"Mrs Smith has no rehab potential”: Does rehabilitation have a role in the management of people with dementia?

This is the author accepted manuscript. The final version is available from OUP via the DOI in this recordRehabilitation is a “process aiming to restore personal autonomy in those aspects of daily living considered most relevant by patients, service users and their family carers” [1]. For older people experiencing illness, injury or disability the process of rehabilitation, which may include exercise, enables them to maximise their abilities and potential [2]. However, as demand for healthcare services grows alongside limited resources, clinicians often have to make decisions as to which patients may benefit from rehabilitation. The concept of ‘no rehabilitation potential’ often rears its ugly head in relation to people with dementia but what is it that informs this label, what is the impact and is it justified

Sensitivity of global warming to carbon emissions: effects of heat and carbon uptake in a suite of Earth system models

Climate projections reveal global-mean surface warming increasing nearly linearly with cumulative carbon emissions. The sensitivity of surface warming to carbon emissions is interpreted in terms of a product of three terms: the dependence of surface warming on radiative forcing, the fractional radiative forcing from CO2, and the dependence of radiative forcing from CO2 on carbon emissions. Mechanistically each term varies, respectively, with climate sensitivity and ocean heat uptake, radiative forcing contributions, and ocean and terrestrial carbon uptake. The sensitivity of surface warming to fossil-fuel carbon emissions is examined using an ensemble of Earth system models, forced either by an annual increase in atmospheric CO2 or by RCPs until year 2100. The sensitivity of surface warming to carbon emissions is controlled by a temporal decrease in the dependence of radiative forcing from CO2 on carbon emissions, which is partly offset by a temporal increase in the dependence of surface warming on radiative forcing. The decrease in the dependence of radiative forcing from CO2 is due to a decline in the ratio of the global ocean carbon undersaturation to carbon emissions, while the increase in the dependence of surface warming is due to a decline in the ratio of ocean heat uptake to radiative forcing. At the present time, there are large intermodel differences in the sensitivity in surface warming to carbon emissions, which are mainly due to uncertainties in the climate sensitivity and ocean heat uptake. These uncertainties undermine the ability to predict how much carbon may be emitted before reaching a warming target

Open questions in the study of population III star formation

The first stars were key drivers of early cosmic evolution. We review the main physical elements of the current consensus view, positing that the first stars were predominantly very massive. We continue with a discussion of important open questions that confront the standard model. Among them are uncertainties in the atomic and molecular physics of the hydrogen and helium gas, the multiplicity of stars that form in minihalos, and the possible existence of two separate modes of metal-free star formation.Comment: 15 pages, 2 figures. To appear in the conference proceedings for IAU Symposium 255: Low-Metallicity Star Formation: From the First Stars to Dwarf Galaxie

Independently getting off the floor (IGO): a feasibility study of teaching people with stroke to get up after a fall

This is the author accepted manuscript. The final version is available from Mark Allen Healthcare via the DOI in this record.Background: Falls are common among stroke survivors but many are not taught how to get up again. A technique from Action for Rehabilitation following Neurological Injury (ARNI) addresses this problem. We investigated the feasibility and safety of teaching this technique to stroke survivors. Methods: Stroke survivors (mean 7.1 years post-stroke) with mild-to-moderate disability (mean modified Rankin Score 2.4), who could get up with assistance but not independently, received up to six sessions of training to independently get off the floor (IGO). The primary outcome was IGO success; safety and feasibility were investigated by participant and trainer interviews, biomechanical and video analysis and expert panel review. Findings: Six of the 10 participants achieved IGO and five of nine retained the skill two months post-training. One to six sessions (median 3) were needed to master IGO; one minor but no serious adverse events occurred. Expert reviewers indicated training involved an acceptable risk of falls and no concerns for knee and wrist positions. Conclusions: This feasibility study indicates IGO may be useful. IGO was taught to and safely used by selected stroke survivors. Further assessment of IGO has now been part of a pilot randomised controlled trial of ARNI based stroke rehabilitation.The study was part-funded by the Royal Devon and Exeter NHS Foundation Trust small research grants scheme. This paper presents independent research part-funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust

Efficient tight-binding Monte Carlo structural sampling of complex materials

While recent work towards the development of tight-binding and ab-initio algorithms has focused on molecular dynamics, Monte Carlo methods can often lead to better results with relatively little effort. We present here a multi-step Monte Carlo algorithm that makes use of the possibility of quickly evaluating local energies. For the thermalization of a 1000-atom configuration of {\it a}-Si, this algorithm gains about an order of magnitude in speed over standard molecular dynamics. The algorithm can easily be ported to a wide range of materials and can be dynamically optimized for a maximum efficiency.Comment: 5 pages including 3 postscript figure

Theory for the Ultrafast Structural Response of optically excited small clusters: Time-dependence of the Ionization Potential

Combining an electronic theory with molecular dynamics simulations we present results for the ultrafast structural changes in small clusters. We determine the time scale for the change from the linear to a triangular structure after the photodetachment process Ag$_3^- \rightarrow {\rm Ag}_3$. We show that the time-dependent change of the ionization potential reflects in detail the internal degrees of freedom, in particular coherent and incoherent motion, and that it is sensitive to the initial temperature. We compare with experiment and point out the general significance of our results.Comment: 10 pages, Revtex, 3 postscript figure

A fine-scale, broadly applicable index of vocal performance: frequency excursion

Our understanding of the evolution and function of animal displays has been advanced through studies of vocal performance. A widely used metric of vocal performance, vocal deviation, is limited by being applicable only to vocal trills, and also overlooks certain fine-scale aspects of song structure that might reflect vocal performance. In light of these limitations we here introduce a new index of vocal performance, \u27frequency excursion\u27. Frequency excursion calculates, for any given song or song segment, the sum of frequency modulations both within and between notes on a per-time basis. We calculated and compared the two performance metrics in three species: chipping sparrows, Spizella passerina, swamp sparrows, Melospiza georgiana, and song sparrows, Melospiza melodia. The two metrics correlated as expected, yet frequency excursion accounted for subtle variations in performance overlooked by vocal deviation. In swamp sparrows, frequency excursion values varied significantly by song type but not by individual. Moreover, song type performance in swamp sparrows, according to both metrics, varied negatively with the extent to which song types were shared among neighbours. In song sparrows, frequency excursion values of trilled song segments exceeded those of nontrilled song segments, although not to a statistically significant degree. We suggest that application of frequency excursion in birds and other taxa will provide new insights into diverse open questions concerning vocal performance, function and evolution. (c) 2016 The Association for the Study of Animal Behaviour. Published by Elsevier Ltd. All rights reserved

Branching ratios for the beta decay of 21Na

We have measured the beta-decay branching ratio for the transition from 21Na to the first excited state of 21Ne. A recently published test of the standard model, which was based on a measurement of the beta-nu correlation in the decay of 21Na, depended on this branching ratio. However, until now only relatively imprecise (and, in some cases, contradictory) values existed for it. Our new result, 4.74(4)%, reduces but does not remove the reported discrepancy with the standard model.Comment: Revtex4, 2 fig

'Staying safe' – A narrative review of falls prevention in people with Parkinson’s -'PDSAFE'

This is the author accepted manuscript. The final version is available from Taylor & Francis via the DOI in this record.Background: Parkinson's disease demonstrates a spectrum of motor and non-motor symptoms. Falling is common and disabling. Current medical management shows minimal impact to reduce falls, or fall related risk factors such as deficits in gait, strength and postural instability. Despite evidence supporting rehabilitation in reducing fall risk factors, the most appropriate intervention to reduce overall fall rate remains inconclusive. This paper aims to 1) synthesise current evidence and conceptual models of falls rehabilitation in Parkinson's in a narrative review; and based on this evidence 2) introduce the treatment protocol used in the falls prevention, multi-centre clinical trial 'PDSAFE'. Method: Search of four bibliographic databases using the terms ‘Parkinson*’ and ‘Fall*’ combined with each of the following; ‘Rehab*, Balanc*, Strength*, Strateg*and Exercis*' and a framework for narrative review was followed. 3557 papers were identified, 416 were selected for review. The majority report the impact of rehabilitation on isolated fall risk factors. Twelve directly measure the impact on overall fall rate. Discussion: Results were used to construct a narrative review with conceptual discussion based on the 'International Classification of Functioning’, leading to presentation of the 'PDSAFE' intervention protocol. Conclusion: Evidence suggests training single, fall risk factors may not affect overall fall rate. Combining with behavioural and strategy training in a functional, personalised multi-dimensional model, addressing all components of the ‘International Classification of Functioning’ is likely to provide a greater influence on falls reduction. 'PDSAFE' is a multi-dimensional, physiotherapist delivered, individually tailored, progressive, home-based programme. It is designed with a strong evidence based approach and illustrates a model for the clinical delivery of the conceptual theory discussed.This project was funded by the National Institute for Health Research Health Technologies Assessment programme (project number 10/57/21). VG is supported by the National Institute of Health Research Collaboration for Applied Health Research and Care South West Peninsula.

Precise Half-Life Measurement of the Superallowed Beta+ Emitter 26Si

We have measured the half-life of the superallowed 0+ -to- 0+ beta+ emitter 26Si to be 2245.3(7) ms. We used pure sources of 26Si and employed a high-efficiency gas counter, which was sensitive to positrons from both this nuclide and its daughter 26mAl. The data were analyzed as a linked parent-daughter decay. To contribute meaningfully to any test of the unitarity of the Cabibbo-Kobayashi-Maskawa (CKM) matrix, the ft value of a superallowed transition must be determined to a precision of 0.1% or better. With a precision of 0.03% the present result is more than sufficient to be compatable with that requirement. Only the branching ratio now remains to be measured precisely before a +/-0.1% ft value can be obtained for the superallowed transition from 26Si