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In this article we engage in a critical examination of how local authority Housing Solutions staff, newly placed centre stage in preventing homelessness amongst prison leavers in Wales, understand and go about their work. Drawing on Carlen’s concept of ‘imaginary penalities’ and Ugelvik’s notion of ‘legitimation work’ we suggest practice with this group can be ritualistic and underpinned by a focus on prison leavers’ responsibilities over their rights, and public protection over promoting resettlement. In response we advocate for less-punitive justice and housing policies, underpinned by the right to permanent housing for all prison leavers and wherein stable accommodation is understood as the starting point for resettlement. The analysis presented in this article provides insights to how homelessness policies could play out in jurisdictions where more joint working between housing and criminal justice agencies are being pursued and/or preventative approaches to managing homelessness are being considered.
This study examines the potential health-related impact of recent versus lifetime experiences of sexual orientation discrimination among older Australian lesbian women and gay men. In a nationwide survey, a sample of 243 lesbian women and 513 gay men aged 60 years and over reported on their experiences of sexual orientation discrimination and their mental and physical health, including psychological distress, positive mental health and self-rated health. Among both lesbian women and gay men, recent discrimination uniquely predicted lower positive mental health after adjusting for experiences of discrimination across the lifetime and socio-demographic variables. In addition, recent discrimination uniquely predicted higher psychological distress among gay men. Experiences of discrimination over the lifetime further predicted higher psychological distress and poorer self-rated health among gay men after adjusting for recent experiences of discrimination and socio-demographic variables. However, there were no associations between lifetime discrimination and any of the outcome variables among lesbian women. Overall, recent and lifetime experiences of sexual orientation discrimination were related to mental and physical health in different ways, especially among the men. These findings have potential implications for policy/practice, and suggest that distinguishing between recent and lifetime experiences of discrimination may be useful when assessing potential health-related impacts of sexual orientation discrimination among older lesbian women and gay men, while also taking account of differences between these two groups.
Electron and proton microprobes, along with electron backscatter diffraction (EBSD) analysis were used to study the microstructure of the contemporary Al–Cu–Li alloy AA2099-T8. In electron probe microanalysis, wavelength and energy dispersive X-ray spectrometry were used in parallel with soft X-ray emission spectroscopy (SXES) to characterize the microstructure of AA2099-T8. The electron microprobe was able to identify five unique compositions for constituent intermetallic (IM) particles containing combinations of Al, Cu, Fe, Mn, and Zn. A sixth IM type was found to be rich in Ti and B (suggesting TiB2), and a seventh IM type contained Si. EBSD patterns for the five constituent IM particles containing Al, Cu, Fe, Mn, and Zn indicated that they were isomorphous with four phases in the 2xxx series aluminium alloys including Al6(Fe, Mn), Al13(Fe, Mn)4 (two slightly different compositions), Al37Cu2Fe12 and Al7Cu2Fe. SXES revealed that Li was present in some constituent IM particles. Al SXES mapping revealed an Al-enriched (i.e., Cu, Li-depleted) zone in the grain boundary network. From the EBSD analysis, the kernel average misorientation map showed higher levels of localized misorientation in this region, suggesting greater deformation or stored energy. Proton-induced X-ray emission revealed banding of the TiB2 IM particles and Cu inter-band enrichment.
Three models are evaluated for restoring basement rocks coring tectonic windows (Window-Basement) in the Scandinavian Caledonides; parautochthonous (Model I) and allochthonous (models II/III), with initial imbrication of the Window-Basement post-dating or pre-dating, respectively, that in the external imbricate zone (Lower Allochthon). In Model I, the Window-Basement comes from the eastern margin of the basin now imbricated into the Lower Allochthon, while in models II/III it comes from the western margin. In Model II, the Window-Basement formed a basement-high between Tonian and Cryogenian sediments imbricated into the Middle and Lower allochthons; in Model III deposition of the Lower Allochthon sediments commenced in Ediacaran times. Balanced cross-sections and branch-line restorations of four transects (Finnmark–Troms, Västerbotten–Nordland, Jämtland–Trøndelag, Telemark–Møre og Romsdal) show similar restored lengths for the models in two transects and longer restorations for models II/III in the other transects. Model I can result in c. 280 km wide gaps in the restored Lower Allochthon, evidence for which is not seen in the sedimentology. The presence of <3 km thick alluvial-fan deposits at the base of the Middle Allochthon indicates proximal, rapidly uplifting basement during Tonian–Cryogenian periods, taken as the origin of the Window-Basement during thrusting in models II/III. Model I requires multiple changes in thrusting-direction and predicts major thrusts or back-thrusts, currently unrecognized, separating parts of the Lower Allochthon; neither are required in models II/III. Metamorphic data are consistent with models II/III. Despite considerable along-strike structural variability in the external Scandinavian Caledonides, models II/III are preferred for the restoration of the Window-Basement.
There is a growing body of literature describing the characteristics of patients who plan for the end of life, but little research has examined how caregivers influence patients' advance care planning (ACP). The purpose of this study was to examine how patient and caregiver characteristics are associated with advance directive (AD) completion among patients diagnosed with a terminal illness. We defined AD completion as having completed a living will and/or identified a healthcare power of attorney.
A convenience sample of 206 caregiver–patient dyads was included in the study. All patients were diagnosed with an advanced life-limiting illness. Trained research nurses administered surveys to collect information on patient and caregiver demographics (i.e., age, sex, race, education, marital status, and individual annual income) and patients' diagnoses and completion of AD. Multivariate logistic regression was employed to model predictors for patients' AD completion.
Over half of our patient sample (59%) completed an AD. Patients who were older, diagnosed with amyotrophic lateral sclerosis, and with a caregiver who was Caucasian or declined to report an income level were more likely to have an AD in place.
Significance of results:
Our results suggest that both patient and caregiver characteristics may influence patients' decisions to complete an AD at the end of life. When possible, caregivers should be included in advance care planning for patients who are terminally ill.
We describe a hybrid pixel array detector (electron microscope pixel array detector, or EMPAD) adapted for use in electron microscope applications, especially as a universal detector for scanning transmission electron microscopy. The 128×128 pixel detector consists of a 500 µm thick silicon diode array bump-bonded pixel-by-pixel to an application-specific integrated circuit. The in-pixel circuitry provides a 1,000,000:1 dynamic range within a single frame, allowing the direct electron beam to be imaged while still maintaining single electron sensitivity. A 1.1 kHz framing rate enables rapid data collection and minimizes sample drift distortions while scanning. By capturing the entire unsaturated diffraction pattern in scanning mode, one can simultaneously capture bright field, dark field, and phase contrast information, as well as being able to analyze the full scattering distribution, allowing true center of mass imaging. The scattering is recorded on an absolute scale, so that information such as local sample thickness can be directly determined. This paper describes the detector architecture, data acquisition system, and preliminary results from experiments with 80–200 keV electron beams.
Orchid seeds are among the smallest seeds in nature and they are naturally rich in fatty acids. However, the fatty acid composition of orchid seeds has not been investigated because the sample masses utilized for widely used methods for fatty acid profiling would generally require prohibitively large numbers (i.e. 10,000s) of seeds. The present work aimed to develop a method for fatty acid analysis using gas chromatography–mass spectrometry on small quantities (mg) of seeds. The method was developed using the seeds of two species, Dactylorhiza fuchsii, a temperate terrestrial, and Grammatophyllum speciosum, a tropical epiphyte. A range of sample masses was tested to determine the minimum mass required to achieve reliable fatty acid composition data. A direct transesterification method was used, which did not require extraction of fatty acids from seeds prior to analysis, and the effects of seed processing (crushed versus intact seeds) and incubation time in toluene on fatty acid yield were tested. Stable fatty acid profiles were obtained using as little as 10 mg of seeds. Neither crushing the seeds nor extending the toluene incubation step had much effect on the fatty acid yield. The simple direct transesterification method presented will enable the fatty acid composition of orchid seeds, and possibly other small seeds, to be determined reliably for studies into seed development, storage and germination.
Loneliness is a debilitating condition with particular negative health effects, including psychological distress. While the vast majority of older people do not experience significant degrees of loneliness, a minority do and there are some reports that this is even greater among lesbian, gay, bisexual, transgender and intersex (LGBTI) seniors. This article examines the experience of loneliness and social support among LGBTI people aged 50 and over living in New South Wales, Australia. It also explores their interest in participating in social and health-promoting activities. Findings from an online survey delivered to 312 people are reported. Loneliness was associated with living alone, not being in a relationship, higher psychological distress and lower mental health. Nonetheless, most respondents reported that they are able to gain support from both biological family and friends if they need it in a crisis. The social and health-promoting activities that were most preferred among all respondents were fitness groups, walking groups, swimming and meditation. Those who experienced the greatest degree of loneliness were much more likely than those who were less lonely to want to participate in social and health-promoting activities with other LGBTI people. The findings indicate scope for community organisations to develop targeted interventions, such as those social and health-promoting activities most preferred by the participants of this study.
Determining how clinicians should meet their professional obligations to treat patients with Ebola virus disease in nonepidemic settings necessitates considering measures to minimize risks to clinicians, the context of care, and fairness. Minimizing risks includes providing appropriate equipment and training, implementing strategies for reducing exposure to infectious material, identifying a small number of centers to provide care, and determining which risky procedures should be used when they pose minimal likelihood of appreciable clinical benefit. Factors associated with the clinical environment, such as the local prevalence of the disease, the nature of the setting, and the availability of effective treatment, are also relevant to obligations to treat. Fairness demands that the best possible medical care be provided for health care professionals who become infected and that the rights and interests of relevant stakeholders be addressed through policy-making processes. Going forward it will be essential to learn from current approaches and to modify them based on data. (Disaster Med Public Health Preparedness. 2015;9:527–530)
Transcranial magnetic stimulation (TMS) is an effective and safe therapy for major depressive disorder (MDD). This study assessed quality of life (QOL) and functional status outcomes for depressed patients after an acute course of TMS.
Forty-two, U.S.-based, clinical TMS practice sites treated 307 outpatients with a primary diagnosis of MDD and persistent symptoms despite prior adequate antidepressant pharmacotherapy. Treatment parameters were based on individual clinical considerations and followed the labeled procedures for use of the approved TMS device. Patient self-reported QOL outcomes included change in the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the EuroQol 5-Dimensions (EQ-5D) ratings from baseline to end of the acute treatment phase.
Statistically significant improvement in functional status on a broad range of mental health and physical health domains was observed on the SF-36 following acute TMS treatment. Similarly, statistically significant improvement in patient-reported QOL was observed on all domains of the EQ-5D and on the General Health Perception and Health Index scores. Improvement on these measures was observed across the entire range of baseline depression symptom severity.
These data confirm that TMS is effective in the acute treatment of MDD in routine clinical practice settings. This symptom benefit is accompanied by statistically and clinically meaningful improvements in patient-reported QOL and functional status outcomes.
High levels of homocysteine have been associated with increased risk for dementia although results have been inconsistent. There are no reported studies from the developing world including Africa.
In this longitudinal study of two community-dwelling cohorts of elderly Yoruba and African Americans, levels of homocysteine, vitamin B12 and folate were measured from blood samples taken in 2001. These levels were compared in two groups, participants who developed incident dementia in the follow-up until 2009 (59 Yoruba and 101 African Americans) and participants who were diagnosed as cognitively normal or in the good performance category at their last follow-up (760 Yoruba and 811 African Americans). Homocysteine levels were divided into quartiles for each site.
After adjusting for age, education, possession of ApoE, smoking, and time of enrollment the higher quartiles of homocysteine were associated with a non-significant increase in dementia risk in the Yoruba (homocysteine quartile 4 vs. 1 OR: 2.19, 95% CI 0.95–5.07, p = 0.066). For the African Americans, there was a similar but non-significant relationship between higher homocysteine levels and dementia risk. There were no significant relationships between levels of vitamin B12 and folate and incident dementia in either site although folate levels were lower and vitamin B12 levers were higher in the Yoruba than in the African Americans.
Increased homocysteine levels were associated with a similar but non-significant increase in dementia risk for both Yoruba and African Americans despite significant differences in folate levels between the two sites.
With advances in therapeutics for rare, genetic and syndromic diseases, there is an increasing need for objective assessments of phenotypic endpoints. These assessments will preferentially be high precision, non-invasive, non-irradiating, and relatively inexpensive and portable. We report a case of a child with an extensive lymphatic vascular malformation of the head and neck, treated with an mammalian target of Rapamycin (mTOR) inhibitor that was assessed using 3D facial analysis. This case illustrates that this technology is prospectively a cost-effective modality for treatment monitoring, and it supports that it may also be used for novel explorations of disease biology for conditions associated with disturbances in the mTOR, and interrelated, pathways.