasing emphasis on the need for effective ways of sharing knowledge to enhance environmental management and sustainability. Knowledge exchange (KE) are processes that generate, share and/or use knowledge through various methods appropriate to the context, purpose, and participants involved. KE includes concepts such as sharing, generation, coproduction, comanagement, and brokerage of knowledge. This paper elicits the expert knowledge of academics involved in research and practice of KE from different disciplines and backgrounds to review research themes, identify gaps and questions, and develop a research agenda for furthering understanding about KE. Results include 80 research questions prefaced by a review of research themes. Key conclusions are: (1) there is a diverse range of questions relating to KE that require attention; (2) there is a particular need for research on understanding the process of KE and how KE can be evaluated; and (3) given the strong interdependency of research questions, an integrated approach to understanding KE is required. To improve understanding of KE, action research methodologies and embedding evaluation as a normal part of KE research and practice need to be encouraged. This will foster more adaptive approaches to learning about KE and enhance effectiveness of environmental management.
Protein-permeable dense (non-porous) urethane membranes have been evaluated for in vitro cell culture, and in vivo cell encapsulation. Polyurethane membranes were designed to exhibit permeability to proteins, gases, and nutrients without the existence of pores. The membranes are non-cytotoxic, angiogenic, and permeable to gases, nutrients, secretagogues and cell products via purely concentration-driven transport. Non-anchorage and anchorage dependent cells were grown encapsulated within the membrane and with the membrane as a growth substrate. Several non-anchorage dependent cell types proliferated within the membrane both in-vitro and in-vivo. Anchorage-dependent cells were grown on the membranes as a substrate. Encapsulated cells have been maintained in culture for up to six months with nutrients supplied only by the external media. Immuno-isolation has been demonstrated with cells implanted into murine hosts. Explants of membrane encapsulated cells exhibited a high degree of vascularization, with little or no fibrous tissue. The ability to support cell growth and function, and the ability to protect xenogenic cells from immunologic rejection suggest that the membranes would be useful in the construction of hybrid artificial organs, devices for cell transplantation, and substrates for cell and tissue culture.
Allan Hills nunatak, south Victoria Land, Antarctica, exposes an exceptional example of a shallow depth (< 500 m) intrusive complex formed during the evolution of the Ferrar large igneous province (LIP). Dyke distribution, geometries and relationships allow reconstruction of its history and mechanics of intrusion. Sills interconnect across host sedimentary layers, and a swarm of parallel inclined dolerite sheets is intersected by a radiating dyke-array associated with remnants of a phreatomagmatic vent, where the dolerite is locally quenched and mixed to form peperite. Intrusion geometries, and lack of dominant rift-related structures in the country rock indicate that magma overpressure, local stresses between mutually interacting dykes and vertical variations of host rock mechanical properties controlled the intrusive process throughout the thick and otherwise undeformed pile of sedimentary rocks (Victoria Group). Dolerite sills connected to one another by inclined sheets are inferred to record the preferred mode of propagation for magma-carrying cracks that represent the shallow portions of the Ferrar LIP plumbing system.
The chromosome 8q24 region (specifically, 8q24.21.a) is known to harbor variants associated with risk of breast, colorectal, prostate, and bladder cancers. In 2008, variants rs10505477 and rs6983267 in this region were associated with increased risk of invasive ovarian cancer (p < 0.01); however, three subsequent ovarian cancer reports of 8q24 variants were null. Here, we used a multi-site case-control study of 940 ovarian cancer cases and 1,041 controls to evaluate associations between these and other single-nucleotide polymorphisms (SNPs) in this 8q24 region, as well as in the 9p24 colorectal cancer associated-region (specifically, 9p24.1.b). A total of 35 SNPs from previous reports and additional tagging SNPs were assessed using an Illumina GoldenGate array and analyzed using logistic regression models, adjusting for population structure and other potential confounders. We observed no association between genotypes and risk of ovarian cancer considering all cases, invasive cases, or invasive serous cases. For example, at 8q24 SNPs rs10505477 and rs6983267, analyses yielded per-allele invasive cancer odds ratios of 0.95 (95% confidence interval (CI) 0.82–1.09, p trend 0.46) and 0.97 (95% CI 0.84–1.12, p trend 0.69), respectively. Analyses using an approach identical to that of the first positive 8q24 report also yielded no association with risk of ovarian cancer. In the 9p24 region, no SNPs were associated with risk of ovarian cancer overall or with invasive or invasive serous disease (all p values > 0.10). These results indicate that the SNPs studied here are not related to risk of this gynecologic malignancy and that the site-specific nature of 8q24.21.a associations may not include ovarian cancer.
Disturbances of visual perception frequently accompany neurodegenerative disorders but have been little studied in Huntington's disease (HD) gene carriers. We used psychophysical tests to assess visual perception among individuals in the prediagnostic and early stages of HD. The sample comprised four groups, which included 201 nongene carriers (NG), 32 prediagnostic gene carriers with minimal neurological abnormalities (PD1); 20 prediagnostic gene carriers with moderate neurological abnormalities (PD2), and 36 gene carriers with diagnosed HD. Contrast sensitivity for stationary and moving sinusoidal gratings, and tests of form and motion discrimination, were used to probe different visual pathways. Patients with HD showed impaired contrast sensitivity for moving gratings. For one of the three contrast sensitivity tests, the prediagnostic gene carriers with greater neurological abnormality (PD2) also had impaired performance as compared with NG. These findings suggest that early stage HD disrupts visual functions associated with the magnocellular pathway. However, these changes are only observed in individuals diagnosed with HD or who are in the more symptomatic stages of prediagnostic HD. (JINS, 2008, 14, 446–453.)
Reflexive Democracy: Political Equality and the Welfare
State. By Kevin Olson. Cambridge, MA: MIT Press, 2006. 288p.
Recent work on the welfare state has largely focused on the role of
welfare programs in state economies—their redistributive functions
and their role in managing incentives for work. Reflexive
Democracy marks a much-needed shift in focus, offering an analysis
and then a reconstruction of the relationship between welfare programs and
The distinction between the deserving and the undeserving poor has always been critical in the context of American poverty policy. Recent work by Martin Gilens (1999), Ange-Marie Hancock (2004), and Deborah Ward (2005) has demonstrated the ways in which this distinction has been racialized. Such work illustrates the promise of an intersectional approach for fields ranging from the study of public opinion to historical institutionalism and contemporary policy analysis. Indeed, at this point in our disciplinary history, it is difficult to imagine how research in any of these areas can be done in either an empirically satisfying or normatively responsible way without attention to intersectionality.
A prospective study was undertaken to examine the clinical presentation of peritonitis in patients maintained on intermittent peritoneal dialysis and to determine the value of qualitative and quantitative dialysate cultures, gram stain, neutrophil counts, and a semiquantitative leukocyte test strip for case detection. Seven cases of peritonitis developed among 30 patients who underwent 553 dialyses. In most cases, neutrophil counts, cultures, and leukocyte test strip determinations were done within 48 hours prior to the clinical onset of peritonitis and in all instances failed to provide clues for incipient infection. Peritonitis was associated with a dialysate neutrophil count of >500/mm3 and leukocyte test strips were highly sensitive and specific for the detection of this quantity of neutrophils. A total of 16 dialysate cultures was positive in asymptomatic patients who did not have peritonitis. None of these patients subsequently developed peritonitis with the same organism. Dialysate gram stains, cultures, neutrophil counts or leukocyte test strips did not provide an early diagnosis of peritonitis and their use in the absence of symptoms is therefore not recommended.
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