We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
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.
Identification of paediatric coronary artery abnormalities is challenging. We studied whether coronary artery CT angiography can be performed safely and reliably in children.
Materials:
Retrospective analysis of consecutive coronary CT angiography scans was performed for image quality and estimated radiation dose. Both factors were assessed for correlation with electrocardiographic-gating technique that was protocoled on a case-by-case basis, radiation exposure parameters, image noise artefact parameters, heart rate, and heart rate variability.
Results:
Sixty scans were evaluated, of which 96.5% were diagnostic for main left and right coronaries and 91.3% were considered diagnostic for complete coronary arteries. Subjective image quality correlated significantly with lower heart rate, increasing patient age, and higher signal-to-noise ratio. Estimated radiation dose only correlated significantly with choice of electrocardiographic-gating technique with median doses as follows: 2.42 mSv for electrocardiographic-gating triggered high-pitch spiral technique, 5.37 mSv for prospectively triggered axial sequential technique, 3.92 mSv for retrospectively gated technique, and 5.64 mSv for studies which required multiple runs. Two scans were excluded for injection failure and one for protocol outside the study scope. Five non-diagnostic cases were attributed to breathing motion, scanning prior to peak contrast enhancement, or scan acquisition during the incorrect portion of the R-R interval.
Conclusions:
Diagnostic-quality coronary CT angiography can be performed reliably with a low estimated radiation exposure by tailoring each scan protocol to the patient’s body habitus and heart rate. We propose coronary CT angiography is a safe and effective diagnostic modality for coronary artery abnormalities in children.
The Hawaiian archipelago was formerly home to one of the most species-rich land snail faunas (> 752 species), with levels of endemism > 99%. Many native Hawaiian land snail species are now extinct, and the remaining fauna is vulnerable. Unfortunately, lack of information on critical habitat requirements for Hawaiian land snails limits the development of effective conservation strategies. The purpose of this study was to examine the plant host preferences of native arboreal land snails in Puʻu Kukui Watershed, West Maui, Hawaiʻi, and compare these patterns to those from similar studies on the islands of Oʻahu and Hawaiʻi. Concordant with studies on other islands, we found that four species from three diverse families of snails in Puʻu Kukui Watershed had preferences for a few species of understorey plants. These were not the most abundant canopy or mid canopy species, indicating that forests without key understorey plants may not support the few remaining lineages of native snails. Preference for Broussaisia arguta among various island endemic snails across all studies indicates that this species is important for restoration to improve snail habitat. As studies examining host plant preferences are often incongruent with studies examining snail feeding, we suggest that we are in the infancy of defining what constitutes critical habitat for most Hawaiian arboreal snails. However, our results indicate that preserving diverse native plant assemblages, particularly understorey plant species, which facilitate key interactions, is critical to the goal of conserving the remaining threatened snail fauna.
Infants born preterm miss out on the peak period of in utero DHA accretion to the brain during the last trimester of pregnancy which is hypothesised to contribute to the increased prevalence of neurodevelopmental deficits in this population. This study aimed to determine whether DHA supplementation in infants born preterm improves attention at 18 months’ corrected age. This is a follow-up of a subset of infants who participated in the N3RO randomised controlled trial. Infants were randomised to receive an enteral emulsion of high-dose DHA (60 mg/kg per d) or no DHA (soya oil – control) from within the first days of birth until 36 weeks’ post-menstrual age. The assessment of attention involved three tasks requiring the child to maintain attention on toy/s in either the presence or absence of competition or a distractor. The primary outcome was the child’s latency of distractibility when attention was focused on a toy. The primary outcome was available for seventy-three of the 120 infants that were eligible to participate. There was no evidence of a difference between groups in the latency of distractibility (adjusted mean difference: 0·08 s, 95 % CI –0·81, 0·97; P = 0·86). Enteral DHA supplementation did not result in improved attention in infants born preterm at 18 months’ corrected age.
This paper examines the political economy of the Orange Revolution in an effort to understand routes by which less democratic postcommunist countries might break with an illiberal status quo. The fusion of Ukraine's rent-seeking economic interests and illiberal political regime produced an unstable equilibrium that is poorly explained by two leading theoretical frameworks: ‘market reform’ and ‘political competition’ theory. Only by combining key insights from each do we get a full explanation of the pressures that generated Ukraine's challenge to illiberalism in 2004. We examine this story with a particular focus on the crisis-prone nature of ‘competitive authoritarian regimes’ and the related strategic calculations of business elites.
This paper applies the insights of obsolescing bargaining theory to a situation in which a host country interacted with both multinational corporations and an international organization, the World Bank. Drawing on resource curse literature and the Rubinstein bargaining model, we demonstrate the continued usefulness of obsolescing bargaining theory by explaining why the World Bank had to renegotiate its initial bargain with Chad in the Chad-Cameroon Oil Pipeline Project. The paper explores how specific bargaining parameters changed over time in this case and suggests how resource curse dynamics and their impact on domestic politics might be particularly relevant for bargaining between host countries and international actors. The case study serves as a warning to international financial institutions and corporations alike with regard to the ways in which obsolescing bargains can arise in the contemporary global political-economy.
The history of life is replete with apparent order. Much of this order may reflect the deterministic causes conventionally invoked, but we cannot be sure until we measure and subtract the order that arises in simple random systems. Consequently, we have constructed a random model that builds evolutionary trees by allowing lineages to branch and become extinct at equal probabilities. We proceed by dividing our simulated tree into clades and by comparing their sizes and shapes with the patterns exhibited by “real” clades as recorded by fossils.
We regard the similarity of real and random clades as the outstanding result of this comparison. In both real and random systems, extinct clades arising after an “ecological barrel” had been filled have their maximum diversity at the midpoint of their duration; clades arising during the initial “filling” reach an earlier climax during this preequilibrial period of rapid diversification. However, some potential differences also emerge. Clades still living are much larger than extinct clades. We may attribute this to the morphological superiority of survivors, but we can also simulate it in a model that chooses the originators of clades at random. Real clades undergo greater fluctuations in diversity than do random clades, but the effect is not marked.
We discuss the stellar halos of massive elliptical galaxies, as revealed by our ambitious integral-field spectroscopic survey MASSIVE. We show that metallicity drops smoothly as a function of radius out to ~ 2.5 Re, while the [α/Fe] abundance ratios stay flat. The stars in the outskirts likely formed rapidly (to explain the high ratio of alpha to Fe) but in a relatively shallow potential (to explain the low metallicities). This is consistent with expectations for a two-phase growth of massive galaxies, in which the second phase involves accretion of small satellites. We also show some preliminary study of the gas content of these most MASSIVE galaxies.
Refrigeration, air conditioning, and other cooling requirements in buildings, industry, and transportation sectors account for about 10 quads of U.S. primary energy consumption. Therefore, advanced technologies for space cooling in buildings and vehicles – as well as for refrigeration in residential, commercial, and industrial applications – that are more energy efficient, avoid net direct greenhouse gas emissions, reduce lifecycle costs, and can impact large markets are needed. Although current technologies are reaching their efficiency limits, thermoelectric (TE) materials can be used for cooling applications and have potential for significant improvements. Compared to traditional bulk phase TE materials, literature results suggest that nanometer-scale materials allow additional opportunities to improve the efficiency of TE materials. Aerogels are one type of nano-material that offers opportunities to increase the efficiency of TE materials by controlling particle size, particle composition and by reducing the thermal conductivity. Bismuth telluride (Bi2Te3) is the most studied TE material and our objective was to produce bismuth telluride aerogels with controlled microstructures and thermal conductivities to increase the TE figure of merit. Aspen Aerogels developed a novel synthesis method to prepare Bi2Te3 aerogels using the principles of colloidal chemistry and sol-gel chemistry. The reaction conditions were investigated and optimized so that gels could be obtained at low reaction temperatures. The gels were aged and dried using supercritical CO2. The aerogels were characterized by BET, XRD, and SEM. The best aerogels were hot pressed and Seebeck coefficients were determined. The synthetic approach developed and the properties of the aerogels will be presented and compared with Bi2Te3 aerogels and materials prepared by other methods.
We examined interventions to optimize piperacillin-tazobactam use at 4 hospitals. Interventions for rotating house staff did not affect use. We could target empiric therapy in only 35% of cases. Because prescribing practices seemed to be institution specific, interventions should address attitudes of local prescribers. Interventions should target empiric therapy and ordering of appropriate cultures.
In 1973, then-Chief Justice Warren Burger, at the suggestion of his administrative assistant, Mark Cannon, created the Judicial Fellows Program to allow scholars to engage in “challenging work for a year” at the Supreme Court and other federal judicial agencies (Tobias 1996, 510). The program is designed to attract, in Justice Ruth Bader Ginsburg's words, “bright-minded, caring, uncommonly fine humans, people who remain … in permanent fellowship with the Federal Judiciary” after their year (Ginsburg 1998, 3).