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Values—the motivational goals that define what is important to us—guide our decisions and actions every day. Their importance is established in a long line of research investigating their universality across countries and their evolution from childhood to adulthood. In adolescence, value structures are subject to substantial change, as life becomes increasingly social. Value change has thus far been understood to operate independently within each person. However, being embedded in various social systems, adolescents are constantly subject to social influence from peers. Thus, we introduce a framework investigating the emergence and evolution of value priorities in the dynamic context of friendship networks. Drawing on stochastic actor-oriented network models, we analyze 73 friendship networks of adolescents. Regarding the evolution of values, we find that adolescents’ value systems evolve in a continuous cycle of internal validation through the selection and enactment of goals—thereby experiencing both congruence and conflicts—and external validation through social comparison among their friends. Regarding the evolution of friendship networks, we find that demographics are more salient for the initiation of new friendships, whereas values are more relevant for the maintenance of existing friendships.
The START (STrAtegies for RelaTives) intervention reduced depressive and anxiety symptoms of family carers of relatives with dementia at home over 2 years and was cost-effective.
To assess the clinical effectiveness over 6 years and the impact on costs and care home admission.
We conducted a randomised, parallel group, superiority trial recruiting from 4 November 2009 to 8 June 2011 with 6-year follow-up (trial registration: ISCTRN 70017938). A total of 260 self-identified family carers of people with dementia were randomised 2:1 to START, an eight-session manual-based coping intervention delivered by supervised psychology graduates, or to treatment as usual (TAU). The primary outcome was affective symptoms (Hospital Anxiety and Depression Scale, total score (HADS-T)). Secondary outcomes included patient and carer service costs and care home admission.
In total, 222 (85.4%) of 173 carers randomised to START and 87 to TAU were included in the 6-year clinical efficacy analysis. Over 72 months, compared with TAU, the intervention group had improved scores on HADS-T (adjusted mean difference −2.00 points, 95% CI −3.38 to −0.63). Patient-related costs (START versus TAU, respectively: median £5759 v. £16 964 in the final year; P = 0.07) and carer-related costs (median £377 v. £274 in the final year) were not significantly different between groups nor were group differences in time until care home (intensity ratio START:TAU was 0.88, 95% CI 0.58–1.35).
START is clinically effective and this effect lasts for 6 years without increasing costs. This is the first intervention with such a long-term clinical and possible economic benefit and has potential to make a difference to individual carers.
Declarations of interest
G.L., Z.W. and C.C. are supported by the UCLH National Institute for Health Research (NIHR) Biomedical Research Centre. G.L. and P.R. were in part supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Bart's Health NHS Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Z.W. reports during the conduct of the study; personal fees from GE Healthcare, grants from GE Healthcare, grants from Lundbeck, other from GE Healthcare, outside the submitted work.
Increased intraocular pressure (IOP) in open angle glaucoma (OAG) may lead to optic nerve damage due to progressive obstruction of aqueous humor drainage. Among surgery options, trabecular micro-bypass stent (iStent®) was recently introduced. This Health Technology Assessment (HTA) aimed to assess the effectiveness and safety of iStent®, combined or not with cataract surgery, in patients with mild-to-moderate OAG.
A systematic review (SR) was performed from 2000 to August 2016. Studies reporting data at three months or more on IOP and hypotensive medication use following iStent® implant were eligible. Governmental databases on safety issues were reviewed. The project involved an interdisciplinary group of experts.
Two HTA reports, one SR, four randomized controlled trials (RCTs) and nine observational studies (OSs) were included. Compared to cataract surgery alone, implantation of iStent®combined with cataract surgery was associated with a decrease in IOP at 12 months in RCTs (-1.37 mmHg; 95 percent Confidence Interval, CI: - 2.76 to .03 mmHg, p = .055). Results from RCTs and OSs on the effect of iStent® combined or not with cataract surgery suggest also a 12-month positive effect on IOP (mean reduction: 1.5 to 9.5 mmHg) and on mean number of medications (reduction: .3 to 2.0) compared to baseline. Scattered results were found on the proportion of patients who no longer use glaucoma medications. Small sample size, short duration of follow-up, and potential conflicts of interest were among studies limitations. The most common adverse events reported were posterior capsular opacification, decrease in visual acuity, and stent obstruction or malposition.
Appraisal of the effectiveness and safety suggests that iStent® implantation combined to cataract surgery in mild-to-moderate OAG is an emerging practice. Uncertainties related to clinical benefits, safety and care organization need to be clarified before an introduction as a standard of medical practice.
Based on a single right cheliped from the Cape de Naze Formation (middle–upper Maastrichtian), Senegal, a new genus and species of hermit crab with capsulated setae is described. Paracapsulapagurus poponguinensis n. gen. n. sp. is characterized by platy, scale-like, non-spinose tubercles with setae arranged in curved rows. This is only the third record of a fossil hermit crab with capsulated setae. These are documented in detail using SEM-imaging. For the first time, capsulated setae are also figured for the Early Jurassic hermit crab Schobertella.
La très grande majorité des travaux, ancients et récents, consacrés au cris posent, souvent en d’autres termes mais cela revient au même, que la longueur est phonologique au niveau vocalique. En effet, qu’il s’agisse des ouvrages de Michelson (1939), ou de Bloomfield (1946), ou qu’il s’agisse des travaux de Lacombe (1874), de Hives (1948), de Watkins (1938), de Horden (1881), ou de Howse (1844), ou encore, des recherches de Rogers (1958), de Ellis (1962), de Mackenzie (1971), de Longacre (1957), ou de Wolfart (1973), partout l’on maintient, même si cela est souvent dit autrement, que la longueur exerce une fonction distinctive.
The monoamine oxidase A (MAOA) gene has been shown to
moderate the impact of maltreatment on antisocial behaviour. Replication
efforts have, however, yielded inconsistent results.
To investigate whether the interaction between the MAOA
gene and violence is present across the full distribution of violence or
emerges at higher levels of exposure.
Participants were 327 male members of the Québec Longitudinal Study of
Kindergarten Children. Exposure to violence comprised retrospective
reports of mother's and father's maltreatment, sexual and physical abuse.
Conduct disorder and antisocial personality symptoms were assessed in
semi-structured interviews and partner violence, property-violent crimes
and arrest were self-reported.
Non-linear interactions between the MAOA gene and
violence were detected, suggesting that the genetic moderation may come
about once a certain level of violence is experienced.
Future studies should investigate the mechanisms translating substantial
violence exposure, which could, subsequently, trigger the expression of
genetically based differences in antisocial behaviour.
From 1984 to 1986, the Computer Science and Law Research Group at The University of Quebec at Montreal conducted a socio-legal survey for the Government of Quebec on personal data banks in the private sector of Quebec's economy. The study flowed from a concern for the defence and promotion of individual rights and freedoms, which appeared to be threatened by the growth of relatively unregulated data banks. By furnishing an often confidential computerized double, sophisticated data bases can often give a better picture of individuals than they themselves could provide. Ultimately, decisions affecting individuals and social choices could be taken without any control over their conformity to rules of natural justice and democracy. With these concerns in mind, we studied both the current state of development of such data banks and the state of the law regulating them.
The objective of this work was to develop a field method for the determination of labile organic carbon in hyper-arid desert soils. Industry standard methods rely on expensive analytical equipment that are not possible to take into the field, while scientific challenges require fast turn-around of large numbers of samples in order to characterize the soils throughout this region. Here we present a method utilizing acid-hydrolysis extraction of the labile fraction of organic carbon followed by potassium permanganate oxidation, which provides a quick and inexpensive approach to investigate samples in the field. Strict reagent standardization and calibration steps within this method allowed the determination of very low levels of organic carbon in hyper-arid soils, in particular, with results similar to those determined by the alternative methods of Calcination and Pyrolysis–Gas Chromatography–Mass Spectrometry. Field testing of this protocol increased the understanding of the role of organic materials in hyper-arid environments and allowed real-time, strategic decision making for planning for more detailed laboratory-based analysis.
Surface-enhanced Raman spectroscopy (SERS) is highly dependent upon the substrate, where excitation of the localized metal surface plasmon resonance enhances the vibrational scattering signal of proximate analyte molecules. This article reviews recent progress in the fabrication of SERS substrates and the requirements for characterization of plasmonic materials as SERS platforms. We discuss bottom-up fabrication of SERS substrates and illustrate the advantages of rational control of metallic nanoparticle synthesis and assembly for hot spot creation. We also detail top-down methods, including nanosphere lithography for the preparation of tunable, highly sensitive, and robust substrates, as well as the unique benefits of tip-enhanced Raman spectroscopy for simultaneous acquisition of molecular vibrational information and high spatial resolution imaging. Finally, we discuss future prospects and challenges in SERS, including the development of surface-enhanced femtosecond stimulated Raman spectroscopy, microfluidics with SERS, creating highly reproducible substrates, and the need for reliable characterization of substrates.
An overview about the German cluster project Cool Silicon aiming at increasing the energy efficiency for semiconductors, communications, sensors and software is presented. Examples for achievements are: 1000 times reduced gate leakage in transistors using high-fc (HKMG) materials compared to conventional poly-gate (SiON) devices at the same technology node; 700 V transistors integrated in standard 0.35 μm CMOS; solar cell efficiencies above 19% at < 200 W/m2 irradiation; 0.99 power factor, 87% efficiency and 0.088 distortion factor for dc supplies; 1 ns synchronization resolution via Ethernet; database accelerators allowing 85% energy savings for servers; adaptive software yielding energy reduction of 73% for e-Commerce applications; processors and corresponding data links with 40% and 70% energy savings, respectively, by adaption of clock frequency and supply voltage in less than 20 ns; clock generator chip with tunable frequency from 83-666 MHz and 0.62-1.6 mW dc power; 90 Gb/s on-chip link over 6 mm and efficiency of 174 fJ/mm; dynamic biasing system doubling efficiency in power amplifiers; 60 GHz BiCMOS frontends with dc power to bandwidth ratio of 0.17 mW/MHz; driver assistance systems reducing energy consumption by 10% in cars
Depression is a common and costly comorbidity in dementia. There are very few data on the cost-effectiveness of antidepressants for depression in dementia and their effects on carer outcomes.
To evaluate the cost-effectiveness of sertraline and mirtazapine compared with placebo for depression in dementia.
A pragmatic, multicentre, randomised placebo-controlled trial with a parallel cost-effectiveness analysis (trial registration: ISRCTN88882979 and EudraCT 2006-000105-38). The primary cost-effectiveness analysis compared differences in treatment costs for patients receiving sertraline, mirtazapine or placebo with differences in effectiveness measured by the primary outcome, total Cornell Scale for Depression in Dementia (CSDD) score, over two time periods: 0–13 weeks and 0–39 weeks. The secondary evaluation was a cost-utility analysis using quality-adjusted life years (QALYs) computed from the Euro-Qual (EQ-5D) and societal weights over those same periods.
There were 339 participants randomised and 326 with costs data (111 placebo, 107 sertraline, 108 mirtazapine). For the primary outcome, decrease in depression, mirtazapine and sertraline were not cost-effective compared with placebo. However, examining secondary outcomes, the time spent by unpaid carers caring for participants in the mirtazapine group was almost half that for patients receiving placebo (6.74 v. 12.27 hours per week) or sertraline (6.74 v. 12.32 hours per week). Informal care costs over 39 weeks were £1510 and £1522 less for the mirtazapine group compared with placebo and sertraline respectively.
In terms of reducing depression, mirtazapine and sertraline were not cost-effective for treating depression in dementia. However, mirtazapine does appear likely to have been cost-effective if costing includes the impact on unpaid carers and with quality of life included in the outcome. Unpaid (family) carer costs were lower with mirtazapine than sertraline or placebo. This may have been mediated via the putative ability of mirtazapine to ameliorate sleep disturbances and anxiety. Given the priority and the potential value of supporting family carers of people with dementia, further research is warranted to investigate the potential of mirtazapine to help with behavioural and psychological symptoms in dementia and in supporting carers.
Although race and ethnic background are known to be important factors in the completion of advance directives, there is a dearth of literature specifically investigating the effect of race and ethnicity on advance directive completion rate after palliative care consultation (PCC).
A chart review of all patients seen by the PCC service in an academic hospital over a 9-month period was performed. Data were compiled using gender, race, ethnicity, religion, and primary diagnosis. For this study, advance directives were defined as: “Do Not Resuscitate” (DNR) and/or “Do Not Intubate” (DNI).
Of the 400 medical records reviewed, 57% of patients were female and 71.3% documented their religion as Christian. The most common documented diagnosis was cancer (39.5%). Forty-seven percent reported their race as white. White patients completed more advance directives than did nonwhite patients both before (25.67% vs. 12.68%) and after (59.36% vs. 40.84%) PCC. There was a significantly higher proportion of whites who signed an advance directive after a PCC than of nonwhites (p = 0.021); of the 139 whites who did not have an advance directive at admission, 63 signed an advance directive after a PCC compared with 186/60 nonwhites (45% vs. 32%, respectively, p = 0.021). Further analysis revealed that African Americans differed from whites in the likelihood of advance directive execution rates pre-PCC, but not post-PCC.
Significance of results:
This study demonstrates the impact of a PCC on the completion of advance directives, on both whites and nonwhites. The PCC Intervention significantly reduced differences between whites and African Americans in completing advance directives, which have been consistently documented in the end-of-life literature.
Agricultural production systems that reduce the use of in-crop herbicides
could greatly reduce risks of environmental damage and the development of
herbicide-resistant weeds. Few studies have investigated the long-term
effects of in-crop herbicide omissions on weed seedbank community size and
structure. A crop-rotation study was sampled 10 yr after a strictly annual
rotation and an annual/perennial rotation were exposed to different in-crop
herbicide omission treatments. In-crop herbicides were applied either in all
annual crops (control), omitted from oats only, or omitted from both flax
and oats. Seedbank densities were greatest when in-crop herbicides were
omitted from flax and oats, and this treatment also reduced crop yield.
Shannon-Wiener diversity differed among crops in the annual crop rotation
and among herbicide omission treatments in the perennial rotation. Herbicide
omissions changed the weed-community structure in flax and in wheat and
canola crops in the annual rotation enough to warrant alternate control
methods in some treatments. The magnitude of the effects on the seedbank
parameters depended largely on the competitive ability of the crop in which
herbicides were omitted. No yield response to omitting herbicides in oats
indicated that standard weed management practices have reduced weed
populations below yield-loss thresholds.
The purpose of this study was to assess the impact of a palliative medicine consultation on medical intensive care unit (MICU) and hospital length of stay, Do Not Resuscitate (DNR) designation, and location of death for MICU patients who died during hospitalization.
A comparison of two retrospective cohorts in a 17-bed MICU in a tertiary care university-affiliated hospital was conducted. Patients admitted to the MICU between January 1, 2003 and June 30, 2004 (N = 515) were compared to MICU patients who had had a palliative medicine consultation between January 1, 2005 and June 1, 2009 (N = 693). To control for disease severity, only patients in both cohorts who died during their hospitalization were considered for this study.
Palliative medicine consultation reduced time until death during the entire hospitalization (log-rank test, p < 0.01). Time from MICU admission until death was also reduced (log-rank test, p < 0.01), further demonstrating the impact of the palliative care consultation on the duration of dying for hospitalized patients. The intervention group contained a significantly higher percentage of patients with a DNR designation at death than did the control group (86% vs. 68%, χ2 test, p < 0.0001).
Significance of results:
Palliative medicine consultation is associated with an increased rate of DNR designation and reduced time until death. Patients in the intervention group were also more likely to die outside the MICU as compared to controls in the usual care group.