Understanding the relationship transitions and associated end of life clinical needs of young adults with life-limiting illnesses:a triangulated longitudinal qualitative study

Background: Care of young adults with life-limiting illnesses can often be complex due to the fact that they are growing and developing within the continuing presence of their illness. There is little research conducted nationally and internationally, which has examined the life issues of young adults or taken a longitudinal approach to understand such issues over a period of time. Aim: To gain clear understanding of one particular and pertinent life issue—relationship transition—occurring in the context of being a young adult with a life-limiting illness and the clinical needs arising from this. Design: This was a triangulated, longitudinal, qualitative study involving young adults with life-limiting illnesses and their significant others, namely, family members and healthcare professionals. Semi-structured interviews were conducted with participants and analysed using thematic analysis. Clinical case note reviews were also carried out. Setting/participants: A total of 12 young adults (aged between 17 and 23 years) from 2 hospices and 22 nominated significant others participated in a total of 58 interviews. Results: Thematic analysis revealed 4 main themes and 11 subthemes. The main themes were ‘Dependence dichotomy’, ‘In it together’, ‘Biographical uncertainty’, and ‘Conserving integrity’. These themes helped to establish the nature of relationship transitions that the young adult participants from the study experienced and additionally allowed insight into their possible needs at their end of life. Conclusion: This study has identified the nature of relationship transitions pertinent to young adults and has highlighted associated end of life clinical needs. This study can influence further research into the transitions and end of life needs of this particular patient group receiving palliative care, while informing the lacking evidence base which exists internationally

Analysis of vertical ground loop heat exchangers applied to buildings in the UK

The work presented here deals with the design and performance of ground-source heat pumps and ground-sink cooling systems using vertical borehole arrays for commercial applications in the UK. Heating and cooling energy demands for a range of building and HVAC plant options are obtained by thermal modelling applied to four HVAC plant options: space heating only; heating with chilled ceilings; fan coil units and constant volume all-air plant. Ground loop designs are conducted for each system option using an impulse-response method and the parameters extracted from this are used in 10-year simulations of plant response which have been carried out using HVACSIM+. The 10-year time horizon was used to assess any degradation in earth temperature over time. The results show that a substantial reduction in energy (and, hence, carbon) can be expected of up to and exceeding 50% when using ground source heat pumps for winter heating with direct cooling in summer in association with moderate temperature cooling systems such as chilled ceilings. A degradation of earth temperature was evident with systems utilising limited cooling or no cooling but this did not appear to influence heat pump performance greatly. Practical Applications: Design and performance data for use in vertical ground loop (borehole) heat exchanger arrays providing source heat for heat pumps as well as direct cooling for buildings are generated and reported in this paper. The data should be of help to design practitioners for the sizing of borehole arrays for both heating and cooling. Design and performance matching to a wide variety of HVAC combinations, building energy demand levels and two contrasting sets of earth thermal property data are included so that practitioners will be able to select results that suit a range of modern applications. Also included are results of 10-year energy simulations that demonstrate the required design and operating conditions needed to ensure that initial undisturbed earth conditions will not drift with time to an unacceptable extent. Comparisons are made with conventional heating and cooling methods so that estimates of carbon savings due to the use of ground-coupled heat pumps with (and without) direct cooling can be made

Observation of an Excited Bc⁺ state

Using p p collision data corresponding to an integrated luminosity of 8.5     fb − 1 recorded by the LHCb experiment at center-of-mass energies of √ s = 7 , 8, and 13 TeV, the observation of an excited B + c state in the B + c π + π − invariant-mass spectrum is reported. The observed peak has a mass of 6841.2 ± 0.6 ( stat ) ± 0.1 ( syst ) ± 0.8 ( B + c )     MeV / c 2 , where the last uncertainty is due to the limited knowledge of the B + c mass. It is consistent with expectations of the B ∗ c ( 2 3 S 1 ) + state reconstructed without the low-energy photon from the B ∗ c ( 1 3 S 1 ) + → B + c γ decay following B ∗ c ( 2 3 S 1 ) + → B ∗ c ( 1 3 S 1 ) + π + π − . A second state is seen with a global (local) statistical significance of 2.2 σ ( 3.2 σ ) and a mass of 6872.1 ± 1.3 ( stat ) ± 0.1 ( syst ) ± 0.8 ( B + c )     MeV / c 2 , and is consistent with the B c ( 2 1 S 0 ) + state. These mass measurements are the most precise to date

Observation of an Excited B-c(+) State

Using $pp$ collision data corresponding to an integrated luminosity of $8.5\,\mathrm{fb}^{-1}$ recorded by the LHCb experiment at centre-of-mass energies of $\sqrt{s} = 7$, $8$ and $13\mathrm{\,Te\kern -0.1em V}$, the observation of an excited $B_c^+$ state in the $B_c^+\pi^+\pi^-$ invariant-mass spectrum is reported. The observed peak has a mass of $6841.2 \pm 0.6 {\,\rm (stat)\,} \pm 0.1 {\,\rm (syst)\,} \pm 0.8\,(B_c^+) \mathrm{\,MeV}/c^2$, where the last uncertainty is due to the limited knowledge of the $B_c^+$ mass. It is consistent with expectations of the $B_c^{*}(2^{3}S_{1})^+$ state reconstructed without the low-energy photon from the $B_c^{*}(1^{3}S_{1})^+ \to B_c^+ \gamma$ decay following $B_c^{*}(2^{3}S_{1})^+ \to B_c^{*}(1^{3}S_{1})^+ \pi^+ \pi^-$. A second state is seen with a global (local) statistical significance of $2.2\,\sigma$ ($3.2\,\sigma$) and a mass of $6872.1 \pm 1.3 {\,\rm (stat)\,} \pm 0.1 {\,\rm (syst)\,} \pm 0.8\,(B_c^+) \mathrm{\,MeV}/c^2$, and is consistent with the $B_c(2^{1}S_{0})^+$ state. These mass measurements are the most precise to date.Comment: All figures and tables, along with any supplementary material and additional information, are available at https://cern.ch/lhcbproject/Publications/p/LHCb-PAPER-2019-007.htm

The evolutionary origins of natural pedagogy: Rhesus monkeys show sustained attention following nonsocial cues versus social communicative signals

The natural pedagogy hypothesis proposes that human infants preferentially attend to communicative signals from others, facilitating rapid cultural learning. In this view, sensitivity to such signals is a uniquely human adaptation and as such nonhuman animals should not produce or utilize these communicative signals. We test these evolutionary predictions by examining sensitivity to communicative cues in 206 rhesus monkeys (Macaca mulatta) using an expectancy looking time task modeled on prior work with infants. Monkeys observed a human actor who either made eye contact and vocalized to the monkey (social cue), or waved a fruit in front of her face and produced a tapping sound (nonsocial cue). The actor then either looked at an object (referential look) or looked toward empty space (look away). We found that, unlike human infants in analogous situations, rhesus monkeys looked longer at events following nonsocial cues, regardless of the demonstrator’s subsequent looking behavior. Moreover younger and older monkeys showed similar patterns of responses across development. These results provide support for the natural pedagogy hypothesis, while also highlighting evolutionary changes in human sensitivity to communicative signals.This study examines how rhesus monkeys respond to social communicative cues, which are proposed to underpin human‐unique forms of cultural learning. In an expectancy looking time task modeled on prior infant studies, we found that monkeys exhibited longer looking responses following nonsocial attention‐grabbing cues compared to social cues, and did not expect social cues to be followed by referential actions, unlike human infants. These results provide support for the proposal that sensitivity to ‘ostensive’ cues may be a human cognitive adaptation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163960/1/desc12987.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163960/2/desc12987_am.pd