'Overjoyed that I can go outside': Using walking interviews to learn about the lived experience and meaning of neighbourhood for people living with dementia

This study explores the relationships between people living with dementia and their neighbourhood as they venture out from home on a regular and often routine basis. Here, we report findings from the Swedish field site of an international 5-year project: Neighbourhoods: our people, our places. The aims of this study were to investigate the lived experience of the neighbourhood for people with dementia and through this to better understand the meaning that neighbourhood held for the participants. In this study, we focus on the walking interviews which were conducted with 14 community-dwelling people with dementia (11 men and 3 women) and were analysed using an interpretative phenomenological method. Four themes were revealed from these interviews: life narratives embedded within neighbourhood; the support of selfhood and wellbeing through movement; the neighbourhood as an immediate social context; and restorative connections to nature. These themes were distilled into the ‘essence’ of what neighbourhood meant for the people we interviewed: A walkable area of subjective significance and social opportunity in which to move freely and feel rejuvenated. We have found that the neighbourhood for community-dwelling people with dementia holds a sense of attachment and offers the potential for freedom of movement. Our research indicates that a dementia diagnosis doesn’t necessarily reduce this freedom of movement. The implications for practice and policy are considered: future research should explore and pay closer attention to the diverse living conditions of people living with dementia, and not least the particular challenges faced by people living alone with dementia

Pacific climate reflected in Waipuna Cave drip water hydrochemistry

Cave microclimate and geochemical monitoring is vitally important for correct interpretations of proxy time series from speleothems with regard to past climatic and environmental dynamics. We present results of a comprehensive cave-monitoring programme in Waipuna Cave in the North Island of New Zealand, a region that is strongly influenced by the Southern Westerlies and the El Niño-Southern Oscillation (ENSO). This study aims to characterise the response of the Waipuna Cave hydrological system to atmospheric circulation dynamics in the southwestern Pacific region in order to assure the quality of ongoing palaeo-environmental reconstructions from this cave. Drip water from 10 drip sites was collected at roughly monthly intervals for a period of ca. 3 years for isotopic (d18O, dD, d-excess parameter, d17O, and 17Oexcess) and elemental (Mg=Ca and Sr=Ca) analysis. The monitoring included spot measurements of drip rates and cave air CO2 concentration. Cave air temperature and drip rates were also continuously recorded by automatic loggers. These datasets were compared to surface air temperature, rainfall, and potential evaporation from nearby meteorological stations to test the degree of signal transfer and expression of surface environmental conditions in Waipuna Cave hydrochemistry. Based on the drip response dynamics to rainfall and other characteristics, we identified three types of discharge associated with hydrological routing in Waipuna Cave: (i) type 1-diffuse flow, (ii) type 2-fracture flow, and (iii) type 3-combined flow. Drip water isotopes do not reflect seasonal variability but show higher values during severe drought. Drip water d18O values are characterised by small variability and reflect the mean isotopic signature of precipitation, testifying to rapid and thorough homogenisation in the epikarst. Mg=Ca and Sr=Ca ratios in drip waters are predominantly controlled by prior calcite precipitation (PCP). Prior calcite precipitation is strongest during austral summer (December-February), reflecting drier conditions and a lack of effec tive infiltration, and is weakest during the wet austral winter (July-September). The Sr=Ca ratio is particularly sensitive to ENSO conditions due to the interplay of congruent or incongruent host rock dissolution, which manifests itself in lower Sr=Ca in above-average warmer and wetter (La Niña-like) conditions. Our microclimatic observations at Waipuna Cave provide a valuable baseline for the rigorous interpretation of speleothem proxy records aiming at reconstructing the past expression of Pacific climate modes. © 2020 Author(s)

Pacific climate reflected in Waipuna Cave drip water hydrochemistry

Cave microclimate and geochemical monitoring is vitally important for correct interpretations of proxy time series from speleothems with regard to past climatic and environmental dynamics. We present results of a comprehensive cave-monitoring programme in Waipuna Cave in the North Island of New Zealand, a region that is strongly influenced by the Southern Westerlies and the El Niño–Southern Oscillation (ENSO). This study aims to characterise the response of the Waipuna Cave hydrological system to atmospheric circulation dynamics in the southwestern Pacific region in order to assure the quality of ongoing palaeo-environmental reconstructions from this cave. Drip water from 10 drip sites was collected at roughly monthly intervals for a period of ca. 3 years for isotopic (δ18O, δD, d-excess parameter, δ17O, and 17Oexcess) and elemental (Mg∕Ca and Sr∕Ca) analysis. The monitoring included spot measurements of drip rates and cave air CO2 concentration. Cave air temperature and drip rates were also continuously recorded by automatic loggers. These datasets were compared to surface air temperature, rainfall, and potential evaporation from nearby meteorological stations to test the degree of signal transfer and expression of surface environmental conditions in Waipuna Cave hydrochemistry. Based on the drip response dynamics to rainfall and other characteristics, we identified three types of discharge associated with hydrological routing in Waipuna Cave: (i) type 1 – diffuse flow, (ii) type 2 – fracture flow, and (iii) type 3 – combined flow. Drip water isotopes do not reflect seasonal variability but show higher values during severe drought. Drip water δ18O values are characterised by small variability and reflect the mean isotopic signature of precipitation, testifying to rapid and thorough homogenisation in the epikarst. Mg∕Ca and Sr∕Ca ratios in drip waters are predominantly controlled by prior calcite precipitation (PCP). Prior calcite precipitation is strongest during austral summer (December–February), reflecting drier conditions and a lack of effective infiltration, and is weakest during the wet austral winter (July–September). The Sr∕Ca ratio is particularly sensitive to ENSO conditions due to the interplay of congruent or incongruent host rock dissolution, which manifests itself in lower Sr∕Ca in above-average warmer and wetter (La Niña-like) conditions. Our microclimatic observations at Waipuna Cave provide a valuable baseline for the rigorous interpretation of speleothem proxy records aiming at reconstructing the past expression of Pacific climate modes

The Victorian Newsletter (Spring 1966)

The Victorian Newsletter is edited for the English X Group of the Modern Language Association by William E. Buckler, New York University, New York, N.Y. 10003.No Arnold Could Ever Write a Novel / A. Dwight Culler -- Matthew Arnold's Empedocles on Etna / Charles Berryman -- The George-Amelia-Dobbin Triangle in the Structure of Vanity Fair / Myron Taube -- Browning's Duke as Theatrical Producer / W. David Shaw -- Wilkie Collins' Heart and Science and the Vivisection Controversy / Dougald B. MacEachen -- Jude the Obscure as Pagan Self-Assertion / Ward Hellstrom -- Trabb's Boy and Orlick / Barry D. Bort -- Recent Publications: A Selected List / Arthur F. Minerof -- English X New

No association between the aluminium content of trabecular bone and bone density, mass or size of the proximal femur in elderly men and women

BACKGROUND: Aluminium is considered a bone toxic metal since poisoning can lead to aluminium-induced bone disease in patients with chronic renal failure. Healthy subjects with normal renal function retain 4% of the aluminium consumed. They might thus also accumulate aluminium and eventually be at risk of long-term low-grade aluminium intoxication that can affect bone health. METHODS: We therefore examined 62 patients with femoral neck fractures or osteoarthritis of the hip (age range 38–93), with the aim of examining whether aluminium in bone is associated with bone-mineral density (BMD), content (BMC) or width of the femoral neck measured by dual-energy X-ray absorptiometry (DXA). During operations bone biopsies were taken from the trabecular bone of the proximal femur. The samples were measured for their content of aluminium using a mass spectrometer. RESULTS: No significant association between the aluminium content in bone and femoral neck BMD, BMC or width could be found after multivariate adjustment. CONCLUSION: Our results indicate that the accumulated aluminium content in bone during life does not substantially influence the extent of osteoporosis

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700