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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.
The mineral in monomineralic glauconite pellets is an iron-rich mixed-layer illite-smectite (here called glauconite), often composed almost entirely of illite layers. The nature of the interlayering is closely analagous to that of aluminous illite-smectite and varies with the proportions of the layer types: >30 per cent smectite, randomly interstratified; 15–30 per cent smectite, allevardite-like ordering; < 15 per cent smectite, ‘IMII’ ordering.
Glauconite is analagous to aluminous illite-smectite chemically as well as structurally. A good correlation has been found between the number of potassium atoms per O10(OH)2 in structural formulas calculated from the chemical analyses and the proportion of illite layers as determined by X-ray powder diffraction methods. This relationship indicates a remarkably systematic increase in the potassium content of the illite layers with an increasing proportion of illite layers. This feature and the existence of ordered interlayering at high proportions of illite layers can be explained by crystal-chemical effects of illite layers on neighboring smectite layers. Glauconite differs from aluminous illite-smectite in that glauconite contains significantly less potassium per illite layer than does aluminous illite-smectite with the same proportion of illite layers except near the pure illite composition. The strength with which the interlayer potassium is held and the ease of conversion of smectite to illite layers in glauconite may be attributed to its 1M structure and, perhaps, to its high octahedral iron content, which lead to stronger bonding of potassium by allowing a higher tilt angle of the O-H axis of hydroxyls adjacent to the potassium ion.
The apparent octahedral cation occupancy in excess of two-thirds of the octahedral positions in many glauconites appears largely attributable to the presence of significant amounts of interlayer hydroxy-iron, aluminum and magnesium complexes in the smectite layers.
The standard method of assessing the available portion of the nutrient reservoir of a forest soil is to use a neutral salt solution, such as NH4OAc, to extract the exchangeable plus dissolved ions, which are analyzed and considered available. This approach, designed for evaluating nutrients available for the short growth term of agricultural crops, is inadequate for assessing the nutrient pool of forests where tree growth term may reach 100 yr or more.
Soil nutrient reservoirs were evaluated in two forest soils for K, Na, Ca, Mg and Fe, using an approach based on continuous extraction of the elements and kinetic analyses of the extraction rate curves. The analyses of the curves indicate that K, Na, Ca and Fe are each released at four separateconstant rates, and Mg is released at three separate constant rates. By analogy with similar kinetic studies done on monomineralic layer silicate samples, each separate extraction rate is thought to correspond to a single type of bond site in the soil. Higher extraction rates indicate greater ease of removal and are interpreted as indicating a higher degree of availability relative to the extractant.
The available K reserves of the Everett soil evaluated by standard methods, compared with annual net K uptake rates of its forest system, indicates growth limiting K deficiency in 12–17 yr. K availability assessed by kinetic analyses indicates about 100 yr supply of K is available.
Herbicide resistance in weeds significantly threatens crop production in the United States. The introduction of dicamba-resistant soybean and cotton stacked with other herbicide tolerance traits has provided farmers with the flexibility of having multiple herbicide options to diversify their weed management practices and delay resistance evolution. XtendiMax® herbicide with VaporGrip® Technology is a dicamba formulation registered for use on dicamba-resistant soybean and cotton crops by the U.S. Environmental Protection Agency (EPA). One of the terms of its registration includes an evaluation of inquiries on reduced weed control efficacy by growers or users of XtendiMax for suspected weed resistance. A total of 3,555 product performance inquiries (PPIs) were received from 2018 to 2021 regarding reduced weed control efficacy by dicamba. Following the criteria recommended by EPA for screening of suspected resistance in the field, a total of 103 weed accessions from 63 counties in 13 states were collected for greenhouse testing over those 4 yr. Weed accessions for greenhouse testing were collected only in states where resistance to dicamba was not yet confirmed in the weed species under investigation. The accessions, which consisted primarily of waterhemp and Palmer amaranth, were treated with dicamba at rates of 560 g ae ha−1 and 1,120 g ae ha−1. All weed accessions, except for one accession each of Palmer amaranth and waterhemp, were controlled by ≥90% with dicamba at 21 d after treatment in the greenhouse.
The social cost of greenhouse gases is important in many regulatory impact analyses. However, calculations of the social cost of greenhouse gases are highly complex and periodically revisited. We offer seven recommendations to improve current estimates. These include recommendations to use both country-level and global measures of the social cost of greenhouse gases, to use country-specific values for monetizing climate damages, to represent uncertainties by reporting distributions instead of using only central values, and to conduct a temporal distributional analysis that shows the magnitudes of climate damages across generations. We also provide recommendations for the discount rates that should be used when estimating the social cost of greenhouse gases, and the appropriate discount rates for regulatory impact analyses that include the social cost of greenhouse gases.
Herbicide resistance in Palmer amaranth and waterhemp is on the rise and poses a great concern to growers in the United States. A multistate screening was conducted for these two weed species in the United States to assess their sensitivity to glufosinate, dicamba, and 2,4-D. The screening was designed to understand the weed sensitivity landscape and emerging trends in resistance evolution by testing each herbicide at its respective label rate and at half the label rate. A total of 303 weed seed accessions from 21 states representing 162 Palmer amaranth and 141 waterhemp seeds were collected from grower fields in 2019 and screened in greenhouse conditions. Statistical power of different sample sizes and probability of survivors in each accession were estimated for each species and herbicide treatment. Overall, the efficacy of glufosinate, dicamba, and 2,4-D against all these accessions was excellent, with greater than 90% average injury. The variability in herbicide injury, if any, was greater with half the label rate of 2,4-D in some Palmer amaranth accessions, while waterhemp accessions had exhibited variable sensitivity with half the label rate of dicamba and glufosinate. The study highlights the value of monitoring weeds for herbicide sensitivity across broader landscape and the importance of glufosinate, dicamba, and 2,4-D herbicides in managing troublesome weeds as part of a diversified weed control program integrated with other chemical, mechanical and cultural practices.
Paleoproterozoic massive Cu-Zn±Pb±Au±Ag sulphide deposits metamorphosed to the middle-upper amphibolite facies in central-south Colorado formed in a volcanic arc setting on the edge of the Yavapai crustal province. Previously published U-Pb ages on spatially related granitoids range from ∼1.9 to ∼1.1 Ga, while Pb isotope studies on galena from massive sulphides suggest mineralization formed at around 1.8–1.7 Ga. Some deposits in the Dawson-Green Mountain trend (DGMT) and the Gunnison belt are composed of Cu-Zn-Au-(Pb-Ag) mineralization that were overprinted by later Au-(Ag-Cu-Bi-Se-Te) mineralization. Sulphide mineralization is spatially related to amphibolite and bimodal, mafic-felsic volcanic rocks (gabbro, amphibolite, rhyolite and dacite) and granitoids, but it occurs mostly in biotite-garnet-quartz±sillimanite±cordierite schists and gneisses, spatially related to nodular sillimanite rocks, and in some locations, exhalative rocks (iron formations, gahnite-rich rocks and quartz-garnetite). The major metallic minerals of the massive sulphides include chalcopyrite, sphalerite, pyrite, pyrrhotite, and magnetite, with minor galena and gahnite. Altered rocks intimately associated with mineralization primarily consist of various amphiboles (gedrite, tremolite and hornblende), gahnite, biotite, garnet, cordierite, carbonate and rare högbomite. The Zn/Cd ratios of sphalerite (44 to 307) in deposits in the DGMT fall within the range of global volcanogenic massive sulphide (VMS) deposits but overlap with sphalerite from sedimentary exhalative (Sedex) deposits. Sulphur isotope values of sulphides (δ34S = −3.3 to +6.5) suggest sulphur was largely derived from magmatic sources, and that variations in isotopic values resulting from thermochemical sulphate reduction are due to small differences in physicochemical conditions. The preferred genetic model is for the deposits to be bimodal-mafic (Gunnison) to mafic-siliciclastic VMS deposits (Cotopaxi, Cinderella-Bon Ton, DGMT).
Cowvine (Ipomoea lonchophylla J.M. Black) is a native and widely spread summer broadleaf weed in Australia. It contains glycoresins, which are toxic to livestock. However, limited information is available on seed germination ecology and growth phenology of this species. A series of experiments were conducted to determine the response of I. lonchophylla to different environmental conditions. Results showed that the primary dormancy exhibited by I. lonchophylla is due to the physical impediment of the hard seed coat. The seed germination percentage was the highest at the constant temperature of 27 C and alternating temperatures of 35/25 C. Germination of I. lonchophylla was not stimulated by light, suggesting that this species is non-photoblastic. Ipomoea lonchophylla germination was intolerant of a medium to high level of salt stress, and germination was completely inhibited at 250 mM NaCl. The emergence of I. lonchophylla was not restricted by seeding depth up to 8 cm, but only 5% emergence was recorded when seeds were planted at a 16-cm depth. The germination percentage was also drastically reduced by 90% to 100% after exposure to either 3 mo in silage, 48-h digestion in steers, or silage plus digestion treatments. The growth and reproductive phenology of I. lonchophylla was affected by emergence time. Plants that emerged in late spring (November 15) were able to produce more berries per plant than those that emerged in midsummer (January 15) in southern New South Wales. Information gained in our study concerning high soil salinity, ensiling, and digestion will help to develop more sustainable and effective integrated weed management strategies for controlling and reducing the spread of this weed.
This element offers a review and synthesis of the research on economic methods for evaluating regulations that improve air quality, save energy, and reduce climate risks. The intended audience is regulators and other constituencies interested in the nexus between scholarship and practice; analysts in government agencies and research organizations; and academic scholars and their graduate students. Topics include the evolution of regulatory impact assessment in the OECD; cost estimation, including engineering, partial equilibrium, and general equilibrium approaches; benefit valuation, with an emphasis on the value of reducing risk of illness and premature mortality, and methods for pricing carbon emissions; discounting methods, and their relationship to carbon pricing; the distribution of regulatory costs and benefits; and uncertainty evaluation methods for addressing less and more fundamental uncertainty. Perspective on the relevance and limitations of current research is offered. This title is also available as Open Access on Cambridge Core.
This paper proposes a framework for comprehensive, collaborative, and community-based care (C4) for accessible mental health services in low-resource settings. Because mental health conditions have many causes, this framework includes social, public health, wellness and clinical services. It accommodates integration of stand-alone mental health programs with health and non-health community-based services. It addresses gaps in previous models including lack of community-based psychotherapeutic and social services, difficulty in addressing comorbidity of mental and physical conditions, and how workers interact with respect to referral and coordination of care. The framework is based on task-shifting of services to non-specialized workers. While the framework draws on the World Health Organization’s Mental Health Gap Action Program and other global mental health models, there are important differences. The C4 Framework delineates types of workers based on their skills. Separate workers focus on: basic psychoeducation and information sharing; community-level, evidence-based psychotherapeutic counseling; and primary medical care and more advanced, specialized mental health services for more severe or complex cases. This paper is intended for individuals, organizations and governments interested in implementing mental health services. The primary aim is to provide a framework for the provision of widely accessible mental health care and services.
To evaluate variables that affect risk of contamination for endoscopic retrograde cholangiopancreatography and endoscopic ultrasound endoscopes.
Design:
Observational, quality improvement study.
Setting:
University medical center with a gastrointestinal endoscopy service performing ∼1,000 endoscopic retrograde cholangiopancreatography and ∼1,000 endoscopic ultrasound endoscope procedures annually.
Methods:
Duodenoscope and linear echoendoscope sampling (from the elevator mechanism and instrument channel) was performed from June 2020 through September 2021. Operational changes during this period included standard reprocessing with high-level disinfection with ethylene oxide gas sterilization (HLD–ETO) was switched to double high-level disinfection (dHLD) (June 16, 2020–July 15, 2020), and duodenoscopes changed to disposable tip model (March 2021). The frequency of contamination for the co-primary outcomes were characterized by calculated risk ratios.
Results:
The overall pathogenic contamination rate was 4.72% (6 of 127). Compared to duodenoscopes, linear echoendoscopes had a contamination risk ratio of 3.64 (95% confidence interval [CI], 0.69–19.1). Reprocessing using HLD-ETO was associated with a contamination risk ratio of 0.29 (95% CI, 0.06–1.54). Linear echoendoscopes undergoing dHLD had the highest risk of contamination (2 of 18, 11.1%), and duodenoscopes undergoing HLD-ETO and the lowest risk of contamination (0 of 53, 0%). Duodenoscopes with a disposable tip had a 0% contamination rate (0 of 27).
Conclusions:
We did not detect a significant reduction in endoscope contamination using HLD-ETO versus dHLD reprocessing. Linear echoendoscopes have a risk of contamination similar to that of duodenoscopes. Disposable tips may reduce the risk of duodenoscope contamination.
Innovative shoe insoles, designed to enhance sensory information on the plantar surface of the feet, could help to improve walking in people with Multiple Sclerosis.
Objective:
To compare the effects of wearing textured versus smooth insoles, on measures of gait, foot sensation and patient-reported outcomes, in people with Multiple Sclerosis.
Methods:
A prospective, randomised controlled trial was conducted with concealed allocation, assessor blinding and intention-to-treat analysis. Thirty ambulant men and women with multiple sclerosis (MS) (Disease Steps rating 1–4) were randomly allocated to wear textured or smooth insoles for 12 weeks. Self-reported insole wear and falls diaries were completed over the intervention period. Laboratory assessments of spatiotemporal gait patterns, foot sensation and proprioception, and patient-reported outcomes, were performed at Weeks 0 (Baseline 1), 4 (Baseline 2) and 16 (Post-Intervention). The primary outcome was the size of the mediolateral base of support (stride/step width) when walking over even and uneven surfaces. Independent t-tests were performed on change from baseline (average of baseline measures) to post-intervention.
Results:
There were no differences in stride width between groups, when walking over the even or uneven surfaces (P ≥ 0.20) at post-intervention. There were no between-group differences for any secondary outcomes including gait (all P values > 0.23), foot sensory function (all P values ≥ 0.08) and patient-reported outcomes (all P values ≥ 0.23).
Conclusions:
In our small trial, prolonged wear of textured insoles did not appear to alter walking or foot sensation in people with MS who have limited foot sensory loss. Further investigation is needed to explore optimal insole design.
Clinical Trial Registration:
Australian and New Zealand Clinical Trials Registry (ACTRN12615000421538).
The coral reefs of the Pitcairn Islands are in one of the most remote areas of the Pacific Ocean, and yet they are exposed to the impacts of anthropogenic climate change. The Pitcairn Islands Marine Protected Area was designated in 2016 and is one of the largest in the world, but the marine environment around these highly isolated islands remains poorly documented. Evidence collated here indicates that while the Pitcairn Islands' reefs have thus far been relatively sheltered from the effect of warming sea temperatures, there is substantial risk of future coral decalcification due to ocean acidification. The projected acceleration in the rate of sea level rise, and the reefs' exposure to risks from distant ocean swells and cold-water intrusions, add further uncertainty as to whether these islands and their reefs will continue to adapt and persist into the future. Coordinated action within the context of the Pitcairn Islands Marine Protected Area can help enhance the resilience of the reefs in the Pitcairn Islands. Options include management of other human pressures, control of invasive species and active reef interventions. More research, however, is needed in order to better assess what are the most appropriate and feasible options to protect these reefs.
Various global-scale proposals exist to reduce the loss of biological diversity. These include the Half-Earth and Whole-Earth visions that respectively seek to set aside half the planet for wildlife conservation or to diversify conservation practices fundamentally and change the economic systems that determine environmental harm. Here we assess these visions in the specific context of Bornean orangutans Pongo pygmaeus and their conservation. Using an expert-led process we explored three scenarios over a 10-year time frame: continuation of Current Conditions, a Half-Earth approach and a Whole-Earth approach. In addition, we examined a 100-year population recovery scenario assuming 0% offtake of Bornean orangutans. Current Conditions were predicted to result in a population c. 73% of its current size by 2032. Half-Earth was judged comparatively easy to achieve and predicted to result in an orangutan population of c. 87% of its current size by 2032. Whole-Earth was anticipated to lead to greater forest loss and ape killing, resulting in a prediction of c. 44% of the current orangutan population for 2032. Finally, under the recovery scenario, populations could be c. 148% of their current size by 2122. Although we acknowledge uncertainties in all of these predictions, we conclude that the Half-Earth and Whole-Earth visions operate along different timelines, with the implementation of Whole-Earth requiring too much time to benefit orangutans. None of the theorized proposals provided a complete solution, so drawing elements from each will be required. We provide recommendations for equitable outcomes.
We discuss evolutionary perspectives on two neurodevelopmental disorders: attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Both have a genetic background, and we explore why these genes may have survived the process of natural selection. We draw on the concept of evolutionary mismatch, in which a trait that may have conferred advantages in the past can become disadvantageous when the environment changes. We also describe the non-genetic influences on these conditions. We point out that children with neurodevelopmental conditions are more likely to suffer maltreatment, so it is important to consider both the genes and the environment in which children have grown up. In hunter-gatherer societies, ADHD may have favoured risk-taking, which may explain why it has survived. The contemporary model of schooling, in which children are expected to sit still for many hours a day, does not favour this. Understanding ADHD in terms of an evolutionary mismatch therefore raises ethical issues regarding both medication and the school environment. ASDs are far more heterogeneous and are characterised by high heritability and low reproductive success. At the severe end of the spectrum, ASD is highly disadvantageous and often co-occurs with intellectual disability. On the other hand, high-functioning ASD may have been adaptive in our evolutionary past in terms of the potential for the development of specialist skills and can still be so today in the right environment.
Throughout human evolutionary history, infants and children have been dependent on adult caregivers for survival. The care that adults give is greatly influenced by prevailing conditions, including the availability of food and their social contacts, and also by their own experience of care. We use an evolutionary perspective to discuss possible reasons why children may suffer trauma at the hands of their parents and consider how children have adapted in response to such trauma to maximise their chances of survival in order to reach reproductive age and produce their own offspring. We examine how child maltreatment might differ at the hands of mothers, fathers and step-parents and discuss parent–offspring conflict, life history theory, attachment theory and differential susceptibility to help explain the complexity of childhood trauma. We end with recommendations for clinical practice.
Variation exists in the timing of surgery for balanced complete atrioventricular septal defect repair. We sought to explore associations between timing of repair and resource utilisation and clinical outcomes in the first year of life.
Methods:
In this retrospective single-centre cohort study, we included patients who underwent complete atrioventricular septal defect repair between 2005 and 2019. Patients with left or right ventricular outflow tract obstruction and major non-cardiac comorbidities (except trisomy 21) were excluded. The primary outcome was days alive and out of the hospital in the first year of life.
Results:
Included were 79 infants, divided into tertiles based on age at surgery (1st = 46 to 137 days, 2nd = 140 – 176 days, 3rd = 178 – 316 days). There were no significant differences among age tertiles for days alive and out of the hospital in the first year of life by univariable analysis (tertile 1, median 351 days; tertile 2, 348 days; tertile 3, 354 days; p = 0.22). No patients died. Fewer post-operative ICU days were used in the oldest tertile relative to the youngest, but days of mechanical ventilation and hospitalisation were similar. Clinical outcomes after repair and resource utilisation in the first year of life were similar for unplanned cardiac reinterventions, outpatient cardiology clinic visits, and weight-for-age z-score at 1 year.
Conclusions:
Age at complete atrioventricular septal defect repair is not associated with important differences in clinical outcomes or resource utilisation in the first year of life.
This chapter examines the history of fracking as a new technology for enhancing the production of oil and gas, looking for explanations of why the practice is restricted or banned in some jurisdictions but permitted and fostered in others. The classic risk-perception paradigm, which emphasizes the role of public opinion, the mass media, and grass-roots activism, provides useful insight into how and why fracking was banned first in France and later in the UK. Risk perception provides less insight into why fracking is generally acceptable in some states of the US but not in others. Several contextual factors favoring fracking in the US are explored: private ownership of mineral rights and royalty policies, favorable state regulatory climates, a national interest in energy security, and vocal support of fracking from national political leaders of both parties. We look at fracking governance in Texas, North Dakota and Pennsylvania, where fracking technologies are treated as acceptable extensions of conventional technologies and where the practice is neither widely feared nor stigmatized. These states appreciate the benefits of employment and tax revenue fracking operations stimulate.
Online peer support platforms have been shown to provide a supportive space that can enhance social connectedness and personal empowerment. Some studies have analysed forum messages, showing that users describe a range of advantages, and some disadvantages to their use. However, the direct examination of users’ experiences of such platforms is rare and may be particularly informative for enhancing their helpfulness. This study aimed to understand users’ experiences of the Support, Hope and Recovery Online Network (SHaRON), an online cognitive behavioural therapy-based peer support platform for adults with mild to moderate anxiety or depression. Platform users (n = 88) completed a survey on their use of different platform features, feelings about using the platform, and overall experience. Responses were analysed descriptively and using thematic analysis. Results indicated that most features were generally well used, with the exception of private messaging. Many participants described feeling well supported and finding the information and resources helpful; the majority of recent users (81%) rated it as helpful overall. However, some participants described feeling uncomfortable about posting messages, and others did not find the platform helpful and gave suggestions for improvements. Around half had not used the platform in the past 3 months, for different reasons including feeling better or forgetting about it. Some described that simply knowing it was there was helpful, even without regular use. The findings highlight what is arguably a broader range of user experiences than observed in previous studies, which may have important implications for the enhancement of SHaRON and other platforms.
Key learning aims
(1) To understand what an online peer support platform is and how this can be used to support users’ mental health.
(2) To learn how users described their experience of the SHaRON platform.
(3) To understand the benefits that online peer support may provide.
(4) To consider what users found helpful and unhelpful, and how this might inform the further development of these platforms.