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Forensic pathologists are increasingly faced with challenges when it comes to geriatric cases, due to an aging population and increased co-morbidities in the elderly. This text provides an up-to-date guide to all facets of geriatric forensic pathology, with contributions from experts from a variety of disciplines. Packed with color illustrations and case examples, chapters cover inflicted, self-inflicted and accidental trauma, as well as natural conditions leading to unexpected death. In addition, specific chapters cover a wide range of difficult and topical areas, from elder abuse, dementias and nutrition to pharmacology and toxicology issues, long-term care facilities and scene investigation. Topics such as euthanasia are also explored to provide the reader with a rich, contemporary understanding of medicolegal issues. This is an invaluable resource not only for pathologists, but also for medical practitioners and lawyers dealing with geriatric cases. The book comes packaged with online access to the text and high-resolution images.
This Handbook provides both breadth and depth regarding current approaches to the understanding, assessment, and treatment of personality disorders. The five parts of the book address etiology; models; individual disorders and clusters; assessment; and treatment. A comprehensive picture of personality pathology is supplied that acknowledges the contributions and missteps of the past, identifies the crucial questions of the present, and sets a course for the future. It also follows the changes the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) has triggered in the field of personality disorders. The editors take a unique approach where all chapters include two commentaries by experts in the field, as well as an author rejoinder. This approach engages multiple perspectives and an exchange of ideas. It is the ideal resource for researchers and treatment providers at all career stages.
Fermented feeds are being considered as practical alternatives to antimicrobial growth promoters (AGP) supplemented in nursery pig diets. This study aimed to investigate health-promoting effects of fermented barley in weaned pigs challenged with Escherichia coli K88 +. A total of 37 piglets were weaned at 21 ± 1 day of age (6.41 ± 0.47 kg of BW) and assigned to either of the following five treatment groups: (1) unchallenged control (UCC; n = 7), (2) challenged control (CC; n = 7), (3) AGP (CC + 0.1% AGP; n = 7), (4) Ferm1 (challenged and fed homofermentative Lactobacillus plantarum (Homo)-fermented barley; n = 8) and (5) Ferm2 (challenged and fed heterofermentative L. buchneri (Hetero)-fermented barley; n = 8). The control diet included unfermented barley. Barley was fermented with either Homo or Hetero for 90 days under anaerobic conditions. On day 10, all pigs except those in UCC group were orally inoculated with E. coli K88 + (6 × 109 colony forming units/ml). The pre-planned orthogonal test was performed to compare (1) UCC and CC, (2) CC and AGP, (3) CC and Ferm1 + Ferm2, as well as (4) Ferm1 and Ferm2. Challenged control pigs showed shorter (P < 0.05) villus height (VH) in the duodenum and deeper (P < 0.05) crypt depth (CD) in the jejunum than UCC pigs. The AGP group had higher (P < 0.05) VH and lower (P < 0.05) IL-6 gene expression in the jejunum compared with CC group. Compared to CC, Ferm1 and Ferm2 had decreased (P < 0.05) CD in the duodenum, IL-6 gene expression in the jejunum and rectal temperature at 24 h post-challenge. Pigs fed fermented barley diets showed greater (P < 0.05) faecal abundance of Clostridium Cluster IV and Lactobacilli than those fed UCC diet. Ferm2-fed pigs showed lower (P < 0.05) concentrations of band cells, eosinophils and lymphocytes at 6, 24 and 48 h after challenge, respectively, and lower (P < 0.05) faecal abundance of Enterobacteriaceae 24 h after challenge than the Ferm1-fed pigs. In conclusion, the substitution of unfermented barley with fermented barley in a nursery diet showed similar results as those shown by AGP supplementation in terms of enhancing the intestinal morphology and modulating faecal microbiota composition, as well as down-regulating the pro-inflammatory cytokines; therefore, fermented barley can be a possible nutritional strategy for managing nursery pigs fed diets without in-feed AGP.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
To define optimal thromboprophylaxis strategy after stent implantation in superior or total cavopulmonary connections.
Stent thrombosis is a rare complication of intravascular stenting, with a perceived higher risk in single-ventricle patients.
All patients who underwent stent implantation within superior or total cavopulmonary connections (caval vein, innominate vein, Fontan, or branch pulmonary arteries) were included. Cohort was divided into aspirin therapy alone versus advanced anticoagulation, including warfarin, enoxaparin, heparin, or clopidogrel. Primary endpoint was in-stent or downstream thrombus, and secondary endpoints included bleeding complications.
A total of 58 patients with single-ventricle circulation underwent 72 stent implantations. Of them 14 stents (19%) were implanted post-superior cavopulmonary connection and 58 (81%) post-total cavopulmonary connection. Indications for stenting included vessel/conduit stenosis (67%), external compression (18%), and thrombotic occlusion (15%). Advanced anticoagulation was prescribed for 32 (44%) patients and aspirin for 40 (56%) patients. Median follow up was 1.1 (25th–75th percentile, 0.5–2.6) years. Echocardiograms were available in 71 patients (99%), and advanced imaging in 44 patients (61%). Thrombosis was present in two patients on advanced anticoagulation (6.3%) and none noted in patients on aspirin (p = 0.187). Both patients with in-stent thrombus underwent initial stenting due to occlusive left pulmonary artery thrombus acutely post-superior cavopulmonary connection. There were seven (22%) significant bleeding complications for advanced anticoagulation and none for aspirin (p < 0.001).
Antithrombotic strategy does not appear to affect rates of in-stent thrombus in single-ventricle circulations. Aspirin alone may be sufficient for most patients undergoing stent implantation, while pre-existing thrombus may warrant advanced anticoagulation.
This invited paper is a review of the significance of couple relationships to the practice of all therapists. The article begins with a summary of the evidence on the centrality of committed couple relationships to the lives and wellbeing of adults, and the association of the quality of the parents’ couple relationship on the wellbeing of children. We argue that the well-established reciprocal association between individual problems and couple relationship problems means that all therapists need to pay attention to how a couple relationship might be influencing a client's functioning, even if the relationship is not the presenting problem. There is an outline the evolution of current approaches to behavioural couple therapy, and the current state of the art and science of couple therapy. We present an analysis of the evidence for couple therapy as a treatment for relationship distress, as well as couple-based treatments for individual problems. This is followed by a description of the distinctive challenges in working with couples and how to address those challenges, and recommendations about how to address the needs of diverse couple relationships. Finally, we propose some core therapist competencies needed to work effectively with couples.
Infrared signal measurements from a micro-turbojet engine are conducted to understand the characteristics of the engine performance and the infrared signal by varying the exhaust nozzle configuration. A cone type nozzle and five rectangle type nozzles whose aspect ratios vary from one to five are used for this experimental work. As a result, it is confirmed that the thrust and the fuel consumption rate of the engine do not change greatly by varying the exhaust nozzle shape. In the case of the aspect ratio of 5, the specific fuel consumption of the engine is increased by about 3% compared to the reference cone nozzle, but the infrared signal can be reduced by up to 14%. As a result of measuring the temperature distribution of the plume gas, the correlation of infrared signal with plume gas temperature distribution can be understood. In the case of a cone shape, the distribution of plume gas formed to circular shape, and the high-temperature core region of plume gas continued to develop farther to the downstream. However, the temperature distribution was maintained in the rectangular shape as the aspect ratio increased, and the average temperature decreased sharply. As the aspect ratio increases, the plume spreads more widely.
This study of loneliness across adult lifespan examined its associations with sociodemographics, mental health (positive and negative psychological states and traits), subjective cognitive complaints, and physical functioning.
Analysis of cross-sectional data
340 community-dwelling adults in San Diego, California, mean age 62 (SD = 18) years, range 27–101 years, who participated in three community-based studies.
Loneliness measures included UCLA Loneliness Scale Version 3 (UCLA-3), 4-item Patient-Reported Outcomes Measurement Information System (PROMIS) Social Isolation Scale, and a single-item measure from the Center for Epidemiologic Studies Depression (CESD) scale. Other measures included the San Diego Wisdom Scale (SD-WISE) and Medical Outcomes Survey- Short form 36.
Seventy-six percent of subjects had moderate-high levels of loneliness on UCLA-3, using standardized cut-points. Loneliness was correlated with worse mental health and inversely with positive psychological states/traits. Even moderate severity of loneliness was associated with worse mental and physical functioning. Loneliness severity and age had a complex relationship, with increased loneliness in the late-20s, mid-50s, and late-80s. There were no sex differences in loneliness prevalence, severity, and age relationships. The best-fit multiple regression model accounted for 45% of the variance in UCLA-3 scores, and three factors emerged with small-medium effect sizes: wisdom, living alone and mental well-being.
The alarmingly high prevalence of loneliness and its association with worse health-related measures underscore major challenges for society. The non-linear age-loneliness severity relationship deserves further study. The strong negative association of wisdom with loneliness highlights the potentially critical role of wisdom as a target for psychosocial/behavioral interventions to reduce loneliness. Building a wiser society may help us develop a more connected, less lonely, and happier society.
Geochemical and related studies have been made of near-surface sediments from the River Clyde estuary and adjoining areas, extending from Glasgow to the N, and W as far as the Holy Loch on the W coast of Scotland, UK. Multibeam echosounder, sidescan sonar and shallow seismic data, taken with core information, indicate that a shallow layer of modern sediment, often less than a metre thick, rests on earlier glacial and post-glacial sediments. The offshore Quaternary history can be aligned with onshore sequences, with the recognition of buried drumlins, settlement of muds from quieter water, probably behind an ice dam, and later tidal delta deposits. The geochemistry of contaminants within the cores also indicates shallow contaminated sediments, often resting on pristine pre-industrial deposits at depths less than 1m. The distribution of different contaminants with depth in the sediment, such as Pb (and Pb isotopes), organics and radionuclides, allow chronologies of contamination from different sources to be suggested. Dating was also attempted using microfossils, radiocarbon and 210Pb, but with limited success. Some of the spatial distribution of contaminants in the surface sediments can be related to grain-size variations. Contaminants are highest, both in absolute terms and in enrichment relative to the natural background, in the urban and inner estuary and in the Holy Loch, reflecting the concentration of industrial activity.
Concentrations of total organic carbon (TOC), total petroleum hydrocarbons, polycyclic aromatic hydrocarbons (PAHs) and polychlorinated biphenyls (PCBs) were determined in 84 near-surface soils (5–20cm depth) taken from a 255km2 area of Glasgow in the Clyde Basin, UK, during July 2011. Total petroleum hydrocarbon range was 79–2,505mgkg–1 (mean 388mgkg–1; median 272mgkg–1) of which the aromatic fraction was 13–74 % (mean 44 %, median 43 %) and saturates were 28–87 % (mean 56 %, median 57 %). ∑16 PAH varied from 2–653mgkg–1 (mean 32.4mgkg–1; median 12.5mgkg–1) and ∑31 PAH range was 2.47–852mgkg–1 (mean 45.4mgkg–1; median 19.0mgkg–1). ∑PCBtri-hepta range was 2.2–1052μgkg–1 (mean 32.4μgkg–1; median 12.7μgkg–1) and the ∑PCB7 range was 0.3–344μgkg–1 (mean 9.8μgkg–1; median 2.7μgkg–1). The concentration, distribution and source of the persistent organic pollutants were compared with those found in urban soils from other cities and to human health assessment criteria for chronic exposure to chemicals in soil. Total concentrations encountered were generally similar to other urban areas that had a similar industrial history. Benzo[a]pyrene concentrations were assessed against four different land use scenarios (irrespective of current land use) using generic assessment criteria resulting in six of 84 samples exceeding the residential criteria. Isomeric PAH ratios and relative abundance of perylene suggest multiple and environmentally modified pyrogenic PAH sources, inferred to be representative of diffuse pollution. ∑PCB7 concentrations were exceeded in 10 % of sites using the Dutch target value of 20μgkg–1. PCB congener profiles were environmentally attenuated and generally dominated by penta-, hexa- and hepta-chlorinated congeners.
Surface sediments from a 160-km stretch of the River Clyde, Scotland, were analysed for persistent organic pollutants to investigate distribution, source and environmental effect. Glasgow's urban tributaries polyaromatic hydrocarbons (PAH) ranged from 2.3 to 4226mgkg–1, total petroleum hydrocarbons (TPH) 72 to 37879mgkg–1 and polychlorinated biphenyls (PCB) 3 to 809μgkg–1, which were more polluted than the upper River Clyde PAH that ranged from 0.1 to 42mgkg–1, TPH 3 to 260mgkg–1 and PCB 2 to 147μgkg–1. Intermediate values of the inner Clyde estuary PAH ranging from 0.6 to 30mgkg–1, and PCB ranging from 5 to 130μgkg–1, were attributed to point sources and sediment transfer from the urban tributaries. Comparison with sediment quality criteria suggested possible adverse effects on aquatic biota. PAH isomeric ratios confirmed a pyrolytic source throughout the Clyde and benzo[a]pyrene/benzo[g,h,i]perylene ratios >0.6 confirmed that upper, urban and estuarine domains all to a lesser or greater extent accumulated PAH from traffic emissions. The degree of chlorination determined from PCB homologues differed in each of the three domains, suggesting variable source or that the process aerobic/anaerobic degradation varied in each of the three domains. The anthropogenic impact of the city of Glasgow can be quantified in that the urban tributary sediment mean values were 60 (PAH), 33 (TPH) and 11 (PCB) times higher than the rural upper Clyde counterpart.
Surface sediments (n=85) from a 160-km river-estuarine transect of the Clyde, UK, were analysed for total mercury (Hg), saturated hydrocarbons and unresolved complex mixtures (UCMs) of hydrocarbons. Results show that sediment-Hg concentration ranges from 0.01 to 1.38mgkg–1 (mean 0.20mgkg–1) and a spatial trend in Hg-content low–high–low–high, from freshwater source, to Glasgow, to estuary, is evident. In summary, sediment-Hg content is low in the upper Clyde (mean of 0.05Hg mgkg–1), whereas sediments from the Clyde in urbanised Glasgow have higher Hg concentrations (0.04 to 1.26mgkg–1; mean 0.45mgkg–1), and the inner estuary sediments contain less Hg (mean 0.06mgkg–1). The highest mean sediment Hg (0.65mgkg–1) found in the outer estuary is attributed to historical anthropogenic activities. A significant positive Spearman correlation between Hg and total organic carbon is observed throughout the river estuary (0.86; P<0.001). Comparison with Marine Scotland guidelines suggests that no sites exceed the 1.5mgkg–1 criterion (Action Level 2); 22 fall between 0.25 and 1.5mgkg–1 dry wt. (Action Level 1) and 63 are of no immediate concern (<0.25mgkg–1 dry wt.). Saturated (n-alkane) hydrocarbons in the upper Clyde are of natural terrestrial origin. By contrast, the urbanised Glasgow reaches and outer estuary are characterised by pronounced and potentially toxic UCM concentrations in sediments (380–914mg/kg and 103–247mgkg–1, respectively), suggesting anthropogenic inputs such as biodegraded crude oil, sewage discharge and/or urban run-off.
Rising sea levels due to climate change can have severe consequences for coastal populations and ecosystems all around the world. Understanding and projecting sea-level rise is especially important for low-lying countries such as the Netherlands. It is of specific interest for vulnerable ecological and morphodynamic regions, such as the Wadden Sea UNESCO World Heritage region.
Here we provide an overview of sea-level projections for the 21st century for the Wadden Sea region and a condensed review of the scientific data, understanding and uncertainties underpinning the projections. The sea-level projections are formulated in the framework of the geological history of the Wadden Sea region and are based on the regional sea-level projections published in the Fifth Assessment Report of the Intergovernmental Panel on Climate Change (IPCC AR5). These IPCC AR5 projections are compared against updates derived from more recent literature and evaluated for the Wadden Sea region. The projections are further put into perspective by including interannual variability based on long-term tide-gauge records from observing stations at Den Helder and Delfzijl.
We consider three climate scenarios, following the Representative Concentration Pathways (RCPs), as defined in IPCC AR5: the RCP2.6 scenario assumes that greenhouse gas (GHG) emissions decline after 2020; the RCP4.5 scenario assumes that GHG emissions peak at 2040 and decline thereafter; and the RCP8.5 scenario represents a continued rise of GHG emissions throughout the 21st century. For RCP8.5, we also evaluate several scenarios from recent literature where the mass loss in Antarctica accelerates at rates exceeding those presented in IPCC AR5.
For the Dutch Wadden Sea, the IPCC AR5-based projected sea-level rise is 0.07±0.06m for the RCP4.5 scenario for the period 2018–30 (uncertainties representing 5–95%), with the RCP2.6 and RCP8.5 scenarios projecting 0.01m less and more, respectively. The projected rates of sea-level change in 2030 range between 2.6mma−1 for the 5th percentile of the RCP2.6 scenario to 9.1mma−1 for the 95th percentile of the RCP8.5 scenario. For the period 2018–50, the differences between the scenarios increase, with projected changes of 0.16±0.12m for RCP2.6, 0.19±0.11m for RCP4.5 and 0.23±0.12m for RCP8.5. The accompanying rates of change range between 2.3 and 12.4mma−1 in 2050. The differences between the scenarios amplify for the 2018–2100 period, with projected total changes of 0.41±0.25m for RCP2.6, 0.52±0.27m for RCP4.5 and 0.76±0.36m for RCP8.5. The projections for the RCP8.5 scenario are larger than the high-end projections presented in the 2008 Delta Commission Report (0.74m for 1990–2100) when the differences in time period are considered. The sea-level change rates range from 2.2 to 18.3mma−1 for the year 2100.
We also assess the effect of accelerated ice mass loss on the sea-level projections under the RCP8.5 scenario, as recent literature suggests that there may be a larger contribution from Antarctica than presented in IPCC AR5 (potentially exceeding 1m in 2100). Changes in episodic extreme events, such as storm surges, and periodic (tidal) contributions on (sub-)daily timescales, have not been included in these sea-level projections. However, the potential impacts of these processes on sea-level change rates have been assessed in the report.
Aerofoils operating in a turbulent flow generate broadband noise by scattering vorticity into sound at the leading edge. Previous work has demonstrated the effectiveness by which serrations, or undulations, introduced onto the leading edge, can substantially reduce broadband leading-edge noise. All of this work has focused on sinusoidal (single-wavelength) leading-edge serration profiles. In this paper, a new leading-edge serration geometry is proposed which provides significantly greater noise reductions compared to the maximum noise reductions achievable by single-wavelength serrations of the same amplitude. This is achieved through destructive interference between different parts of the aerofoil leading edge, and therefore involves a fundamentally different noise reduction mechanism from conventional single-wavelength serrations. The new leading-edge serration profiles simply comprise the superposition of two single-wavelength components of different wavelength, amplitude and phase with the objective of forming two roots that are sufficiently close together and separated in the streamwise direction. Compact sources located at these root locations then interfere, leading to less efficient radiation than single-wavelength geometries. A detailed parametric study is performed experimentally to investigate the sensitivity of the noise reductions to the profile geometry. A simple model is proposed to explain the noise reduction mechanism for these double-wavelength serration profiles and shown to be in close agreement with the measured noise reduction spectra. The study is primarily performed on flat plates in an idealized turbulent flow. The paper concludes by introducing the double-wavelength serration on a 10 % thick aerofoil, where near-identical noise reductions are obtained compared to the flat plate.
Angiostrongylus cantonensis (rat lungworm), a parasitic nematode, is expanding its distribution. Human infection, known as angiostrongyliasis, may manifest as eosinophilic meningitis, an emerging infectious disease. The range and incidence of this disease are expanding throughout the tropics and subtropics. Recently, the Hawaiian Islands have experienced an increase in reported cases. This study addresses factors affecting the parasite's distribution and projects its potential future distribution, using Hawaii as a model for its global expansion. Specimens of 37 snail species from the Hawaiian Islands were screened for the parasite using PCR. It was present on five of the six largest islands. The data were used to generate habitat suitability models for A. cantonensis, based on temperature and precipitation, to predict its potential further spread within the archipelago. The best current climate model predicted suitable habitat on all islands, with greater suitability in regions with higher precipitation and temperatures. Projections under climate change (to 2100) indicated increased suitability in regions with estimated increased precipitation and temperatures, suitable habitat occurring increasingly at higher elevations. Analogously, climate change could facilitate the spread of A. cantonensis from its current tropical/subtropical range into more temperate regions of the world, as is beginning to be seen in the continental USA.