945 research outputs found

    ‘Hobson’s choice’: a qualitative study of consent in acute surgery

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    Objectives: The study aimed to understand through qualitative research what patients considered material in their decision to consent to an acute surgical intervention. Participants, setting and intervention: The patients selected aged between 18 and 90, having been admitted to a major trauma centre to undergo an acute surgical intervention within 14 days of injury, where English was their first language. Data saturation point was reached after 21 patients had been recruited. Data collection and analysis were conducted simultaneously, through interviews undertaken immediately prior to surgery. The data were coded using NVIVO V.12 software. Results: The key theme that originated from the data analysis was patients were unable to identify any individual risk that would modify their decision-making process around giving consent. The patient’s previous experience and the experience of others around them were a further theme. Patients sensed that there were no non-operative options for their injuries. Conclusion: This is the first study investigating what patient considered a material risk in the consent process. Patients in this study did attribute significance to past experiences of friends and family as material, prompting us to suggest that the surgeon asks about these experiences as part of the consent process. Concern about functional recovery was important to patients but insufficient to stop them from consenting to surgery, thus could not be classified as material risk

    Comparison of Algorithms and Parameterisations for Infiltration into Organic-Covered Permafrost Soils

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    Infiltration into frozen and unfrozen soils is critical in hydrology, controlling active layer soil water dynamics and influencing runoff. Few Land Surface Models (LSMs) and Hydrological Models (HMs) have been developed, adapted or tested for frozen conditions and permafrost soils. Considering the vast geographical area influenced by freeze/thaw processes and permafrost, and the rapid environmental change observed worldwide in these regions, a need exists to improve models to better represent their hydrology. In this study, various infiltration algorithms and parameterisation methods, which are commonly employed in current LSMs and HMs were tested against detailed measurements at three sites in Canada’s discontinuous permafrost region with organic soil depths ranging from 0.02 to 3 m. Field data from two consecutive years were used to calibrate and evaluate the infiltration algorithms and parameterisations. Important conclusions include: (1) the single most important factor that controls the infiltration at permafrost sites is ground thaw depth, (2) differences among the simulated infiltration by different algorithms and parameterisations were only found when the ground was frozen or during the initial fast thawing stages, but not after ground thaw reaches a critical depth of 15 to 30 cm, (3) despite similarities in simulated total infiltration after ground thaw reaches the critical depth, the choice of algorithm influenced the distribution of water among the soil layers, and (4) the ice impedance factor for hydraulic conductivity, which is commonly used in LSMs and HMs, may not be necessary once the water potential driven frozen soil parameterisation is employed. Results from this work provide guidelines that can be directly implemented in LSMs and HMs to improve their application in organic covered permafrost soils

    Beyond hormone replacement: quality of life in women with congenital hypogonadotropic hypogonadism.

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    Little is known about how women with isolated GnRH deficiency cope with their condition. This study aimed to examine the health and informational needs of women with congenital hypogonadotropic hypogonadism (CHH) and evaluate if their experiences differ from women with more common forms of infertility. Cross-sectional, multiple methods study using web-based data collection to reach dispersed rare disease patients. A community-based participatory research framework was employed to develop an online survey and collect quantitative and qualitative data. Adult women diagnosed with CHH who had received at least one year of hormonal treatment completed the Morisky Medication Adherence Scale, Revised Illness Perception Questionnaire and Zung Self-Rating Depression Scale. Information on health care experiences, treatment outcomes and patient-reported challenges were also collected. Women (n = 55) were often diagnosed late (20.7 ± 7.4, range: 10-48 years) and 16/20 patients receiving fertility treatment conceived. Poor adherence was frequently observed (34/55) while more than half (27/49) reported a gap in treatment exceeding a year. Low adherence correlated with depressive symptoms (r = 0.3, P > 0.05). Negative illness perceptions were pervasive and 30/55 exhibited some depressive symptoms - significantly greater than women with common female factor infertility (P < 0.01). Symptoms were underappreciated by providers as only 15 of 55 patients had discussions about psychological services. Women identified isolation, need for information and finding expert care as challenges to living with CHH. Despite being a treatable form of female infertility, the presumable availability of treatment does not necessarily ensure adequate quality of life for women with isolated GnRH deficiency

    The interdisciplinary nature of SOIL

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    The holistic study of soils requires an interdisciplinary approach involving biologists, chemists, geologists, and physicists, amongst others, something that has been true from the earliest days of the field. In more recent years this list has grown to include anthropologists, economists, engineers, medical professionals, military professionals, sociologists, and even artists. This approach has been strengthened and reinforced as current research continues to use experts trained in both soil science and related fields and by the wide array of issues impacting the world that require an in-depth understanding of soils. Of fundamental importance amongst these issues are biodiversity, biofuels/energy security, climate change, ecosystem services, food security, human health, land degradation, and water security, each representing a critical challenge for research. In order to establish a benchmark for the type of research that we seek to publish in each issue of SOIL, we have outlined the interdisciplinary nature of soil science research we are looking for. This includes a focus on the myriad ways soil science can be used to expand investigation into a more holistic and therefore richer approach to soil research. In addition, a selection of invited review papers are published in this first issue of SOIL that address the study of soils and the ways in which soil investigations are essential to other related fields. We hope that both this editorial and the papers in the first issue will serve as examples of the kinds of topics we would like to see published in SOIL and will stimulate excitement among our readers and authors to participate in this new venture

    A Comparative Study of Three Different Chemical Vapor Deposition Techniques of Carbon Nanotube Growth on Diamond Films

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    This paper compares between the methods of growing carbon nanotubes (CNTs) on diamond substrates and evaluates the quality of the CNTs and the interfacial strength. One potential application for these materials is a heat sink/spreader for high-power electronic devices. The CNTs and diamond substrates have a significantly higher specific thermal conductivity than traditional heat sink/spreader materials making them good replacement candidates. Only limited research has been performed on these CNT/diamond structures and their suitability of different growth methods. This study investigates three potential chemical vapor deposition (CVD) techniques for growing CNTs on diamond: thermal CVD (T-CVD), microwave plasma-enhanced CVD (MPE-CVD), and floating catalyst thermal CVD (FCT-CVD). Scanning electron microscopy (SEM) and high-resolution transmission electron microscopy (TEM) were used to analyze the morphology and topology of the CNTs. Raman spectroscopy was used to assess the quality of the CNTs by determining the ID/IG peak intensity ratios. Additionally, the CNT/diamond samples were sonicated for qualitative comparisons of the durability of the CNT forests. T-CVD provided the largest diameter tubes, with catalysts residing mainly at the CNT/diamond interface. The MPE-CVD process yielded non uniform defective CNTs, and FCT-CVD resulted in the smallest diameter CNTs with catalyst particles imbedded throughout the length of the nanotubes
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