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Motor neuron disease (MND) is a progressive, fatal, neurodegenerative condition that affects motor neurons in the brain and spinal cord, resulting in loss of the ability to move, speak, swallow and breathe. Acceptance and commitment therapy (ACT) is an acceptance-based behavioural therapy that may be particularly beneficial for people living with MND (plwMND). This qualitative study aimed to explore plwMND’s experiences of receiving adapted ACT, tailored to their specific needs, and therapists’ experiences of delivering it.
Method:
Semi-structured qualitative interviews were conducted with plwMND who had received up to eight 1:1 sessions of adapted ACT and therapists who had delivered it within an uncontrolled feasibility study. Interviews explored experiences of ACT and how it could be optimised for plwMND. Interviews were audio recorded, transcribed and analysed using framework analysis.
Results:
Participants were 14 plwMND and 11 therapists. Data were coded into four over-arching themes: (i) an appropriate tool to navigate the disease course; (ii) the value of therapy outweighing the challenges; (iii) relevance to the individual; and (iv) involving others. These themes highlighted that ACT was perceived to be acceptable by plwMND and therapists, and many participants reported or anticipated beneficial outcomes in the future, despite some therapeutic challenges. They also highlighted how individual factors can influence experiences of ACT, and the potential benefit of involving others in therapy.
Conclusions:
Qualitative data supported the acceptability of ACT for plwMND. Future research and clinical practice should address expectations and personal relevance of ACT to optimise its delivery to plwMND.
Key learning aims
(1) To understand the views of people living with motor neuron disease (plwMND) and therapists on acceptance and commitment therapy (ACT) for people living with this condition.
(2) To understand the facilitators of and barriers to ACT for plwMND.
(3) To learn whether ACT that has been tailored to meet the specific needs of plwMND needs to be further adapted to potentially increase its acceptability to this population.
James Dominic argues in response to a previous article by me that the view according to which God is the formal cause of creatures is unorthodox and ultimately incoherent. This is because it involves either making God a part of creatures, or dividing God into finite parts, both of which, he claims, lead to contradictions with traditional Christian claims. However, Rooney both misunderstands central parts of my presentation, and fails to make his case.
Crafting is often assumed to have been a ‘dirty’ and hence low-status activity: elites managed the supply of materials or distribution of the products, lower-status workers undertook the hard graft. Here, the authors present an in situ stoneworking toolkit from El Perú-Waka’ in the central Maya lowlands of Guatemala. Recovered from a high-status neighbourhood, the tools indicate the involvement of elite crafters in the working of various types of stone and greenstone. The assemblage is discussed with reference to ontological understandings of raw materials in the Maya world and the importance of specialised and ritual knowledge. The results encourage greater consideration of the involvement of elites in craft production across Mesoamerica and beyond.
In the generalized quasilinear approximation (GQLA) (Marston et al., Phys. Rev. Lett., vol. 116, 2016, 214501), a threshold wavenumber ($k_0$) in the direction of translational symmetry segregates the total into large- ($l$) and small-scale ($h$) fields. While the governing equation for the large-scale field is fully nonlinear, that for the small scales is linearized with respect to the large-scale field. In addition, some nonlinear triad interactions are omitted in the GQLA. Herein, the GQLA is applied to two-dimensional planar Rayleigh–Bénard convection (RBC). A scale separation between the large-scale convection rolls and small-scale turbulent fluctuations is typical in RBC. The present work explores the efficacy of GQLA in capturing the scale-by-scale energy transfer processes in RBC. The initial condition for the GQLA simulations was either the statistically stationary state obtained in direct numerical simulation (DNS) or random fluctuations superimposed on the linear conductive temperature profile and $\boldsymbol {u}=0$. The GQLA simulations can capture the convection rolls for $k_0$ larger than or equal to the dominant wavenumber for thermal driving of the flow ($k_0 \ge k_{\hat {Q}}$). Additionally, the GQLA emulates the fully nonlinear dynamics for $k_0$ larger than or equal to the first harmonic of the convection-roll wavenumber ($k_0 \ge 2k_{roll}$). In the intermediate regime with $2k_{roll} > k_0 \ge k_{\hat {Q}}$, the dynamics captured in GQLA simulations is different from the DNS. In DNS, two primary energy transfer processes dominate: (i) the energy transfer to/from the convection rolls and (ii) the scale-by-scale inverse kinetic energy and forward thermal energy cascades mediated by the convection rolls. The fully nonlinear dynamics is emulated by GQLA when these energy transfer processes are faithfully reproduced. Utilizing the framework of altering the triad interactions in GQLA, an additional intrusive calculation, including target triad interactions, is performed here to study their influence. This intrusive calculation shows that the convection rolls are not captured in GQLA for $k_0 < k_{\hat {Q}}$ because of the exclusion of the $h \to l \to l$ and $l \to h \to h$ triad interactions in GQLA. The inclusion of these triad interactions in the intrusive calculation yields the convection rolls, and the reproduced dynamics is similar to that of the intermediate GQLA regime with $2k_{roll} > k_0 \ge k_{\hat {Q}}$.
Earthquakes cause devastating effects, resulting in the deaths of thousands of people each year. Understanding the full range of impacts, including fatalities, and the pathophysiological mechanisms underlying these effects is crucial for mitigating the aftermath of earthquakes. Therefore, this review aims to: delineate the critical golden time periods following earthquakes and identify the most effective responses and resilience factors during these periods; accurately define the terminology for injuries sustained post-earthquake; elucidate the basic pathophysiology of CRUSH injury-induced myopathy, one of the most significant pathologies in post-earthquake patient management; explore the role of nitric oxide (NO) mechanisms in crush injuries, which are believed to be fundamental to the “smiling death phenomenon” and represent the unseen part of the iceberg; and highlight the importance of the 3 main phenomena responsible for mortality—acidosis, coagulopathy, and hypothermia—during disasters. This comprehensive review, based on the latest literature, encompasses search and rescue, pre-hospital processes, emergency department procedures, and subsequent internal and surgical management algorithms.
Recently there have been extraordinary instances of public and political elite complaints toward the Supreme Court. Through a survey experiment, we find that when respondents read that a copartisan executive is offended by recent Supreme Court decisions and threatening to ignore future decisions, respondents increase their support of executives’ not complying with and going public against the Court. Additionally, we find that partisans reward candidates by voting for them at higher rates if they ignore a Court decision that harmed the participant’s party. Our findings hold implications for continued institutional arrangements and our understanding of the functioning of our democracy.
Health care and health security are the fundamental pillars of disaster preparedness and crisis management. An established routine health care is necessary for any society, enabling full access to care and fulfilling the rights of every individual. Health security, on the other hand, is what a society needs to be flexible in managing an unexpected situation. To overcome a disaster with minimal damage or to avert such a critical situation, health care and health security should exist simultaneously. Thus, resilience in disaster preparedness and crisis management requires investment in both health care and health security. This ensures local public health services and infrastructure, local ambulances, both acute and chronic care referral systems, prompt vaccinations, and prevention of communicable diseases to name but a few. These measures which have proven to be the most sensitive evaluation of fair governance are critically absent in several nations, particularly in areas with long-standing conflicts. Strengthening health care and health security measures are paramount to the maintenance of the health system in peace and recovery of health delivery post-conflict and require political and economic considerations.
This work experimentally investigates the flow structure around a rectangular cylinder with an aspect ratio of 2 under varying incidence angles to examine how acoustic perturbations modify and modulate the unsteady flow instabilities. In the absence of acoustic excitation, the angle of incidence is found to markedly influence the flow topology and the natural shedding pattern altering the vortex formation length and wake dynamics. With acoustic perturbations, it is observed that for incidence angles $\alpha = 0^{\circ }$ and $\alpha = 5^{\circ }$, the masked impinging leading-edge vortex (ILEV)/trailing-edge vortex shedding (TEVS) instability modes of $n= 1$ and $n= 2$ become evident when their frequencies coincide with the frequencies of the acoustic perturbations (i.e. resonant condition). Both trailing-edge and leading-edge vortices were found to be modulated by the acoustic pressure cycle. These instability modes, which are naturally present under non-resonant conditions for significantly higher aspect ratios, highlight the role of incidence angle and self-excited acoustic resonance in virtually augmenting the streamwise length of the cylinder, thereby facilitating the emergence and sustenance of the ILEV/TEVS shedding pattern.
This study was conducted to determine the relationships between nurses’ competency, motivation, and stress levels in disaster management, as well as to shed light on the establishment of effective disaster management programs.
Methods
In our research we used a correlational, descriptive, cross-sectional design. The sample of the study was composed of 498 nurses working in Turkey. The “Descriptive and Professional Characteristics and Disaster Experiences of Nurses” form, the “Competencies for Disaster Nursing Management Questionnaire,” the “Perceived Stress Scale,” and the “Nurses Job Motivation Scale” were used in data collection.
Results
Nurses’ disaster management competency and motivation levels were found to be adequate, and their stress levels were found to be moderate. A weak positive correlation was found between disaster management competency and motivation, but a weak negative correlation was found between stress levels. Age, education level, experience level, training in disaster nursing, and knowledge of duties and responsibilities in disasters were associated with significant differences in terms of disaster competency and its dimensions, motivation, and stress levels.
Conclusions
The study found that nurses’ disaster experiences impacted their competency, feeling of preparedness, and stress and motivation levels, and motivation was found to be a predictor of increasing competency.
Drawing on resource-based and agency theories, this study examines the effects of business concentration and ownership structure on business group performance. On the basis of panel data (2004–2018) from the top 100 Taiwanese business groups investing globally, this study finds an S-shaped relationship between business concentration and business group performance with the interaction of advantages and costs at different levels. Performance increases when there is little business concentration, decreases when there is a moderate amount and increases again when there is a high level of business concentration. In addition, this study hypothesizes that ownership structure has a different moderating effect on this relationship. The family business group has a positive moderating effect; however, outsider direct and manager ownership have no significant moderating role. These findings have important theoretical and managerial implications for business groups.
Continuing laboratory research into zoonotic diseases is necessary for public health preparedness. However, the COVID-19 pandemic has elevated existing concerns about the risks BSL-4 research facilities can pose to the surrounding community. This study places such concerns in the context of previous research regarding the construction of biosafety labs, as well as policy discussions related to other scientific controversies like gain of function research. Building on this prior knowledge as well as established theories in the field of communication, we propose using a Culture-Centered Approach paired with a Communication Complex approach to facilitate more meaningful and effective communication between researchers and community members, particularly those who tend to be marginalized in such conversations. The commentary concludes by outlining a risk assessment process using the CCA-Communication Complex Approach.
Postprandially, amino acids and di/tripeptides are thought to be primarily absorbed in the proximal small intestine. However, there have been no in vivo demonstrations of regional differences in amino acid transport dynamics between the proximal and distal small intestines. We monitored plasma amino acid responses in the jejunal and ileal mesenteric veins of rats after oral administration of a diet or an amino acid mixture (Expt 1) and in the portal vein after direct administration of the amino acid mixture into the lumen of the jejunum or ileum (Expt 2). In Expt 1, the total and some amino acid concentrations in the jejunal mesenteric vein were slightly higher than those in the ileal mesenteric vein after oral administration of the amino acid mixture, suggesting that the ileum actively transports luminal amino acids to the basolateral side, comparable to the jejunum. In Expt 2, portal amino acid concentrations were elevated to a greater extent after direct administration of the amino acid mixture into the ileal lumen than into the jejunal lumen. These results demonstrate regional differences in amino acid transport dynamics in vivo and suggest that the ileum has a higher capacity for transporting amino acids than the jejunum. Our findings highlight the importance of the ileum in postprandial amino acid absorption and metabolism.
Shear-induced self-diffusion is a fundamental mode of transport in granular flows. Yet its critical behaviour and dependence on the particle solid fraction are still unclear. Here, we rationalize these dependencies by performing two-dimensional pressure-imposed numerical simulations of dense non-Brownian frictional suspensions. Our results, combined with existing numerical data on inertial granular flows, show that the shear-induced diffusion coefficients of both systems can be captured by a single function of the distance to jamming. They further show that the grain diffusive behaviour is underpinned by a specific random walk process, having a constant elementary step length driven at a frequency that increases with the solid fraction. The proposed scaling laws pave the way for a better understanding of mixing processes in granular media.
Flying insects exhibit remarkable capabilities in coordinating their olfactory sensory system and flapping wings during odour plume-tracking flights. While observations have indicated that their flapping wing motion can ‘sniff’ up the incoming plumes for better odour sampling range, how flapping motion impacts the odour concentration field around the antennae is unknown. Here, we reconstruct the body and wing kinematics of a forwards-flying butterfly based on high-speed images. Using an in-house computational fluid dynamics solver, we simulate the unsteady flow field and odourant transport process by solving the Navier–Stokes and odourant advection-diffusion equations. Our results show that, during flapping flight, the interaction between wing leading-edge vortices and antenna vortices strengthens the circulation of antenna vortices by over two-fold compared with cases without flapping motion, leading to a significant increase in odour intensity fluctuation along the antennae. Specifically, the interaction between the wings and antennae amplifies odour intensity fluctuations on the antennae by up to 8.4 fold. This enhancement is critical in preventing odour fatigue during odour-tracking flights. Further analysis reveals that this interaction is influenced by the inter-antennal angle. Adjusting this angle allows insects to balance between resistance to odour fatigue and the breadth of odour sampling. Narrower inter-antennal angles enhance fatigue resistance, while wider angles extend the sampling range but reduce resistance. Additionally, our findings suggest that while the flexibility of the wings and the thorax's pitching motion in butterflies do influence odour fluctuation, their impact is relatively secondary to that of the wing–antenna interaction.