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Personality assessment in nursing home residents with mental and physical multimorbidity: two informant perspectives
- Ankie F. Suntjens, Ruslan Leontjevas, Anne M. A. van den Brink, Richard C. Oude Voshaar, Raymond T. C. M. Koopmans, Debby L. Gerritsen
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- International Psychogeriatrics , First View
- Published online by Cambridge University Press:
- 25 April 2024, pp. 1-13
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Objectives:
In older patients with mental and physical multimorbidity (MPM), personality assessment is highly complex. Our aim was to examine personality traits in this population using the Hetero-Anamnestic Personality questionnaire (HAP), and to compare the premorbid perspective of patients’ relatives (HAP) with the present-time perspective of nursing staff (HAP-t).
Design:Cross-sectional.
Setting:Dutch gerontopsychiatric nursing home (GP-NH) units.
Participants:Totally, 142 GP-NH residents with MPM (excluding dementia).
Measurements:NH norm data of the HAP were used to identify clinically relevant premorbid traits. Linear mixed models estimated the differences between HAP and HAP-t trait scores (0–10). Agreement was quantified by intraclass correlation coefficients (ICCs). All HAP-HAP-t analyses were corrected for response tendency (RT) scores (−10–10).
Results:78.4% of the patients had at least one premorbid maladaptive trait, and 62.2% had two or more. Most prevalent were: “disorderly” (30.3%), “unpredictable/impulsive” (29.1%) and “vulnerable” (27.3%) behavior. The RT of relatives appeared significantly more positive than that of nursing staff (+1.8, 95% CI 0.6–2.9, p = 0.002). After RT correction, the traits “vulnerable”, “perfectionist” and “unpredictable/impulsive” behavior scored higher on the HAP than HAP-t (respectively +1.2, 95% CI 0.6–1.7, p < 0.001; +2.1, 95% CI 1.3–2.8, p < 0.001; +0.6, 95% CI 0.1–1.1, p = 0.013), while “rigid” behavior scored lower (−0.7, 95% CI −1.3 to −0.03, p = 0.042). Adjusted ICCs ranged from 0.15 to 0.58.
Conclusions:Our study shows high percentages of premorbid maladaptive personality traits, which calls for attention on personality assessment in MPM NH residents. Results also indicate that the HAP and HAP-t questionnaires should not be used interchangeably for this patient group in clinical practice.
A psychoeducational intervention to improve sexual functioning in male rectal and anal cancer patients: A pilot randomized controlled trial study
- Christian J. Nelson, Tammy A. Schuler, Anne S. Reiner, Raymond E. Baser, Caraline C. Demirjian, John Mulhall, Larissa Temple, Leslie Schover, Lina Jandorf, Katherine N. DuHamel
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- Palliative & Supportive Care , First View
- Published online by Cambridge University Press:
- 23 February 2024, pp. 1-9
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Objectives
Male rectal and anal cancer patients demonstrate high rates of sexual dysfunction. This pilot randomized controlled trial tested a psychoeducational intervention designed to improve psychosexual adjustment.
MethodsRectal or anal cancer patients were randomized to a Sexual Health Intervention for Men (intervention) or to a referral and information control (control). The intervention included control activities plus 4 sexual health intervention sessions every 4–6 weeks and 3 brief telephone calls timed between these sessions. Assessments were completed pre-intervention (baseline) and 3 months (follow-up 1) and 8 months (follow-up 2) post-intervention. Differences were assessed with statistical significance and Cohen’s d effect sizes (d = 0.2, small effect; d = 0.5, moderate effect; d = 0.8, large effect).
ResultsNinety subjects enrolled. Forty-three participants completed at least 1 follow-up assessment (intervention, n = 14; control n = 29). At follow-up 1, men in intervention, compared to control, improved on all domains of the International Index of Erectile Function (IIEF) (p < 0.001 to p < 0.05) and demonstrated large effects (d = 0.8 to d = 1.5). Similarly, at follow-up 2, changes in all domains of the IIEF except the orgasm domain were either statistically significant or marginally statistically significant (p = 0.01 to p = 0.08) and demonstrated moderate to large treatment effects for intervention versus control (d = 0.5 to d = 0.8). Men in the intervention, compared to control, demonstrated decreased sexual bother at follow-up 1 (p = 0.009, d = 1.1), while Self-Esteem and Relationship (SEAR) total scores and the SEAR sexual relationship subscale demonstrated moderate increases for intervention versus control (d = 0.4 to d = 0.6).
Significance of resultsThis study provides initial evidence for combining a psychoeducational intervention with medical interventions to address sexual dysfunction following rectal and anal cancer. Trials register number: NCT00712751 (date of registration: 7/10/2008).
Resilient functioning is associated with altered structural brain network topology in adolescents exposed to childhood adversity
- Nadia González-García, Elizabeth E.L. Buimer, Laura Moreno-López, Samantha N. Sallie, František Váša, Sol Lim, Rafael Romero-Garcia, Maximilian Scheuplein, Kirstie J. Whitaker, Peter B. Jones, Raymond J. Dolan, NSPN consortium, Peter Fonagy, Ian Goodyer, Edward T. Bullmore, Anne-Laura van Harmelen
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- Development and Psychopathology / Volume 35 / Issue 5 / December 2023
- Published online by Cambridge University Press:
- 26 July 2023, pp. 2253-2263
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Childhood adversity is one of the strongest predictors of adolescent mental illness. Therefore, it is critical that the mechanisms that aid resilient functioning in individuals exposed to childhood adversity are better understood. Here, we examined whether resilient functioning was related to structural brain network topology. We quantified resilient functioning at the individual level as psychosocial functioning adjusted for the severity of childhood adversity in a large sample of adolescents (N = 2406, aged 14–24). Next, we examined nodal degree (the number of connections that brain regions have in a network) using brain-wide cortical thickness measures in a representative subset (N = 275) using a sliding window approach. We found that higher resilient functioning was associated with lower nodal degree of multiple regions including the dorsolateral prefrontal cortex, the medial prefrontal cortex, and the posterior superior temporal sulcus (z > 1.645). During adolescence, decreases in nodal degree are thought to reflect a normative developmental process that is part of the extensive remodeling of structural brain network topology. Prior findings in this sample showed that decreased nodal degree was associated with age, as such our findings of negative associations between nodal degree and resilient functioning may therefore potentially resemble a more mature structural network configuration in individuals with higher resilient functioning.
Cultural adaptation of the Integrated Palliative care Outcome Scale for neurological symptoms – ERRATUM
- Kim Dillen, Yasemin Goereci, Veronika Dunkl, Anne Müller, Gereon R. Fink, Raymond Voltz, Mevhibe Hocaoglu, Clemens Warnke, Heidrun Golla
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- Palliative & Supportive Care / Volume 21 / Issue 6 / December 2023
- Published online by Cambridge University Press:
- 22 May 2023, p. 1069
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Cultural adaptation of the Integrated Palliative care Outcome Scale for neurological symptoms
- Kim Dillen, Yasemin Goereci, Veronika Dunkl, Anne Müller, Gereon R. Fink, Raymond Voltz, Mevhibe Hocaoglu, Clemens Warnke, Heidrun Golla
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- Palliative & Supportive Care / Volume 21 / Issue 6 / December 2023
- Published online by Cambridge University Press:
- 11 April 2023, pp. 1059-1068
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Objectives
Standardized measures for assessing neurological patients needing palliative care remain scarce. The Integrated Palliative care Outcome Scale for neurological patients in its short form (IPOS Neuro-S8) helps assess and identify patients’ symptom burden and needs early but has not yet been validated in German. The aim was to culturally adapt and translate the IPOS Neuro-S8 into the German health-care context and evaluate its face and content validity.
MethodsCultural adaptation study following the first 6 out of 8 phases of the Palliative care Outcome Scale measures manual: (1) conceptual definition, (2) forward translation to German, (3) backward translation to English, (4) expert review, (5) cognitive debriefing, (6) proofreading. Neurological patients needing palliative care and clinical staff of the Department of Palliative Medicine or Neurology of the University Hospital of Cologne were included. Data were analyzed using thematic content analysis and descriptive statistics.
ResultsA total of 13 patients and 16 clinical staff participated in this study. The expert review panel (phase 4) consisted of 11 additional members. While patients (n = 9) and clinical staff (n = 11) confirmed that the IPOS Neuro-S8 is an intelligible tool that is well accepted (phase 5), some linguistic and cultural differences were found between the original English and German versions. These mainly concerned the items mouth problems and spasms.
Significance of resultsThe German version of the IPOS Neuro-S8 has demonstrated face and content validity and captures relevant symptoms of neurological patients needing palliative care. Its psychometric properties, including construct and criterion validity, will be investigated next.
423 - Characteristics of specialized units for people with dementia and very severe challenging behavior in the Netherlands: a mixed method study
- Gerrie Van Voorden, Mijke Lips, Sytse Zuidema, Richard Christiaan Oude Voshaar, Martin Smalbrugge, Anne M.A. Van Den Brink, Anke Persoon, Raymond T. Koopmans, Debby L. Gerritsen
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- International Psychogeriatrics / Volume 33 / Issue S1 / October 2021
- Published online by Cambridge University Press:
- 01 November 2021, p. 45
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Introduction:
Little is known about the raising number of specialized units for patients with dementia and very severe challenging behavior in the Netherlands. This study describes organizational and treatment characteristics of a sample of these units.
Methods:The organizational and treatment characteristics were studied with digital questionnaires completed by the unit managers, interviews with the main physician(s) and observation of the physical environment. The questionnaire consisted of questions about general patient characteristics, unit characteristics and staff characteristics. Furthermore, an interview was held with the main/treating physician often together with another physician or psychologist. The interview guide consisted of questions about admission criteria, the role of staff involved and the treatment process.
Results:Thirteen units participated. Five units were part of a mental health (MH) institution, seven units were part of a nursing home (NH) organization and one unit was a cooperation of MH and NH. Unit sizes ranged from 10 to 28 places. Ten of thirteen units started in 2010 or later. The age of patients admitted was estimated at 75 years. The percentage of involuntary admitted patients was 53% at MH-units and 18% at NH-units. Unit managers mentioned that due to a difference in reimbursement between MH and NH units had difficulty providing the specialized care. Another problem managers faced was recruiting nursing staff. Units strived for expertise in general staffing from both MH and NH. The education level of the nursing staff was comparable between MH and NH. At every unit a physician with background in elderly care medicine or geriatrics and a psychiatrist was involved. Interviewees stressed the role of the nursing staff in the treatment. They were key in providing the care and treatment that, since the main goal of interventions is treatment of and coping with challenging behavior.
Conclusion:The main finding of this study is that units caring for patients with dementia and challenging behavior, despite barriers in regulations and staffing shortage, search for combining expertise from nursing home care and psychiatry in their treatment.
Presentation of the 2020 Paleontological Society Pojeta Award to Patricia H. Kelley
- Anne Raymond
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- Journal of Paleontology / Volume 95 / Issue 5 / September 2021
- Published online by Cambridge University Press:
- 09 August 2021, p. 1102
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210 - Palliative Care in Dementia: Continuous palliative sedation in nursing home residents with dementia suffering from extreme refractory neuropsychiatric symptoms
- Annelies E. Veldwijk-Rouwenhorst, Martin Smalbrugge, Sytse U. Zuidema, Suzan A.J. Hanssen, Raymond T.C.M. Koopmans, Debby L. Gerritsen
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- International Psychogeriatrics / Volume 32 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 04 November 2020, pp. 53-54
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Introduction:
Extreme neuropsychiatric symptoms (NPS) can be a heavy burden for nursing home (NH)-residents, relatives and caregivers. When conventional treatments are ineffective or have intolerable side effects, extreme NPS can be considered refractory. In these situations, continuous palliative sedation (CPS) is sometimes administered. We explored the trajectory leading to CPS and its application in NH-residents with dementia and refractory NPS.
Methods:A qualitative interview study was performed in 2017. Relatives, elderly care physicians and other staff members involved with three NH-residents with dementia and extreme refractory NPS who received CPS were interviewed. These NH-residents lived on dementia special care units of three NHs in the Netherlands. We used consecutive sampling to select participants. Medical files were studied. Semi-structured interviews were conducted. Transcriptions were analyzed with thematic analysis, including directed content analysis.
Results:Nine in-depth interviews with fourteen participants were held. Analysis resulted in five main themes with several subthemes reflecting phases of the trajectory leading to CPS and the CPS application itself, a sixth main theme concerned evaluations thereof. According to the first theme (run-up), the suffering of the NH-resident was described as unbearable/an inner struggle. Participants still had hope for improvement. Concerning the second theme (turning point), hope was lost, participants were convinced they had tried everything and experienced feelings of powerlessness and failure. Regarding theme three (considering CPS), intermittent sedation was applied in all three cases and peer consultation was employed. Honoring the wish of the NH-resident and therapeutic uncertainties, among others, were important subthemes. According to theme four (decision to start CPS), in each case one specific aspect was a decisive trigger for administering CPS. Concerning theme five (applying CPS) feelings of relief were experienced after starting with CPS.
Conclusions:The trajectory leading up to CPS in NH-residents with dementia and extreme refractory NPS was complex and burdensome, but the application led to relief and contentment of all those involved. We recommend to include external consultation in the decision process and to apply intermittent sedation as a preceding step when CPS is considered.
Simulation-based research in emergency medicine in Canada: Priorities and perspectives
- Timothy Chaplin, Brent Thoma, Andrew Petrosoniak, Kyla Caners, Tamara McColl, Chantal Forristal, Christa Dakin, Jean-Francois Deshaies, Eliane Raymond-Dufresne, Mary Fotheringham, David Ha, Nicole Holm, James Huffman, Ann-Marie Lonergan, George Mastoras, Michael O'Brien, Marie-Rose Paradis, Nicholas Sowers, Errol Stern, Andrew K. Hall
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- Canadian Journal of Emergency Medicine / Volume 22 / Issue 1 / January 2020
- Published online by Cambridge University Press:
- 26 September 2019, pp. 103-111
- Print publication:
- January 2020
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Objective
Simulation plays an integral role in the Canadian healthcare system with applications in quality improvement, systems development, and medical education. High-quality, simulation-based research will ensure its effective use. This study sought to summarize simulation-based research activity and its facilitators and barriers, as well as establish priorities for simulation-based research in Canadian emergency medicine (EM).
MethodsSimulation-leads from Canadian departments or divisions of EM associated with a general FRCP-EM training program surveyed and documented active EM simulation-based research at their institutions and identified the perceived facilitators and barriers. Priorities for simulation-based research were generated by simulation-leads via a second survey; these were grouped into themes and finally endorsed by consensus during an in-person meeting of simulation leads. Priority themes were also reviewed by senior simulation educators.
ResultsTwenty simulation-leads representing all 14 invited institutions participated in the study between February and May, 2018. Sixty-two active, simulation-based research projects were identified (median per institution = 4.5, IQR 4), as well as six common facilitators and five barriers. Forty-nine priorities for simulation-based research were reported and summarized into eight themes: simulation in competency-based medical education, simulation for inter-professional learning, simulation for summative assessment, simulation for continuing professional development, national curricular development, best practices in simulation-based education, simulation-based education outcomes, and simulation as an investigative methodology.
ConclusionThis study summarized simulation-based research activity in EM in Canada, identified its perceived facilitators and barriers, and built national consensus on priority research themes. This represents the first step in the development of a simulation-based research agenda specific to Canadian EM.
Characteristics and health conditions of a group of nursing home patients with mental–physical multimorbidity – the MAPPING study
- Anne M.A. van den Brink, Debby L. Gerritsen, Miranda M.H. de Valk, Richard C. Oude Voshaar, Raymond T.C.M. Koopmans
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- International Psychogeriatrics / Volume 29 / Issue 6 / June 2017
- Published online by Cambridge University Press:
- 06 March 2017, pp. 1037-1047
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Background:
Long-term care facilities have partly taken over the traditional asylum function of psychiatric hospitals and house an increasing group of patients with mental–physical multimorbidity (MPM). Little is known about the characteristics, behavior, and care dependency of these patients. This paper aims to describe these aspects.
Methods:Explorative, descriptive study among patients with MPM without dementia (n = 142), living in 17 geronto-psychiatric nursing home (NH) units across the Netherlands, stratified by those referred from mental healthcare services (MHS) and other healthcare services (OHS). Data collection consisted of chart review, semi-structured interviews, (brief) neuropsychological testing, and self-report questionnaires. Patients referred from MHS (n = 58) and from OHS (n = 84) were compared by descriptive statistics.
Results:Despite exclusion of patients with dementia, the majority of participants had cognitive impairment. Prevalence and severity of frontal impairment were high, as well as the number of patients with clinically relevant neuropsychiatric symptoms. MHS patients were younger, had more chronic psychiatric disorders, and more often used antipsychotics. Neuropsychiatric symptoms, domains of care dependency, physical conditions and concomitant medication use differed not significantly between the subgroups.
Conclusions:Both groups of patients with MPM showed heterogeneity in various aspects but differed not significantly regarding the consequences of their multimorbidity. In a variety of characteristics, this group seems to be different from other NH patient groups, which requires extra knowledge and skills of the staff. To uncover which knowledge and skills are necessary, the next step should be to investigate the specific care needs of NH patients with MPM without dementia.
Late Quaternary Biomass Changes from 13C Measurements in a Highland Peatbog from Equatorial Africa (Burundi)
- Anne-Marie Aucour, Claude Hillaire-Marcel, Raymonde Bonnefille
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- Quaternary Research / Volume 41 / Issue 2 / March 1994
- Published online by Cambridge University Press:
- 20 January 2017, pp. 225-233
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Stable carbon isotope ratios of total organic matter were measured in two cores collected from the Kashiru peatbog in Burundi, Equatorial Africa. The record, which spans at least the last 40,000 yr, documents the C3-C4 biomass balance in the organic sediment. Among the major modern peat formers, most plants are C3 species and are characterized by δ13C values of -25.5 ± 2.3% (vs PDB). The C4 plants, which are characterized by higher δ13C values (-11.3 ± 0.7%) belong to the Gramineae (Miscanthidium sp.) and Cyperaceae families (Cyperus latifolius, C. papyrus, Pycreus nigricans). In the fossil record, δ13C values of total organic matter vary between -28 and -15% in response to the relative fluxes of C3 and C4 plants. Before 30,000 yr B.P., low δ13C values (-23.5 ± 1.1%) match high arboreal pollen contents. From 30,000 to 15,000 yr B.P., higher δ13C values (-17.6 ± 1.1%) correspond to a significant increase in percentages of grass pollen. During this episode, a short and sharp shift toward lighter carbon isotopic compositions at 21,000 yr B.P. is synchronous with higher input of arboreal pollen. From 15,000 to 12,000 yr B.P., the 13C content decreases (δ13C = -22.9 ± 1.4%). This shift, which cannot be explained by an increase in the arboreal vegetation, could be explained by the spreading of C3 Gramineae or C3 Cyperaceae. The interval from 12,000 to 7000 yr B.P. is poorly documented in these cores due to much lower organic matter accumulation. Low δ13C values (δ13C = -25.2 ± 1.3%) are observed from 7000 to 5000 yr B.P., when the pollen data show development of C3 mountain forest. The Late Holocene is characterized by a mixed C3-C4 organic matter accumulation (δ13C = -20.9 ± 1.6%). This study depicts a change in the dominant photosynthetic pathway among the herbaceous components, notably at the glacial-interglacial transition, when C3 plants were favored by increased water supply and/or higher atmospheric CO2 concentration.
Understanding barriers to fruit and vegetable intake in the Australian Longitudinal Study of Indigenous Children: a mixed-methods approach
- Katherine Ann Thurber, Cathy Banwell, Teresa Neeman, Timothy Dobbins, Melanie Pescud, Raymond Lovett, Emily Banks
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- Public Health Nutrition / Volume 20 / Issue 5 / April 2017
- Published online by Cambridge University Press:
- 29 November 2016, pp. 832-847
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Objective
To identify barriers to fruit and vegetable intake for Indigenous Australian children and quantify factors related to these barriers, to help understand why children do not meet recommendations for fruit and vegetable intake.
DesignWe examined factors related to carer-reported barriers using multilevel Poisson models (robust variance); a key informant focus group guided our interpretation of findings.
SettingEleven diverse sites across Australia.
SubjectsAustralian Indigenous children and their carers (N 1230) participating in the Longitudinal Study of Indigenous Children.
ResultsAlmost half (45 %; n 555/1230) of carers reported barriers to their children’s fruit and vegetable intake. Dislike of fruit and vegetables was the most common barrier, reported by 32·9 % of carers; however, we identified few factors associated with dislike. Carers were more than ten times less likely to report barriers to accessing fruit and vegetables if they lived large cities v. very remote areas. Within urban and inner regional areas, child and carer well-being, financial security, suitable housing and community cohesion promoted access to fruit and vegetables.
ConclusionsIn this national Indigenous Australian sample, almost half of carers faced barriers to providing their children with a healthy diet. Both remote/outer regional carers and disadvantaged urban/inner regional carers faced problems accessing fruit and vegetables for their children. Where vegetables were accessible, children’s dislike was a substantial barrier. Nutrition promotion must address the broader family, community, environmental and cultural contexts that impact nutrition, and should draw on the strengths of Indigenous families and communities.
Mississippian coral latitudinal diversity gradients (western interior United States): Testing the limits of high resolution diversity data
- Gregory E. Webb, William J. Sando, Anne Raymond
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- Journal of Paleontology / Volume 71 / Issue 5 / September 1997
- Published online by Cambridge University Press:
- 20 May 2016, pp. 780-791
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Analysis of high resolution diversity data for Mississippian corals in the western interior United States yielded mild latitudinal diversity gradients despite the small geographic area covered by samples and a large influence on diversity patterns by geographic sampling intensity (sample bias). Three competing plate tectonic reconstructions were tested using the diversity patterns. Although none could be forcefully rejected, one reconstruction proved less consistent with diversity patterns than the other two and additional coral diversity data from farther north in Canada would better discriminate the two equivalent reconstructions.
Despite the relatively high sampling intensity represented by the analyzed database, diversity patterns were greatly affected by sample abundance and distribution. Hence, some effort at recognizing and accounting for sample bias should be undertaken in any study of latitudinal diversity gradients. Small-scale geographic lumping of sample localities had only small effects on geographic diversity patterns. However, large-scale (e.g., regional) geographic lumping of diversity data may not yield latitudinally sensitive diversity patterns. Temporal changes in coral diversity in this region reflect changes in eustacy, local tectonism, and terrigenous sediment flux, far more than they do shifting latitude. Highest regional diversity occurred during the interval when the studied region occupied the highest latitude. Therefore, diversity data from different regions may not be comparable, in terms of latitudinal inference. Small-scale stratigraphic lumping of the data caused a nearly complete loss of the latitudinal diversity patterns apparent prior to lumping. Hence, the narrowest possible stratigraphic resolution should be maintained in analyzing latitudinal diversity gradients.
Floral diversity, phytogeography, and climatic amelioration during the Early Carboniferous (Dinantian)
- Anne Raymond
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- Paleobiology / Volume 11 / Issue 3 / Summer 1985
- Published online by Cambridge University Press:
- 08 February 2016, pp. 293-309
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Phytogeographic analysis of three Early Carboniferous intervals (Tournaisian–early Visean, Visean, and late Visean–early Namurian A) indicates a high level of phytogeographic differentiation in the beginning of the Early Carboniferous that decreases toward the end of this period. Climatic amelioration (warmer or wetter conditions) in the north middle and high latitudes, caused by the collision of Laurussia and Gondwana at the end of the Early Carboniferous, may be responsible for this decrease in phytogeographic provinciality. Toward the end of the Early Carboniferous, a large number of equatorial genera expand their ranges northward, and the average generic diversity of assemblages in the north high latitudes (Siberia) also rises. Both support the hypothesis of climatic amelioration. Northward migration of equatorial forms and the appearance of new genera endemic to Siberia both contributed to the rise in Siberian diversity. Although this trend is not statistically significant, additional evidence of diversity increase in northern high latitudes tied to climatic amelioration comes from the northernmost limit of diverse (≥ 10 genera) assemblages, which rises from 20°N at the beginning to 55°N at the end of the Early Carboniferous. Global plant diversity assessed at the generic level remained constant during the Early Carboniferous. The increase in Siberian diversity was offset by a decrease in equatorial diversity, perhaps due to the loss of pronounced latitudinal climatic gradients between north-middle and equatorial latitudes.
Laurussian land-plant diversity during the Silurian and Devonian: mass extinction, sampling bias, or both?
- Anne Raymond, Cheryl Metz
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- Paleobiology / Volume 21 / Issue 1 / Winter 1995
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- 08 February 2016, pp. 74-91
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In phytogeographic data sets, the number of assemblages or floras from each interval may provide a test of the influence of sampling intensity on land-plant diversity. Using a data set of Silurian and Devonian compression-impression plant genera from Laurussia and the Acadian terrain, regression of five measures of land-plant diversity (total diversity, mean genus richness of floras, median assemblage diversity, most diverse assemblage, and standing diversity at interval boundaries) against the number assemblages or floras from thirteen intervals suggests that sampling bias influences all of the diversity measures to some extent, including within-habitat measures. The standing diversity of land plants at interval boundaries, the measure least influenced by sampling (r = 0.65, p = 0.05), increased steadily from the Middle Silurian to the late Givetian/early–middle Frasnian boundary, fell sharply in the early–middle Frasnian and remained low throughout the late Frasnian–middle Famennian. Standing diversity rose dramatically in the late Famennian and Strunian (latest Devonian): the Frasnian–Famennian extinction event may have affected land plants. The standing diversity of Silurian and Devonian microspore genera at interval boundaries mirrors that of compression-impression genera: neither record supports a land-plant diversity equilibrium during the Devonian.
The Power of ‘Soft’
- Sarah Morehead, Raymond Oliver, Niamh O’Connor, Patrick Stevenson-Keating, Anne Toomey, Jayne Wallace
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- MRS Advances / Volume 1 / Issue 1 / 2016
- Published online by Cambridge University Press:
- 02 February 2016, pp. 69-80
- Print publication:
- 2016
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Over the last decade, the explosion in research and Development associated with nanoscalar materials has continued apace. In parallel with this has been the rapid rise of both sustainable materials and, as a consequence, Natural, Cellular and Responsive material systems. Many of these originate from inorganic, inorganic-organic hybrid composites and polymeric and bio-nano polymeric systems which exhibit intrinsic physico-chemical properties that can be classed as ‘soft’. That is flexible, malleable, lightweight, transparent or semi-transparent and stretchable in character and which can also offer both biocompatible and bioresorbable characteristics essential to useable and sustainable material systems.
This paper describes some of the ways in which we are beginning to understand, explain and exploit ‘soft’ technology. In particular the interactive role of creative design and innovative material science linked through new fabrication methodologies that have, as their common purpose, a focus on compelling Human centred needs. Examples are health, wellness, ambient assistance and urgent improvements in cleanliness, hygiene and nutrition.
Risk of cardiac disease and observations on lack of potential predictors by clinical history among children presenting for cardiac evaluation of mid-exertional syncope
- Christina Y. Miyake, Kara S. Motonaga, Megan E. Fischer-Colbrie, Liyuan Chen, Debra G. Hanisch, Raymond R. Balise, Jeffrey J. Kim, Anne M. Dubin
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- Cardiology in the Young / Volume 26 / Issue 5 / June 2016
- Published online by Cambridge University Press:
- 17 August 2015, pp. 894-900
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Objective
This study aimed to evaluate the incidence of cardiac disorders among children with mid-exertional syncope evaluated by a paediatric cardiologist, determine how often a diagnosis was not established, and define potential predictors to differentiate cardiac from non-cardiac causes.
Study designWe carried out a single-centre, retrospective review of children who presented for cardiac evaluation due to a history of exertional syncope between 1999 and 2012. Inclusion criteria included the following: (1) age ⩽18 years; (2) mid-exertional syncope; (3) electrocardiogram, echocardiogram and an exercise stress test, electrophysiology study, or tilt test, with exception of long QT, which did not require additional testing; and (4) evaluation by a paediatric cardiologist. Mid-exertional syncope was defined as loss of consciousness in the midst of active physical activity. Patients with peri-exertional syncope immediately surrounding but not during active physical exertion were excluded.
ResultsA total of 60 patients met the criteria for mid-exertional syncope; 32 (53%) were diagnosed with cardiac syncope and 28 with non-cardiac syncope. A majority of cardiac patients were diagnosed with an electrical myopathy, the most common being Long QT syndrome. In nearly half of the patients, a diagnosis could not be established or syncope was felt to be vasovagal in nature. Neither the type of exertional activity nor the symptoms or lack of symptoms occurring before, immediately preceding, and after the syncopal event differentiated those with or without a cardiac diagnosis.
ConclusionsChildren with mid-exertional syncope are at risk for cardiac disease and warrant evaluation. Reported symptoms may not differentiate benign causes from life-threatening disease.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
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- 27 April 2015, pp ix-xxx
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Integrating mobile technology with routine dietetic practice: the case of myPace for weight management
- Michelle Harricharan, Raymond Gemen, Laura Fernández Celemín, David Fletcher, Anne E. de Looy, Josephine Wills, Julie Barnett
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- Proceedings of the Nutrition Society / Volume 74 / Issue 2 / May 2015
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- 25 March 2015, pp. 125-129
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The field of Mobile health (mHealth), which includes mobile phone applications (apps), is growing rapidly and has the potential to transform healthcare by increasing its quality and efficiency. The present paper focuses particularly on mobile technology for body weight management, including mobile phone apps for weight loss and the available evidence on their effectiveness. Translation of behaviour change theory into weight management strategies, including integration in mobile technology is also discussed. Moreover, the paper presents and discusses the myPace platform as a case in point. There is little clinical evidence on the effectiveness of currently available mobile phone apps in enabling behaviour change and improving health-related outcomes, including sustained body weight loss. Moreover, it is unclear to what extent these apps have been developed in collaboration with health professionals, such as dietitians, and the extent to which apps draw on and operationalise behaviour change techniques has not been explored. Furthermore, presently weight management apps are not built for use as part of dietetic practice, or indeed healthcare more widely, where face-to-face engagement is fundamental for instituting the building blocks for sustained lifestyle change. myPace is an innovative mobile technology for weight management meant to be embedded into and to enhance dietetic practice. Developed out of systematic, iterative stages of engagement with dietitians and consumers, it is uniquely designed to complement and support the trusted health practitioner–patient relationship. Future mHealth technology would benefit if engagement with health professionals and/or targeted patient groups, and behaviour change theory stood as the basis for technology development. Particularly, integrating technology into routine health care practice, rather than replacing one with the other, could be the way forward.
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- By Nic Beech, Chris Bilton, Alan Bradshaw, Stephen Broad, Shiona Chillas, Martin Cloonan, Kevina Cody, Christine Coupland, Stephen Cummings, Ann Cunliffe, Chris Cusack, Jane Donald, Martin Dowling, Michael Downes, Celia Duffy, Charlotte Gilmore, Lance Green, Gail Greig, Elizabeth Gulledge, Chris Hackley, Martin John Henry, Paul Hibbert, Casper Hoedemaekers, R. M. Hubbert, John Hunt, Peter Keenan, Nod Knowles, Gretchen Larsen, Johnny Lynch, Raymond MacDonald, Robert MacIntosh, Katy MacKintosh, Donald MacLean, Katy J. Mason, Alan McCusker-Thompson, Lloyd Meredith, Louise Mitchell, Davide Nicolini, Daragh O’Reilly, Jill O’Sullivan, Cliff Oswick, Marco Panagopoulos, Jim Prime, Jenny Reeve, Simon Rose, Michael Saren, David Sims, Ian Smith, Duglas T. Stewart, Chris Stout, Dimitrinka Stoyanova Russell, Antonio Strati, Ben Talbot Dunn:, Robyn Thomas, Lori Watson, Simon Webb, Richard Wigley, Sierk Ybema, Matthew Young, Carlo Zanotti
- Edited by Nic Beech, University of Dundee, Charlotte Gilmore, University of Edinburgh
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- Organising Music
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- 05 January 2015
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- 05 February 2015, pp xii-xxviii
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