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We sought to retrospectively report our outcomes using post-operative stereotactic radiosurgery (SRS)/stereotactic radiotherapy (SRT) in place of whole-brain radiation therapy (WBRT) following resection of brain metastases from our hospital-based community practice.
Materials and Methods:
A retrospective review of 23 patients who underwent post-operative SRS at our single institution from 2013 to 2017 was undertaken. Patient records, treatment plans and diagnostic images were reviewed. Local failure, distant intracranial failure and overall survival were studied. Categorical variables were analyzed using Fisher’s exact tests. Continuous variables were analyzed using Mann–Whitney tests. The Kaplan–Meier method was used to estimate survival times.
16 (70%) were single-fraction SRS, whereas the remaining 7 patients received a five-fraction treatment course. The median single-fraction dose was 16 Gy (range, 16–18). The median total dose for fractionated treatments was 25 Gy (range, 25–35). Overall survival at 6 and 12 months was 95 and 67%, respectively. Comparison of SRS versus SRT local control rates at 6 and 12 months revealed control rates of 92 and 78% versus 29 and 14%, respectively. Every patient with dural/pial involvement at the time of surgery had distant intracranial failure at the 12-month follow-up.
Single-fraction frameless SRS proved to be an effective modality with excellent local control rates. However, the five-fraction SRT course was associated with an increased rate of local recurrence. Dural/pial involvement may portend a high risk for distant intracranial disease; therefore, it may be prudent to consider alternative approaches in these cases.
Nurses are critical to the research enterprise. However all nurses are not prepared to participate as members of the research team since education and training in clinical research nursing and nurse-specific Good Clinical Practice are not consistently included in nursing curricula. The lack of nurse education and training in clinical research and Good Clinical Practice leaves research participants vulnerable with a nursing workforce that is not prepared to balance fidelity to protocol and patient quality care and safety.
A collaborative network of nurses within Clinical and Translational Science Awards and beyond was established to address this education and training need. Over a 2-year period, using expert opinion, Delphi methods, and measures of validity and reliability the team constructed curriculum and knowledge test items.
A pilot modular electronic curriculum, including knowledge pretest and post-tests, in clinical research nursing and nurse-specific Good Clinical Practice competencies was developed.
As the scope and setting of clinical research changes, it is likely that all practicing nurses, regardless of their practice setting or specialty, will care for patients on research protocol, making all nurses, in essence, clinical research nurses. The curriculum developed by this protocol will address that workforce education and training need.
Objectives: The aim of this study was to determine the presence and severity of potential cultural and language bias in widely used cognitive and other assessment instruments, using structural MRI measures of neurodegeneration as biomarkers of disease stage and severity. Methods: Hispanic (n=75) and White non-Hispanic (WNH) (n=90) subjects were classified as cognitively normal (CN), amnestic mild cognitive impairment (aMCI) and mild dementia. Performance on the culture-fair and educationally fair Fuld Object Memory Evaluation (FOME) and Clinical Dementia Rating Scale (CDR) between Hispanics and WNHs was equivalent, in each diagnostic group. Volumetric and visually rated measures of the hippocampus entorhinal cortex, and inferior lateral ventricles (ILV) were measured on structural MRI scans for all subjects. A series of analyses of covariance, controlling for age, depression, and education, were conducted to compare the level of neurodegeneration on these MRI measures between Hispanics and WNHs in each diagnostic group. Results: Among both Hispanics and WNH groups there was a progressive decrease in volume of the hippocampus and entorhinal cortex, and an increase in volume of the ILV (indicating increasing atrophy in the regions surrounding the ILV) from CN to aMCI to mild dementia. For equivalent levels of performance on the FOME and CDR, WNHs had greater levels of neurodegeneration than did Hispanic subjects. Conclusions: Atrophy in medial temporal regions was found to be greater among WNH than Hispanic diagnostic groups, despite the lack of statistical differences in cognitive performance between these two ethnic groups. Presumably, unmeasured factors result in better cognitive performance among WNH than Hispanics for a given level of neurodegeneration. (JINS, 2018, 24, 176–187)
Preston et al (1976) and Burke (1982, these proceedings) have long extolled the virtues of launching a radio telescope into space to increase VLBI baseline lengths and thus angular resolution, and to provide a much enhanced image formation capability. The scientific motivation for this has been covered in a number of memoranda referenced by Burke in these proceedings, and by Anderson et al (1982). Efforts to mobilise western astronomical support for space VLBI met with success in late 1982 at a meeting of US and European radio astronomers in Toulouse, France, at which a decision was taken to propose a joint mission to ESA and NASA. Shortly thereafter, a formal proposal was made to ESA (Anderson et al 1982) for a free flying satellite in an elliptical orbit out to 15000 km from the Earth, designed to observe in concert with the major ground-based VLBI networks and arrays. The mission, dubbed QUASAT, was received favourably in both ESA and NASA, with the result that formal Assessment Studies are scheduled to begin in both agencies in October 1983.
An antenna in geostationary orbit was used for VLBI observations at 2.3 GHz, in combination with ground antennas in Australia and Japan. 23 of the 25 observed sources were detected on orbiter-ground baselines, with baseline lengths as large as 2.15 earth diameters. Brightness temperatures between 1012 K and 4 × 1012 K were measured for 10 sources.
The aims of this study were (a) to examine the effectiveness of an inpatient treatment programme for alcohol dependence based on the ‘Minnesota Model’ and (b) to examine potential predictors of outcomes from such treatment.
Demographics and data relating to psychosocial functioning of a group of individuals who commenced treatment for alcohol dependence were gathered at the point of treatment entry. These individuals were then followed up 6 months after they were to complete their inpatient treatment to establish their alcohol-related outcomes. Outcomes from treatment were identified as an index of treatment effectiveness and the outcome data were analysed to determine whether any of the baseline variables could be used to predict outcomes from treatment.
Of those who were contacted at 6-month follow-up, 81.5% had a ‘good outcome’. This represented 66.7% of the total group who participated in the study. The only variable that was found to predict outcomes at 6-month follow-up was severity of alcohol dependence at treatment entry, with more severe alcohol problems associated with poorer outcomes.
This study provides evidence of the potential for a Minnesota-based treatment programme to be effective in helping people with alcohol dependence to reduce the amount of alcohol they consume and sustain this reduction beyond the treatment period.
There are conflicting reports on the levels of anxiety and depression in individuals with alcohol problems and whether these conditions are substance-related or independent of the alcohol problem. The aim of this study was to characterise rates of co-morbid psychiatric symptoms among a group of individuals commencing treatment for alcohol dependence, and to examine the stability of these symptoms following treatment of the alcohol problem.
Symptoms of anxiety and depression were examined in a group of individuals (n=93) undergoing residential treatment for alcohol dependence. Symptoms were measured at treatment entry and again at treatment completion using the Beck Anxiety Inventory and the Beck Depression Inventory – II.
High levels of anxiety and depressive symptoms were reported at treatment entry, but on completion of treatment (28 days later) the majority of participants were no longer reporting symptoms suggestive of a possible co-morbid condition.
The significant change in rates of reported symptoms following completion of treatment suggests that a large proportion of symptoms reported at treatment entry were substance related. Diagnosing co-morbid conditions is best left until after a period of abstinence during which the alcohol problem has been treated. Assessing for co-morbidity at time of treatment seeking is likely to result in inappropriate co-morbid diagnoses being made and inappropriate or unnecessary treatments being prescribed for such individuals.
Large stores of unstable waste uranic materials such as fluorides or nitrates exist internationally due to legacy civil nuclear enrichment activities. Conversion of these uranic materials to layered metal uranates prior to disposal is possible via aqueous quench - precipitation type reactions. Previous studies1 have shown facile in-situ formation of geologically persistent and labile uranate colloids2 under simulated nuclear waste repository conditions, though the effects of local solution metal-uranium ratios on uranate stoichiometry have yet to be covered. This affects our understanding of how key radionuclides present in repository porewaters such as strontium or caesium may be sequestered in these uranate structures. In this work, we demonstrate a synthesis reaction for calcium monouranate particles via rapid anhydrous curing of a sol-gel. We present some results showing aqueous nucleation of uranate nanoparticles and their phase transformations during thermal curing as well as the effects of solution phase calcium loading on uranate phase purity in the cured particles.
The Dark Energy Survey is undertaking an observational programme imaging 1/4 of the southern hemisphere sky with unprecedented photometric accuracy. In the process of observing millions of faint stars and galaxies to constrain the parameters of the dark energy equation of state, the Dark Energy Survey will obtain pre-discovery images of the regions surrounding an estimated 100 gamma-ray bursts over 5 yr. Once gamma-ray bursts are detected by, e.g., the Swift satellite, the DES data will be extremely useful for follow-up observations by the transient astronomy community. We describe a recently-commissioned suite of software that listens continuously for automated notices of gamma-ray burst activity, collates information from archival DES data, and disseminates relevant data products back to the community in near-real-time. Of particular importance are the opportunities that non-public DES data provide for relative photometry of the optical counterparts of gamma-ray bursts, as well as for identifying key characteristics (e.g., photometric redshifts) of potential gamma-ray burst host galaxies. We provide the functional details of the DESAlert software, and its data products, and we show sample results from the application of DESAlert to numerous previously detected gamma-ray bursts, including the possible identification of several heretofore unknown gamma-ray burst hosts.
The fragmented ecosystems along the Niagara Escarpment World Biosphere Reserve provide important habitats for biota including lichens. Nonetheless, the Reserve is disturbed by dense human populations and associated air pollution. Here we investigated patterns of lichen diversity within urban and rural sites at three different locations (Niagara, Hamilton, and Owen Sound) along the Niagara Escarpment in Ontario, Canada. Our results indicate that both lichen species richness and community composition are negatively correlated with increasing human population density and air pollution. However, our quantitative analysis of community composition using canonical correspondence analysis (CCA) indicates that human population density and air pollution is more independent than might be assumed. The CCA analysis suggests that the strongest environmental gradient (CCA1) associated with lichen community composition includes regional pollution load and climatic variables; the second gradient (CCA2) is associated with local pollution load and human population density factors. These results increase the knowledge of lichen biodiversity for the Niagara Escarpment and urban and rural fragmented ecosystems as well as along gradients of human population density and air pollution; they suggest a differential influence of regional and local pollution loads and population density factors. This study provides baseline knowledge for further research and conservation initiatives along the Niagara Escarpment World Biosphere Reserve.
During 1990 we surveyed the southern sky using a multi-beam receiver at frequencies of 4850 and 843 MHz. The half-power beamwidths were 4 and 25 arcmin respectively. The finished surveys cover the declination range between +10 and −90 degrees declination, essentially complete in right ascension, an area of 7.30 steradians. Preliminary analysis of the 4850 MHz data indicates that we will achieve a five sigma flux density limit of about 30 mJy. We estimate that we will find between 80 000 and 90 000 new sources above this limit. This is a revised version of the paper presented at the Regional Meeting by the first four authors; the surveys now have been completed.
Due to the wide bandgap and other key materials properties of 4H-SiC, SiC MOSFETs
offer performance advantages over competing Si-based power devices. For example,
SiC can more easily be used to fabricate MOSFETs with very high voltage ratings,
and with lower switching losses. Silicon carbide power MOSFET development has
progressed rapidly since the market release of Cree’s 1200V 4H-SiC
power MOSFET in 2011. This is due to continued advancements in SiC substrate
quality, epitaxial growth capabilities, and device processing. For example,
high-quality epitaxial growth of thick, low-doped SiC has enabled the
fabrication of SiC MOSFETs capable of blocking extremely high voltages (up to
15kV); while dopant control for thin highly-doped epitaxial layers has helped
enable low on-resistance 900V SiC MOSFET production. Device design and
processing improvements have resulted in lower MOSFET specific on-resistance for
each successive device generation. SiC MOSFETs have been shown to have a long
device lifetime, based on the results of accelerated lifetime testing, such as
high-temperature reverse-bias (HTRB) stress and time-dependent dielectric
The incorporation of pertechnetate (TcO4–) into feldspathoids produced by alkaline alteration of aluminosilicate clays may offer a potential treatment route for 99Tc-containing groundwater and liquors. Kaolinite was aged in NaOH to determine the effect of base concentration, temperature, and solution composition on mineral transformation and pertechnetate uptake. In all reactions, increased temperature and NaOH concentration increased the rate of kaolinite transformation to feldspathoid phases. In reactions containing only NaOH, sodalite was the dominant alteration product; however, small amounts (6–15%) of cancrinite also formed. In experiments containing NaOH/Cl and NaOH/NO3 mixtures, sodalite and nitrate cancrinite were crystallized (at 70°C), with no reaction intermediates. The addition of SO42– crystallized sulfatic sodalite at 40 and 50°C, but at higher temperatures (60 and 70°C) sulfatic sodalite transforms to vishnevite (sulfatic cancrinite). In experiments where a pertechnetate tracer was added (at ∼1.5 μmol l–1), only 3–5% of the 99Tc was incorporated into the feldspathoid phases. This suggests that the larger pertechnetate anion was unable to compete as favourably for the internal vacancies with the smaller OH–, NO3–, SO42– or Cl– anions in solution, making this method likely to be unsuitable for groundwater treatment.
We report the case of a 52-year-old male with pre-motor Huntington’s disease (HD) who has undergone detailed clinical and neuropsychological examination. This patient’s negative symptomatology and behavioural change are having a detrimental impact on his social, occupational and interpersonal life, in the absence of motor symptoms.
The patient has undergone repeat neuropsychological testing (T1 aged 50; T2 aged 52) with particular focus on executive function and social cognition on repeat testing.
This case details a specific manifestation of HD relating to behavioural, psychiatric and social affective deficits.
This case illustrates how social cognitive changes can occur in HD, months and even years prior to the onset of motor features and how such unrecognized deficits can have a deleterious impact on an individual’s functional ability and lifestyle, before the disease is traditionally considered to have become manifest.
Using an 8-meter Würzburg parabola on an equatorial mount in Washington, D. C., we have completed about half of the necessary observations and reductions for a survey of the 1420-Mc/s hydrogen emission for all sky areas near the galactic plane which are visible here.
This Focus Meeting was designed to lie at the scientific intersection of structure formation and gravitational wave studies. In broad-strokes terms, binary supermassive black holes (BSMBHs) and cosmic strings may both play a central role in shaping the Universe as we know it.