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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.
Patients presenting with intentional ingestion are often unreliable historians; thus, collateral information is essential. This may be obtained from family, friends or emergency medical service personnel and include observed and reported behavior, medication history or empty pill bottles found at the scene. History and physical examination are crucial to establish a diagnosis and to guide treatment. Co-ingestions are common in intentional overdoses, specifically acetaminophen and salicylate, which are commonly available over the counter in multiple preparations.
Stable water isotope records of six firn cores retrieved from two adjacent plateaus on the northern Antarctic Peninsula between 2014 and 2016 are presented and investigated for their connections with firn-core glacio-chemical data, meteorological records and modelling results. Average annual accumulation rates of 2500 kg m−2 a−1 largely reduce the modification of isotopic signals in the snowpack by post-depositional processes, allowing excellent signal preservation in space and time. Comparison of firn-core and ECHAM6-wiso modelled δ18O and d-excess records reveals a large agreement on annual and sub-annual scales, suggesting firn-core stable water isotopes to be representative of specific synoptic situations. The six firn cores exhibit highly similar isotopic patterns in the overlapping period (2013), which seem to be related to temporal changes in moisture sources rather than local near-surface air temperatures. Backward trajectories calculated with the HYSPLIT model suggest that prominent δ18O minima in 2013 associated with elevated sea salt concentrations are related to long-range moisture transport dominated by westerly winds during positive SAM phases. In contrast, a broad δ18O maximum in the same year accompanied by increased concentrations of black carbon and mineral dust corresponds to the advection of more locally derived moisture with northerly flow components (South America) when the SAM is negative.
Molière’s extraordinary success between 1659 and 1673 was due not only to his virtuosity as a dramatist, his comic talent or his exploitation of current affairs; it was due also to his feeling for an ‘event’ and his ability to capture attention. This contribution studies his unprecedented investment in publicity, which mobilised a multitude of forms and mediums, as well as its reliance on a network of agents with varied motivations. Literary history has long tried to distinguish between Molière’s friends and enemies by relying on their praise or criticism of him. This contribution studies them rather as agents who, depending on the context, opportunity and their own interests, sometimes acted for and sometimes against Molière, without this indicating either personal enmity or ties of affection.
Multiple pregnancies, especially those involving monochorionic placentation, have increased risks compared to singleton pregnancies. Better understanding of the angioarchitecture and vascular function of monochorionic placentae will help describe the pathophysiology of disease in monochorionic pregnancies. Research in this area will guide risk stratification, non-invasive diagnosis and treatment strategies in MCDA twins, notably in relation to twin-twin transfusion syndrome (TTTS) and selective growth restriction. Here, we describe MRI and ultrasound advances in placental vascular imaging, including blood oxygenation level dependant (BOLD-MRI), low flow Doppler, and the development of high intensity focused ultrasound (HIFU) as a non-invasive treatment for TTTS and twin reversed arterial perfusion (TRAP) sequence in monochorionic twins.
Objectives: This study aimed to evaluate the influence of lower limb loss (LL) on mental workload by assessing neurocognitive measures in individuals with unilateral transtibial (TT) versus those with transfemoral (TF) LL while dual-task walking under varying cognitive demand. Methods: Electroencephalography (EEG) was recorded as participants performed a task of varying cognitive demand while being seated or walking (i.e., varying physical demand). Results: The findings revealed both groups of participants (TT LL vs. TF LL) exhibited a similar EEG theta synchrony response as either the cognitive or the physical demand increased. Also, while individuals with TT LL maintained similar performance on the cognitive task during seated and walking conditions, those with TF LL exhibited performance decrements (slower response times) on the cognitive task during the walking in comparison to the seated conditions. Furthermore, those with TF LL neither exhibited regional differences in EEG low-alpha power while walking, nor EEG high-alpha desynchrony as a function of cognitive task difficulty while walking. This lack of alpha modulation coincided with no elevation of theta/alpha ratio power as a function of cognitive task difficulty in the TF LL group. Conclusions: This work suggests that both groups share some common but also different neurocognitive features during dual-task walking. Although all participants were able to recruit neural mechanisms critical for the maintenance of cognitive-motor performance under elevated cognitive or physical demands, the observed differences indicate that walking with a prosthesis, while concurrently performing a cognitive task, imposes additional cognitive demand in individuals with more proximal levels of amputation.
Tall fescue vegetative filter strips 0.5 to 4.0 m wide were evaluated for their ability to reduce losses of metolachlor, metribuzin, and runoff (water and sediment) in conventionally tilled soybean. Differences in the parameters studied were significant between filter and no filter strips, regardless of filter strip width. Two days after treatment, metribuzin concentration in runoff from the unfiltered treatment was 231 ng ml−1; filter strips reduced this amount to 119 ng ml−1 or less. Similar trends were observed with metolachlor, with concentrations of 1,009 ng ml−1 from the unfiltered, whereas filter strips of any width reduced this to 523 ng ml−1 or less. Metribuzin loss during the growing season was 41 g ai ha−1, or 9.8% of the amount applied when no filter strip was present. The addition of a filter strip, regardless of width, reduced cumulative metribuzin losses to 11 g ha−1 or less. Similar results were noted with metolachlor. Filter strips, regardless of width, reduced cumulative runoff and sediment loss at least 46 and 83%, respectively.
Early callous–unemotional behaviours identify children at risk for
antisocial behaviour. Recent work suggests that the high heritability of
callous–unemotional behaviours is qualified by interactions with positive
parenting.
Aims
To examine whether heritable temperament dimensions of fearlessness and
low affiliative behaviour are associated with early callous–unemotional
behaviours and whether parenting moderates these associations.
Method
Using an adoption sample (n=561), we examined pathways
from biological mother self-reported fearlessness and affiliative
behaviour to child callous–unemotional behaviours via observed child
fearlessness and affiliative behaviour, and whether adoptive parent
observed positive parenting moderated pathways.
Results
Biological mother fearlessness predicted child callous–unemotional
behaviours via earlier child fearlessness. Biological mother low
affiliative behaviour predicted child callous–unemotional behaviours,
although not via child affiliative behaviours. Adoptive mother positive
parenting moderated the fearlessness to callous–unemotional behaviour
pathway.
Conclusions
Heritable fearlessness and low interpersonal affiliation traits
contribute to the development of callous–unemotional behaviours. Positive
parenting can buffer these risky pathways.
A method is presented for determining the potential flow around bodies of revolution, at incidence, in uniform, incompressible, flow. This method utilises polynomial distributions of both sources and doublets, in the manner of Fuhrmann, and gives considerable advantage over existing techniques. In particular, when compared with the method of Nielsen, in a typical case, the computer storage requirement is reduced by a factor of eleven. Compared with panel methods the saving is very much greater.
Unlike the method of Landweber, both body surface and flow field conditions are obtainable and it would appear that the new method is ideally suited to the ‘store trajectory’ application in place of the existing discrete source method.
Post-World War I Federal Reserve System policy focused on reducing price levels. Faith in liquidationist ideas led Federal Reserve officials to maintain tight-money policies during the depression of 1920–1921. Farmers suffering through this economic crisis objected to contemporary monetary policy. Organized labor and leading Progressive reformer Robert M. La Follette Sr. seconded their criticism. Postwar challenges to the nation’s financial leadership and its priorities bore tangible results by producing a number of notable reforms, including modifications of Federal Reserve policy and the Agricultural Credits Act of 1923. In the absence of similar political pressure during the Great Depression, the Federal Reserve System adhered to liquidationist ideas and did not pursue monetary expansion.
Rancho La Brea is unquestionably the most famous fossil deposit in North America, and its fauna occupies a key position in vertebrate paleontology as the basis for the Rancholabrean Land Mammal Age. The 23 acres now known as Hancock Park yielded the bulk of fossil specimens from this locality. A minimum of 518 taxa have been identified to date including 79 algae (all but one of which are diatoms), 72 vascular plants, 9 nonmarine mollusks (13 taxa of marine mollusks were carried to the site by early Indians), 135 arthropods, 27 lower vertebrates, 138 birds, and 58 mammals. A detailed list of the biota, too lengthy for inclusion here, is available from the authors on request.
Understanding the nutritional demands on serving military personnel is critical to inform training schedules and dietary provision. Troops deployed to Afghanistan face austere living and working environments. Observations from the military and those reported in the British and US media indicated possible physical degradation of personnel deployed to Afghanistan. Therefore, the present study aimed to investigate the changes in body composition and nutritional status of military personnel deployed to Afghanistan and how these were related to physical fitness. In a cohort of British Royal Marines (n 249) deployed to Afghanistan for 6 months, body size and body composition were estimated from body mass, height, girth and skinfold measurements. Energy intake (EI) was estimated from food diaries and energy expenditure measured using the doubly labelled water method in a representative subgroup. Strength and aerobic fitness were assessed. The mean body mass of volunteers decreased over the first half of the deployment ( − 4·6 (sd 3·7) %), predominately reflecting fat loss. Body mass partially recovered (mean +2·2 (sd 2·9) %) between the mid- and post-deployment periods (P< 0·05). Daily EI (mean 10 590 (sd 3339) kJ) was significantly lower than the estimated daily energy expenditure (mean 15 167 (sd 1883) kJ) measured in a subgroup of volunteers. However, despite the body mass loss, aerobic fitness and strength were well maintained. Nutritional provision for British military personnel in Afghanistan appeared sufficient to maintain physical capability and micronutrient status, but providing appropriate nutrition in harsh operational environments must remain a priority.
There are not many public health issues where views are as extremely polarized as those concerning vaccination policies. Ever since its Fast Track approval by the U.S. Food and Drug Administration (FDA) in 2006, Merck's human papilloma virus (HPV) vaccine Gardasil has been sparking controversy. Initially, the criticism has been focused at Merck, due to their overly aggressive marketing strategies and lobbying campaigns. According to a 2007 editorial in Nature Biotechnology, Surrounded by a chorus of disapproval, Merck cracked. As Nature Biotechnology went to press, the company announced a cessation of all efforts to lobby for US state laws requiring compulsory vaccination. Subsequently, questions have been raised whether it was appropriate for vaccine manufacturers to partake in public health policies when their conflicts of interests were so obvious. Some of their advertising campaign slogans, such as cervical cancer kills x women per year and your daughter could become one less life affected by cervical cancer, seemed more designed to promote fear rather than evidence-based decision making about the potential benefits of the vaccine versus any risks.
This chapter reviews the major advances in autosomal recessive and autosomal dominant ataxias, discusses the use of genetic tests in these disorders, and summarizes some current ideas regarding pathogenesis. It also presents a list of the autosomal recessive ataxias that have been genotypically characterized to date. Mutations in ataxia with isolated vitamin E deficiency (AVED) are scattered throughout the gene and some of them may be associated with a mild phenotype, late onset, retinitis pigmentosa, and retained reflexes. A syndrome of ataxia associated with optic atrophy, visual loss, and cochlear degeneration has been mapped to chromosome. The spinocerebellar ataxia (SCAs) exhibits many phenotypic similarities so that it is almost impossible to diagnose the genotype from the phenotype alone. Many persons from families with ataxia will request predictive testing and occasionally prenatal testing. Disease-modifying therapies are under investigation and include antioxidants and drugs that may modify excitotoxicity or apoptosis.