Magnetic domains in terbium

This thesis discusses the various forms of magnetic ordering and the associated fundamental theory. The phenomena of magnetocrystalline anisotropy and magnetostriction are also discussed. The thesis is especially concerned with the rare earth element terbium which exhibits ferromagnetism at temperatures below ~ 222K. The exchange interaction associated with ferromagnetic ordering is discussed in CHAPTER TWO, while CHAPTER THREE, which deals specifically with the rare earth elements, includes a section on the RKKY exchange interaction and its relevance to the magnetic properties of some of the rare earth metals. The magnetic properties of terbium are also included. In particular, the thesis deals with magnetic domains and their observation. The energy minimizing process of domain formation is discussed in detail and various types of domain configurations are shown for cubic and hexagonal symmetry. CHAPTER FIVE represents a review of some of the methods of domain observation. Ferromagnetic domains have been observed in a single crystal of 99.99% pure terbium. These domains have been observed at various temperatures and an attempt has been made to fit the observations toga slab-domain model for 160º Bloch walls. The apparatus used to make the observations is one based upon the magnetic colloid technique and is discussed in detail in CHAPTER SIX. Iron wire is evaporated onto the sample surface in order to outline the surface domain configurations. Photographs of these patterns have been analyzed and domain widths have been deduced for various temperatures. Domain widths/temperature curves have been included based upon the slab-domain model and it has been found that the experimental data is in excellent agreement with this model

Evaluation of a consultant pharmacist-delivered comprehensive medication management service

Background In 2010, a pilot program was implemented by the Medication Assessment Consultants (MAC) to provide comprehensive medication management (CMM) services to patients in the community of Saskatoon, Saskatchewan. Clinical pharmacists working as consultants, independent of any retail pharmacy or health system organization, delivered the program. The goal of the MAC CMM service was to optimize therapeutic outcomes for individual patients through improved medication use, and to reduce the risk of adverse drug reactions (ADRs). Purpose The purpose of this study was to evaluate the independent consultant pharmacist model for delivering comprehensive medication management (CMM) services employed by the Medication Assessment Consultants (MAC) pilot program. Methods A program evaluation was performed on MAC, consisting of a document review of program materials (e.g., MAC Policy and Procedure Manual, electronic patient records) along with stakeholder interviews. The document review consisted of the collection of existing MAC documents, followed by an analysis of the information contained within each document. Patients, physicians and MAC staff were interviewed using a semi-structured interview approach. Patient and physician interviews were conducted by phone and by an interviewer external to the study. Interviews were continued until saturation was reached. The MAC staff was interviewed in person by the investigator. All interviews were recorded and transcribed verbatim. Thematic analysis was used to identify common themes by having three individuals independently review each group of stakeholder interview transcripts. Results During the 17-month pilot, 53 patients were referred to MAC, mostly from family physicians (79.2%). Patients were elderly (mean 71 years) and mostly female (67.9%). On average, patients were taking 13.3 medications and had 9.2 medical conditions. For the 42 patients for whom an assessment was completed, an average of 5.1 drug therapy problems (DTPs) per patient was identified. The document review revealed that MAC did not achieve all of its internal program objectives (e.g., to generate a consistent flow of patient referrals; to promote the service to physicians and patients; and to improve medication-related short-term outcomes for patients). All three interview groups reported a high level of satisfaction and support for the program. Interviewees described various ways in which they felt that they benefitted from the program, including medication regimen optimization (patients), support in dealing with complex medication regimens (physicians), and a strong sense of personal and professional satisfaction and fulfilment (MAC staff). The evaluation of the MAC program resulted in the identification of several program strengths (e.g., a strong, well-defined patient care process; an accessible service location; MAC pharmacist mentorship and support program), along with opportunities for improvement (e.g., expanded promotional activities; administrative support for the program; implementation of a formal satisfaction survey to obtain regular feedback from key stakeholders). Conclusion The results of this study suggest the independent consultant pharmacist model for the provision of CMM services has potential to be utilized as a new service delivery model (in addition to community pharmacies and primary health care teams) to provide CMM services in the primary health care system (PHCS). The study findings have identified several strengths and opportunities for improvement, which may be useful for future attempts at implementing the CMM service model

Gateway effects and electronic cigarettes: a response to J-F Etter

This is a response to an essay by J-F Etter published in Addiction in 2017 (see reference #1 in the article). It was sent to Addiction which offered a 500 word letter. The full response is posted her

The Gateway Effect of E-cigarettes: Reflections on Main Criticisms

The recent spread of e-cigarette use has spurred not only enthusiasm about their harm reduction and smoking cessation potential but also concerns about possible risks from long-term use, and stalled cessation through dual use.1 Another main concern is that e-cigarette use is increasing among tobacco-naive youth2 than among only adult smokers who are using them for cessation and expectation of risk reduction.1 With youth smoking at all-time lows in several nations with advanced tobacco control programs,3–5 there are therefore concerns that e-cigarettes may stall or reverse these declines as youth who were likely to never use any form of nicotine become familiar with it, and start experimenting with other forms of nicotine delivery. These concerns were strengthened by the recent publication of a meta-analysis of longitudinal studies showing that e-cigarettes can serve as a gateway to later cigarette smoking among nicotine-naive youth.6 They were also emphasized by the 2018 report of the National Academies of Sciences, Engineering, and Medicine (NASEM),7 which concluded that such studies “provided “strong evidence of plausibility and specificity of a possible causal effect of e-cigarette use on smoking…” with the Committee “consider[ing] the overall body of evidence of a causal effect of e-cigarette use on risk of transition from never to ever smoking to be substantial” (pp. 16–32). By contrast, Public Health England concluded, “Despite some experimentation with these devices among never smokers, e-cigarettes are attracting very few young people who have never smoked into regular use”.8 Given the importance of putative gateway or “catalyst”9 effects in assessing the population impact of e-cigarettes, proponents of e-cigarettes were quick to criticize such evidence and their underlying gateway hypothesis.10–13 In the context of this debate, the gateway hypothesis is adapted to denote the use of less harmful forms of nicotine delivery (eg, e-cigarettes), leading to the use of more harmful ones (eg, combustible cigarettes).7,10–13 We here present and respond to three major criticisms that have been made of e-cigarettes’ gateway potential based on currently available evidence

A qualitative exploration of older adults' and care providers' perceptions of health and psychosocial factors shaping drinking in later life

Ph. D. ThesisBackground: Numerous factors may influence how older people use alcohol. Risks of harm from drinking increase with age, as alcohol affects common health conditions and medications. Drinking can play a positive role in older people’s social lives, and has been associated with some health benefits. Care providers can support older people to make informed decisions surrounding their drinking. However, their work may be affected by their own views about alcohol. Aim: To explore the views of older adults and primary care providers regarding health and psychosocial factors shaping drinking practices in later life, and how these practices are influenced. Methods: A systematic review of qualitative literature examined older adults’ and care providers’ views of drinking in later life, influencing factors and patterns of consumption. In-depth interviews and focus groups were conducted with older adults and primary care providers. Data were analysed thematically, applying principles of constant comparison to conceptualise how health and psychosocial factors shape drinking. Relevant social theory, including Bury’s biographical disruption and Bourdieu’s theory of practice, aided interpretation. Results: Drinking routines developed across the life course, shaped by cultural expectations and norms, and in response to late-life transitions. Drinking played ritualised roles in older people’s social and leisure lives. Older people did not identify with risks of drinking, unless they had explicit reason to believe their intake was damaging. Care providers’ preconceptions surrounding the meaning of alcohol in older people’s lives shaped their approach to discussion. Discussion: Positive roles of alcohol and processes involved in perceiving risk meant associated risks were overlooked by older adults and care providers. Social, routine and moralistic justifications for risky alcohol use must be challenged to address risky drinking amongst older people. Care providers can support older people to recognise risks and develop healthy routines, but require appropriate resources and knowledge.NIHR School for Primary Care Research

Upwind impacts of ammonia from an intensive poultry unit

This study investigated potential ammonia impacts on a sand dune nature reserve 600 m upwind of an intensive poultry unit. Ammonia concentrations and total nitrogen deposition were measured over a calendar year. A series of ammonia and nitrogen exposure experiments using dune grassland species were conducted in controlled manipulations and in the field. Ammonia emissions from the intensive poultry unit were detected up to 2.8 km upwind, contributing to exceedance of critical levels of ammonia 800 m upwind and exceedance of critical loads of nitrogen 2.8 km upwind. Emissions contributed 30% of the total N load in parts of the upwind conservation site. In the nitrogen exposure experiments, plants showed elevated tissue nitrogen contents, and responded to ammonia concentrations and nitrogen deposition loads observed in the conservation site by increasing biomass. Estimated long-term impacts suggest an increase in the soil carbon pool of 9% over a 50-year timescale

Does left-handedness confer resistance to spatial bias?

We recently demonstrated that drowsiness, indexed using EEG, was associated with left-inattention in a group of 26 healthy right-handers. This has been linked to alertness-related modulation of spatial bias in left neglect patients and the greater persistence of left, compared with right, neglect following injury. Despite handedness being among the most overt aspects of human lateralization, studies of this healthy analogue of left neglect have only been conducted with predominantly or exclusively right-handed individuals. Here, with a group of 26 healthy non-right-handers we demonstrate that, unlike right-handers who showed a rightward shift in attention with drowsiness, non-right-handers showed the opposite pattern on an auditory spatial localization task. The current results are the first indication that factors linked to handedness can affect the development and extremity of spatial biases, potentially conferring resilience to clinical symptoms in non-right-handers and, given that 90% of us are right-handed, why left neglect is disproportionately persistent

Barriers to Accessing Primary Dental Care in Adults with Alcohol Dependence: A Qualitative Study

Background:People with alcohol dependence (AD) frequently experience oral health problems, but their dental attendance is poor, with limited evidence to the reasons why from their perspective.Objective:To explore perceived barriers, motivators, and facilitators to accessing primary dental care in people with AD.Methods:Qualitative study consisting of remote one-to-one and group semistructured interviews with a convenience sample of adults with lived experience of AD in northern England. Data were audio-recorded, transcribed, and coded. A reflexive thematic analysis method was used; use of COM-B model informed data interpretation.Results:Twenty adults with lived experience of AD participated in 18 one-to-one interviews and 1 group interview (of 3 participants). Barriers to access were fear and physical, social, and environmental factors (physical effects of AD, financial barriers, nonprioritization of oral health). Motivators to access were pain and prioritization of oral health. Facilitators to access were patterns of alcohol use (i.e., sobriety) and dental service provision within recovery services.Conclusions:Fear of “the dentist” is a major barrier to accessing dental care, and pain is the primary motivator, among people with AD, although neither are unique to this population. Fear and physical, social, and environmental barriers to access contribute to problem-oriented attendance, which negatively affect oral health outcomes. Opportunity to facilitate attendance increases when a person is in remission from AD through their physical capabilities improving. Increasing capability and opportunity can influence attendance beyond the automatic motivation of pain. Provision of dental care within recovery services could facilitate access to care. Understanding the “web of causation” is key to developing any intervention to improve dental access in people with AD. Further research is needed from the perspective of other adult populations with lived experience of AD, as well as of dental professionals, to gain deeper insight into barriers, facilitators, and possible solutions

Longitudinal assessments highlight long-term behavioural recovery in disorders of consciousness.

Accurate diagnosis and prognosis of disorders of consciousness is complicated by the variability amongst patients' trajectories. However, the majority of research and scientific knowledge in this field is based on cross-sectional studies. The translational gap in applying this knowledge to inform clinical management can only be bridged by research that systematically examines follow-up. In this study, we present findings from a novel longitudinal study of the long-term recovery trajectory of 39 patients, repeatedly assessed using the Coma Recovery Scale-Revised once every 3 months for 2 years, generating 185 assessments. Despite the expected inter-patient variability, there was a statistically significant improvement in behaviour over time. Further, improvements began approximately 22 months after injury. Individual variation in the trajectory of recovery was influenced by initial diagnosis. Patients with an initial diagnosis of unresponsive wakefulness state, who progressed to the minimally conscious state, did so at a median of 485 days following onset-later than 12-month period after which current guidelines propose permanence. Although current guidelines are based on the expectation that patients with traumatic brain injury show potential for recovery over longer periods than those with non-traumatic injury, we did not observe any differences between trajectories in these two subgroups. However, age was a significant predictor, with younger patients showing more promising recovery. Also, progressive increases in arousal contributed exponentially to improvements in behavioural awareness, especially in minimally conscious patients. These findings highlight the importance of indexing arousal when measuring awareness, and the potential for interventions to regulate arousal to aid long-term behavioural recovery in disorders of consciousness