Role of the community matron in advance care planning and ‘do not attempt CPR’ decision-making: a qualitative study

The community matron (CM) is often the key worker caring for patients with chronic, life-limiting, long-term conditions, but these patients are not always recognised as palliative cases. This study explored the experiences of CMs with regard to advance care planning (ACP) and ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) decision-making to understand whether or not they felt adequately prepared for this aspect of their role, and why. Qualitative data were generated from six CMs using a broad interpretive phenomenological approach. Face-to-face recorded interviews were analysed using template analysis. The study found that although participants faced complex ethical situations around ACP and DNACPR almost on a daily basis, none had received any formal training despite the emphasis on training in national and local guidelines. Participants often struggled to get their patients accepted on to the Gold Standards Framework. The research found variability and complexity of cases to be the main barriers to clear identification of the palliative phase

Intellectual functioning in clinically confirmed fetal valproate syndrome

Background: An increased risk of impaired intelligence (IQ) has been documented in valproate-exposed children, but investigations have not previously focused on those with a clinical diagnosis of Fetal Valproate Syndrome (FVS). Methods: This cross sectional observational study recruited individuals with a diagnosis of FVS and completed standardized assessments of intellectual abilities making comparisons to a normative comparison group. Both mean difference (MD) and prevalence of scores below the lower average range were analyzed. Results: The mean full-scale IQ in 31 individuals with FVS (mean age 14.97; range 6–27 years) was 19 points lower (19.55, 95% CI −24.94 to 14.15), and IQ scores <70 were present in 26%. The mean differences for verbal comprehension (21.07, 95% CI −25.84 to −16.29), working memory (19.77, 95% CI −25.00 to −14.55) and processing speed (16.87, 95% CI −22.24 to −11.50) performances were poorer than expected with the mean differences over one standard deviation from the comparison group. Sixty one percent of cases demonstrated disproportionately lower verbal comprehension ability. There were no significant group differences for IQ in high vs. moderate dose valproate or mono vs. polytherapy. There were no differences in IQ between those with and those without a major congenital malformation. The requirement for educational intervention was high at 74%. Conclusion: Intellectual difficulties are a central feature of FVS and are more severe in their presentation in individuals with a diagnosis of valproate embryopathy. Individuals with FVS who present with the characteristic facial presentation should be considered at high risk of cognitive difficulties regardless of the dose of valproate exposure or the presence of a major congenital malformation

Criticality experiments with planar arrays of three-liter bottles containing plutonium nitrate solution

The objective of these experiments was to provide benchmark data to validate calculational codes used in critically safety assessments of plant configurations. Arrays containing up to as many as sixteen three-liter bottles filled with plutonium nitrate were used in the experiments. A split-table device was used in the final assembly of the arrays. Ths planar arrays were reflected with close fitting plexiglas on each side and on the bottom but not the top surface. The experiments addressed a number of factors effecting criticality: the critical air gap between bottles in an array of fixed number of bottles, the number of bottles required for criticality if the bottles were touching, and the effect on critical array spacing and critical bottle number due to the insertion of an hydrogeneous substance into the air gap between bottles. Each bottle contained about 2.4l of Pu(NO{sub 3}){sub 4} solution at a Pu concentration of 105g Pu/l, with the {sup 240}Pu content being 2.9 wt% at a free acid molarity H{sup +} of 5.1. After the initial series of experiments were performed with bottles separated by air gaps, plexiglas shells of varying thicknesses were placed around each bottle to investigate how moderation between bottles affects both the number of bottles required for criticality and the critical spacing between each bottle. The minimum of bottles required for criticality was found to be 10.9 bottles, occurring for a square array with bottles in contact. As the bottles were spaced apart, the critical number increased. For sixteen bottles in a square array, the critical separation between surfaces in both x and y direction was 0.96 cm. The addition of plexiglas around each bottle decreased the critical bottle number, compared to those separated in air, but the critical bottle number, even with interstitial plastic in place was always greater than 10.9 bottles. The most reactive configuration was a tightly packed array of bottles with no intervening material

On continuum driven winds from rotating stars

We study the dynamics of continuum driven winds from rotating stars, and develop an approximate analytical model. We then discuss the evolution of stellar angular momentum, and show that just above the Eddington limit, the winds are sufficiently concentrated towards the poles to spin up the star. A twin-lobe structure of the ejected nebula is seen to be a generic consequence of critical rotation. We find that if the pressure in such stars is sufficiently dominated by radiation, an equatorial ejection of mass will occur during eruptions. These results are then applied to {\eta}-Carinae. We show that if it began its life with a high enough angular momentum, the present day wind could have driven the star towards critical rotation, if it is the dominant mode of mass loss. We find that the shape and size of the Homunculus nebula, as given by our model, agree with recent observations. Moreover, the contraction expected due to the sudden increase in luminosity at the onset of the Great Eruption explains the equatorial "skirt" as well.Comment: 8 pages, 4 figure

Evidence for Pre-Existing Dust in the Bright Type IIn SN 2010jl

SN 2010jl was an extremely bright, Type IIn SNe which showed a significant IR excess no later than 90 days after explosion. We have obtained Spitzer 3.6 and 4.5 \mum and JHK observations of SN 2010jl \sim90 days post explosion. Little to no reddening in the host galaxy indicated that the circumstellar material lost from the progenitor must lie in a torus inclined out of the plane of the sky. The likely cause of the high mid-IR flux is the reprocessing of the initial flash of the SN by pre-existing circumstellar dust. Using a 3D Monte Carlo Radiative Transfer code, we have estimated that between 0.03-0.35 Msun of dust exists in a circumstellar torus around the SN located 6 \times 10 ^17 cm away from the SN and inclined between 60-80\cdot to the plane of the sky. On day 90, we are only seeing the illumination of approximately 5% of this torus, and expect to see an elevated IR flux from this material up until day \sim 450. It is likely this dust was created in an LBV-like mass loss event of more than 3 Msun, which is large but consistent with other LBV progenitors such as {\eta} Carinae.Comment: Accepted in A

Spatial variation of the physical and biomechanical properties within an equestrian arena surface

There is limited information about spatial variation of equestrian arena surfaces despite unequivocal evidence to suggest that lack of uniformity increases risk of injury. Spatial differences in the functional properties of an arena are likely to be due to a number of intrinsic and extrinsic characteristics including variation in the physical properties of the surface. The aim of this work was to examine spatial variation of peak load (cushioning) across an arena surface and investigate the influence that physical properties had on these variations using Principal Component Analysis. Sampling (n=61) of a 20 m by 65 m indoor synthetic equestrian arena surface occurred in one day using an Orono biomechanical surface tester (OBST). The OBST was used at every location to measure peak load (dropped twice on the same point). A 200 g sample of the surface was taken from the point of impact (at every location) and the physical properties were assessed in the laboratory. Samples were oven dried at 45⁰C for 24 hours in order to measure moisture content and percentage binder was quantified using Soxhlet extraction. Sand particle size distribution were determined using sieving and sedimentation methods and percentage organic matter was achieved by burning off organic material using a muffle furnace at 440⁰C. The surface was characterized by three principal components (PC1, PC2 and PC3). Peak load and moisture were the first principal components that accounted for 41% of surface variation. Percentage organic matter and percentage binder were identified as PC2 (20%) and PC3 (18%) respectively. This highlights their respective importance in surface variation. There was a moderate negative correlation between moisture and peak load (rs = 54%; P<0.0001) however cluster analysis revealed that peak load and moisture were grouped into five areas of similarity that corresponded to sample location, reinforced using an ANOVA (P<0.0001). The findings demonstrate an effective method of assessing uniformity and additionally, identify physical factors relevant to the load carrying capacity of this specific surface. Uneven surfaces can influence horse and rider safety therefore recognizing appropriate techniques to monitor spatial variation and implement relevant maintenance, is of key importance to equestrian athletes

Validation of Tagging Suggestion Models for a Hotel Ticketing Corpus

This paper investigates methods for the prediction of tags on a textual corpus that describes hotel staff inputs in a ticketing system. The aim is to improve the tagging process and find the most suitable method for suggesting tags for a new text entry. The paper consists of two parts: (i) exploration of existing sample data, which includes statistical analysis and visualisation of the data to provide an overview, and (ii) evaluation of tag prediction approaches. We have included different approaches from different research fields in order to cover a broad spectrum of possible solutions. As a result, we have tested a machine learning model for multi-label classification (using gradient boosting), a statistical approach (using frequency heuristics), and two simple similarity-based classification approaches (Nearest Centroid and k-Nearest Neighbours). The experiment which compares the approaches uses recall to measure the quality of results. Finally, we provide a recommendation of the modelling approach which produces the best accuracy in terms of tag prediction on the sample data

Karen indigenous music and dance learning in an Australian non-formal context: A case study in maintenance and transmission

This study examines the viability of transmission and maintenance of Karen indigenous music and dance in an Australian non-formal context. Qualitative in design, the research comprised an ethnographic case study of an indigenous music and dance transmission situation (a series of five music and dance workshops) implemented in a non-formal community context in Western Sydney. Participants were a Karen cultural expert in music and dance, four Karen teacher participants and 14 Karen youth student participants. The researcher, as performance participant and participant observer, collected the data through field observation and video recording of the workshops, as well as semi-structured interviews that were conducted with the cultural expert, teacher participants, and the student participants. The first of its kind among the Karen community in Australia, the study explored the viability and means of transmission and maintenance of Karen indigenous music and dance through the involvement of Karen culture bearers and Karen youth. The study explored the views of the cultural expert and the various other culture bearers on Karen music and dance teaching and learning processes, as well as the motivation and learning styles of its student participants. Based on understandings of transmission processes operating in Burma and in the Thai-Burma border refugee camps that emerged during the study, the research revealed the need for evolving modified transmission processes for the diasporic context. The study raised many questions and highlighted culturally sensitive issues, ultimately indicating that the symbolic significance of the project as an initiative outweighed the pedagogical outcomes of the actual workshops

SN 2007od: A Type IIP SN with Circumstellar Interaction

SN 2007od exhibits characteristics that have rarely been seen in a Type IIP supernova (SN). Optical V band photometry reveals a very steep brightness decline between the plateau and nebular phases of ~4.5 mag, likely due to SN 2007od containing a low mass of 56Ni. The optical spectra show an evolution from normal Type IIP with broad Halpha emission, to a complex, four component Halpha emission profile exhibiting asymmetries caused by dust extinction after day 232. This is similar to the spectral evolution of the Type IIn SN 1998S, although no early-time narrow (~200 km s-1) Halpha component was present in SN 2007od. In both SNe, the intermediate-width Halpha emission components are thought to arise in the interaction between the ejecta and its circumstellar medium (CSM). SN 2007od also shows a mid-IR excess due to new dust. The evolution of the Halpha profile and the presence of the mid-IR excess provide strong evidence that SN 2007od formed new dust before day 232. Late-time observations reveal a flattening of the visible lightcurve. This flattening is a strong indication of the presence of a light echo, which likely accounts for much of the broad, underlying Halpha component seen at late-times. We believe the multi-peaked Halpha emission is consistent with the interaction of the ejecta with a circumstellar ring or torus (for the inner components at \pm1500 km s-1), and a single blob or cloud of circumstellar material out of the plane of the CSM ring (for the outer component at -5000 km s-1). The most probable location for the formation of new dust is in the cool dense shell created by the interaction between the expanding ejecta and its CSM. Monte Carlo radiative transfer modeling of the dust emission from SN 2007od implies that up to 4x 10-4Msun of new dust has formed. This is similar to the amounts of dust formed in other CCSNe such as SNe 1999em, 2004et, and 2006jc.Comment: 35 pages, 6 figures. Accepted for publication in Ap

FLUORESCENCE STUDIES ON PHOTOSYNTHETIC PIGMENT DEVELOPMENT IN RHODOPSEUDOMONAS SPHEROIDES * , †

When bleached, aerobically grown cells of Rhodopseudomonas spheroides are transferred to semi-aerobic conditions to induce bacteriochlorophyll synthesis, a new fluorescence band, with a maximum at 790 nm, is observed in addition to the 885 nm emission maximum normally seen in pigmented cells. The 790 nm fluorescence may be due to bacterio-chlorophyll which has not been bound into the chromatophore membrane. The quantum yield of the 885 nm fluorescence is at first relatively high and then, about 1 hour after transfer, drops to the level found in pigmented photosynthetic cells. The coupling to the rest of the photo-synthetic apparatus, as indicated by the effect of dithionite on the fluorescence, also seems to occur during the first hour of pigment development, which suggests that the onset of fluorescence quenching is due at least in part to the synthesis of photochemical reaction centers. Continuation of these studies should provide new information on the formation, structure and molecular interactions of the pigments and the photosynthetic membranes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73322/1/j.1751-1097.1968.tb08021.x.pd