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Family members are often involved in the provision of care to a relative at some point in their life. Their role becomes inherently complex when their care recipient is interested in seeking medical assistance in dying (MAID). As assisted death for “grievous and irremediable conditions” was legalized in Canada in 2016, the perspectives of family caregivers have received little attention. To best support caregivers to individuals seeking assisted dying, healthcare practitioners must first understand the perspectives of family caregivers in this context. The objective of this qualitative study was to explore the experiences and support needs of family caregivers who are or who have provided care to individuals who are seeking or have sought MAID.
Methods
This study employed a qualitative descriptive design. Family caregivers supporting individuals living with grievous and irremediable conditions were recruited through social media outlets and support organizations. Data were collected through semi-structured telephone interviews and online surveys. Data were transcribed and analyzed using thematic analysis.
Results
The study included 11 participants, comprising spouses, parents, and adult children. The research identified three prevalent themes: the caregiver experience including roles and responsibilities and the impact of their role; the MAID experience including the process and their thoughts and feelings about MAID; and caregiver insight into supports and services viewed as valuable or needed for the MAID process.
Significance of results
Study findings may assist in the provision and development of best practice resources and guidelines to support healthcare professionals involved in the delivery of MAID. Specifically, caregivers need to be supported in the context of their caregiving responsibilities to minimize the impact on their own lives and optimize their MAID experience.
Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.
Diet has a major influence on the composition and metabolic output of the gut microbiome. Higher-protein diets are often recommended for older consumers; however, the effect of high-protein diets on the gut microbiota and faecal volatile organic compounds (VOC) of elderly participants is unknown. The purpose of the study was to establish if the faecal microbiota composition and VOC in older men are different after a diet containing the recommended dietary intake (RDA) of protein compared with a diet containing twice the RDA (2RDA). Healthy males (74⋅2 (sd 3⋅6) years; n 28) were randomised to consume the RDA of protein (0⋅8 g protein/kg body weight per d) or 2RDA, for 10 weeks. Dietary protein was provided via whole foods rather than supplementation or fortification. The diets were matched for dietary fibre from fruit and vegetables. Faecal samples were collected pre- and post-intervention for microbiota profiling by 16S ribosomal RNA amplicon sequencing and VOC analysis by head space/solid-phase microextraction/GC-MS. After correcting for multiple comparisons, no significant differences in the abundance of faecal microbiota or VOC associated with protein fermentation were evident between the RDA and 2RDA diets. Therefore, in the present study, a twofold difference in dietary protein intake did not alter gut microbiota or VOC indicative of altered protein fermentation.
Surveillance for acute flaccid paralysis (AFP) cases are essential for polio eradication. However, as most poliovirus infections are asymptomatic and some regions of the world are inaccessible, additional surveillance tools require development. Within England and Wales, we demonstrate how inclusion of environmental sampling (ENV) improves the sensitivity of detecting both wild and vaccine-derived polioviruses (VDPVs) when compared to current surveillance. Statistical modelling was used to estimate the spatial risk of wild and VDPV importation and circulation in England and Wales. We estimate the sensitivity of each surveillance mode to detect poliovirus and the probability of being free from poliovirus, defined as being below a pre-specified prevalence of infection. Poliovirus risk was higher within local authorities in Manchester, Birmingham, Bradford and London. The sensitivity of detecting wild poliovirus within a given month using AFP and enterovirus surveillance was estimated to be 0.096 (95% CI 0.055–0.134). Inclusion of ENV in the three highest risk local authorities and a site in London increased surveillance sensitivity to 0.192 (95% CI 0.191–0.193). The sensitivity of ENV strategies can be compared using the framework by varying sites and the frequency of sampling. The probability of being free from poliovirus slowly increased from the date of the last case in 1993. ENV within areas thought to have the highest risk improves detection of poliovirus, and has the potential to improve confidence in the polio-free status of England and Wales and detect VDPVs.
Atmospheric emissions of nitrogen (N) from New Zealand dairy farms are significant but have the potential to be affected by manure management prior to land application. The current work examined whether reducing cattle manure dry matter (DM) from 0.16 high DM (HDM) to 0.06 low DM (LDM), to enhance infiltration and reduce ammonia (NH3) emissions when applied to grassland, would affect nitrous oxide (N2O) emissions. Pasture was cut, simulating grazing, and either amended with HDM (173 kg N/ha) or LDM manure (48 kg N/ha) or left unamended. Ammonia emissions from HDM manure were higher than from LDM manure, as a flux or as a percentage of total ammoniacal nitrogen (TAN, i.e. NH3 + NH4+) applied, due to more TAN being retained near the soil surface and the higher soil surface pH under HDM manure treatment. Cumulative N2O emissions over 37 days from HDM plots were higher than from the control but not from the LDM plots. After 5 days, the daily N2O emission rate was larger from HDM plots than from LDM and control plots. The N2O fluxes from LDM and HDM treatments did not differ, either as a proportion of TAN applied or as a proportion of total-N applied. Increasing DM contributed to reductions in both oxygen (O2) availability and relative gas diffusivity, and thus potentially N2O production. Under the conditions of the current study, lower manure DM content reduced NH3 emissions but did not increase cumulative losses of N2O.
In the present work, a stability analysis of the bottom boundary layer under solitary waves based on energy bounds and non-modal theory is performed. The instability mechanism of this flow consists of a competition between streamwise streaks and two-dimensional perturbations. For lower Reynolds numbers and early times, streamwise streaks display larger amplification due to their quadratic dependence on the Reynolds number, whereas two-dimensional perturbations become dominant for larger Reynolds numbers and later times in the deceleration region of this flow, as the maximum amplification of two-dimensional perturbations grows exponentially with the Reynolds number. By means of the present findings, we can give some indications on the physical mechanism and on the interpretation of the results by direct numerical simulation in Vittori & Blondeaux (J. Fluid Mech., vol. 615, 2008, pp. 433–443) and Özdemir et al. (J. Fluid Mech., vol. 731, 2013, pp. 545–578) and by experiments in Sumer et al. (J. Fluid Mech., vol. 646, 2010, pp. 207–231). In addition, three critical Reynolds numbers can be defined for which the stability properties of the flow change. In particular, it is shown that this boundary layer changes from a monotonically stable to a non-monotonically stable flow at a Reynolds number of $Re_{\unicode[STIX]{x1D6FF}}=18$.
On 23 May 2011, CDC identified a multistate cluster of Salmonella Heidelberg infections and two multidrug-resistant (MDR) isolates from ground turkey retail samples with indistinguishable pulsed-field gel electrophoresis patterns. We defined cases as isolation of outbreak strains in persons with illness onset between 27 February 2011 and 10 November 2011. Investigators collected hypothesis-generating questionnaires and shopper-card information. Food samples from homes and retail outlets were collected and cultured. We identified 136 cases of S. Heidelberg infection in 34 states. Shopper-card information, leftover ground turkey from a patient's home containing the outbreak strain and identical antimicrobial resistance profiles of clinical and retail samples pointed to plant A as the source. On 3 August, plant A recalled 36 million pounds of ground turkey. This outbreak increased consumer interest in MDR Salmonella infections acquired through United States-produced poultry and played a vital role in strengthening food safety policies related to Salmonella and raw ground poultry.
To determine adherence to nutritional guidelines by pregnant women in New Zealand and maternal characteristics associated with adherence.
Design
A cohort of the pregnant women enrolled into New Zealand’s new birth cohort study, Growing Up in New Zealand.
Setting
Women residing within a North Island region of New Zealand, where one-third of the national population lives.
Subjects
Pregnant women (n 5664) were interviewed during 2009–2010. An FFQ was administered during the face-to-face interview.
Results
The recommended daily number of servings of vegetables and fruit (≥6) were met by 25 % of the women; of breads and cereals (≥6) by 26 %; of milk and milk products (≥3) by 58 %; and of lean meat, meat alternatives and eggs (≥2) by 21 %. One in four women did not meet the recommendations for any food group. Only 3 % met all four food group recommendations. Although adherence to recommendation for the vegetables/fruit group did not vary by ethnicity (P=0·38), it did vary for the breads/cereals, milk/milk products and meat/eggs groups (all P<0·001). Adherence to recommendations for the vegetables/fruit group was higher among older women (P=0·001); for the breads/cereals group was higher for women with previous children (P<0·001) and from lower-income households (P<0·001); and for the meat/eggs group was higher for women with previous children (P=0·003) and from lower-income households (P=0·004).
Conclusions
Most pregnant women in New Zealand do not adhere to nutritional guidelines in pregnancy, with only 3 % meeting the recommendations for all four food groups. Adherence varies more so with ethnicity than with other sociodemographic characteristics.
Nitrous oxide (N2O) emissions associated with urine nitrogen (N) deposition during grazing are a major component of greenhouse gas emissions from domestic livestock. The present study investigated the relationship between urine N loading rate and the efficacy of a nitrification inhibitor, dicyandiamide (DCD), on cumulative N2O emissions from a grassland soil in Ireland over 80 and 360-day periods in 2009/10 and 2010/11. A diminishing curvilinear relationship between urine N rate and cumulative N2O emissions was observed in both years. Despite this increase in cumulative N2O emissions, the emission factor (EF3) for N2O decreased with increasing urine N rate from, on average, 0·24 to 0·10% (urine applied at 300 and 1000 kg N/ha, respectively), during an 80-day measurement period. This was probably the result of a factor other than N, such as carbon (C), limiting the production of N2O. The efficacy of DCD varied with urine N loading rate, and inter-annual variability in efficacy was also observed. Dicyandiamide was effective at reducing N2O production for 50–80 days after urine application, which accounted for the major period of elevated daily flux. However, DCD was ineffective at reducing N2O production after this period, which was likely a result of its removal from the soil via degradation and leaching.
The Australian Square Kilometre Array Pathfinder (ASKAP) will give us an unprecedented opportunity to investigate the transient sky at radio wavelengths. In this paper we present VAST, an ASKAP survey for Variables and Slow Transients. VAST will exploit the wide-field survey capabilities of ASKAP to enable the discovery and investigation of variable and transient phenomena from the local to the cosmological, including flare stars, intermittent pulsars, X-ray binaries, magnetars, extreme scattering events, interstellar scintillation, radio supernovae, and orphan afterglows of gamma-ray bursts. In addition, it will allow us to probe unexplored regions of parameter space where new classes of transient sources may be detected. In this paper we review the known radio transient and variable populations and the current results from blind radio surveys. We outline a comprehensive program based on a multi-tiered survey strategy to characterise the radio transient sky through detection and monitoring of transient and variable sources on the ASKAP imaging timescales of 5 s and greater. We also present an analysis of the expected source populations that we will be able to detect with VAST.
A heuristic greedy algorithm is developed for efficiently tiling spatially dense redshift surveys. In its first application to the Galaxy and MassAssembly (GAMA) redshift survey we find it rapidly improves the spatial uniformity of our data, and naturally corrects for any spatial bias introduced by the 2dF multi-object spectrograph. We make conservative predictions for the final state of the GAMA redshift survey after our final allocation of time, and can be confident that even if worse than typical weather affects our observations, all of our main survey requirements will be met.
Feeding n-3 long-chain polyunsaturated fatty acids (LCPUFA) to gilts or sows has shown different responses to litter growth, pre-weaning mortality and subsequent reproductive performance of the sow. Two hypotheses were tested: (1) that feeding a marine oil-based supplement rich in protected n-3 LCPUFAs to gilts in established gestation would improve the growth performance of their litters; and (2) that continued feeding of the supplement during lactation and after weaning would offset the negative effects of lactational catabolism induced, using an established experimental model involving feed restriction of lactating primiparous sows. A total of 117 primiparous sows were pair-matched at day 60 of gestation by weight, and when possible, litter of origin, and were allocated to be either control sows (CON) fed standard gestation and lactation diets, or treated sows (LCPUFA) fed the standard diets supplemented with 84 g/day of a n-3 LCPUFA rich supplement, from day 60 of first gestation, through a 21-day lactation, and until euthanasia at day 30 of their second gestation. All sows were feed restricted during the last 7 days of lactation to induce catabolism, providing a background challenge against which to determine beneficial effects of n-3 LCPUFA supplementation on subsequent reproduction. In the absence of an effect on litter size or birth weight, n-3 LCPUFA tended to improve piglet BW gain from birth until 34 days after weaning (P = 0.06), while increasing pre-weaning mortality (P = 0.05). It did not affect energy utilization by the sow during lactation, thus not improving the catabolic state of the sows. Supplementation from weaning until day 30 of second gestation did not have an effect on embryonic weight, ovulation rate or early embryonic survival, but did increase corpora lutea (CL) weight (P = 0.001). Eicosapentaenoic acid and docosahexaenoic acid (DHA) levels were increased in sow serum and CL (P < 0.001), whereas only DHA levels increased in embryos (P < 0.01). In conclusion, feeding n-3 LCPUFA to gilts tended to improve litter growth, but did not have an effect on overall subsequent reproductive performance.
Accurate field data on the paddock area affected by cow urine depositions are critical to the estimation and modelling of nitrogen (N) losses and N management in grazed pasture systems. A new technique using survey-grade global positioning system (GPS) technology was developed to precisely measure the paddock spatial area coverage, diversity and distribution of dairy cattle urine patches in grazed paddocks over time. A 4-year study was conducted on the Lincoln University Dairy Farm (LUDF), Canterbury, New Zealand, from 2003 to 2007. Twelve field plots, each 100 m2 in area, were established on typical grazing areas of the farm. All urine and dung deposits within the plots were visually identified, the pasture response area (radius) measured and position marked with survey-grade GPS. The plots were grazed as part of the normal grazing rotation of the farm and urine and dung deposits measured at 12-week intervals. The data were collated using spatial (GIS) software and an assessment of annual urine patch coverage and spatial distribution was made. Grazing intensities ranged from 17 645 to 30 295 cow grazing h/ha/yr. Mean annual areas of urine patches ranged from 0·34 to 0·40 m2 (4-year mean 0·37±0·009 m2), with small but significant variation between years and seasons. Mean annual urine patch numbers were 6240±124 patches/ha/yr. The mean proportional area coverage for a single sampling event or season was 0·058 and the mean proportional annual urine patch coverage was 0·232±0·0071. There was a strong linear relationship between annual cow grazing h/ha and urine patch numbers/ha (R2=0·69) and also annual urine patch area coverage (R2=0·77). Within the stocking densities observed in this study, an annual increase of 10 000 cow grazing h/ha increased urine patch numbers by 1800 urine patches/ha/yr and annual urine patch area coverage by 0·07. This study presents new quantitative data on urine patch size, numbers and the spatial coverage of patches on a temporal basis.
New Zealand is currently the only major fruit producing country in the world that is free of economically important fruit flies. As part of the effort to maintain this status, there is a need to supplement quarantine decision-making procedures with a means of rapidly identifying immature life stage infestations to the species level. Here we describe a molecular method that achieves this, using simple restriction patterns of ribosomal DNA (rDNA) as diagnostic markers. The 18S and 18S plus internal transcribed spacer (ITS) regions were amplified from larval DNA by the polymerase chain reaction (PCR). Nineteen species, spanning four genera (including five subgenera of Bactrocera) were analysed. Restriction analysis of the 18S PCR product provided poor resolution, even at the generic level. Digestion of the 18S + ITS PCR product, however, generated thirteen diagnostic haplotypes as defined by the composite restriction patterns from RsaI, Sau3a HaeIII and AluI. No variation was detected at these restriction sites within or between populations. Twenty two restriction enzymes have been screened, but diagnostic RFLPs have yet to been found for six out of the ten Bactrocera (Bactrocera) species; B. passiflorae (Froggatt) cannot be distinguished from B. facialis (Coquillet), nor B. kirki (Froggatt) from B. trilineola (Froggatt) or B. neohumeralis (Hardy) from B. tryoni (Froggatt). Geographic origin could assist in distinguishing the first four species, but the latter pair are very closely related with overlapping origins, hosts and adult morphology. All six species, however, are considered high risk with respect to their likely establishment in New Zealand. Therefore diagnosis based on this molecular technique would support the same quarantine decision. We consider this method could be useful as a diagnostic technique and discuss directions for further development.