The experiences of relatives of people with Acquired Brain Injury (ABI) of the condition and associated social and health care services

Context: ABI can arise from many causes and is a significant issue for long-term care. Developments in health care have meant that many more people with ABI are living longer, some with complex needs arising from their brain injury. The consequences of injury are generally long-term, even lifelong. Family members of people with ABI are significant to their rehabilitation, support and care, and research has identified many of the challenges they face. Objective: This paper reports work to survey the views of family members of people with ABI to ascertain their experience of the condition and their views and experience of related health and social care services. Method: An online survey was distributed via ABI networks to family members of individuals affected by ABI. One hundred ten respondents ranked the difficulties met by their relative living with an ABI and rated the services they had encountered. A series of open questions enabled respondents to provide greater detail regarding their experience and knowledge. Findings: The key findings are that relationships between the injured and non-injured parties change, alterations to roles and responsibilities are difficult and mediated via unending and complex grief. Relatives reported poor levels of involvement in decisions regarding the provision of social and health care services, a failure to be given good, accurate information in a timely fashion and the need to ‘fight’ for virtually any service provided. Service provision, particularly post-hospital discharge, was very regularly criticized for being either entirely absent, unaware of the impact of brain injury, failing to take account of actual functioning and/or structured in ways that are not concomitant with the needs of the injured person or the relative. Lack of knowledge of the impact of ABI by non-specialist staff and services is particularly highlighted as a barrier to progress and an added burden for relatives to contend with. Social work in particular was commented upon most negatively, most often for a failure to understand the condition and needs. Valued services and professionals are noted to be humane, knowledgeable about ABI, aware of the impact ABI has on the non-injured relative and able to act as a single ‘one-stop’ focal point for service provision. Limitations: As a self-selecting cohort of respondents to an online survey the work is not necessarily generalisable to the population as a whole. The findings, however, provide important considerations for improving social and health care services for people with ABI and the key relatives involved in supporting them. Implications: Commissioners and providers of social and health care services ought to work more closely with family members of people living with ABI. Services and individual practitioners need to be more knowledgeable about the likely functional outcomes of ABI, in particular the impact of invisible impairments to cognition and executive functioning. Relatives identify the benefit of good quality, accurate information and of a knowledgeable single point of contact across time and setting. Knowledge of ABI, of neurorehabilitation and of the impact of ABI upon family members by social workers is noted to be poor and attention to this may help with people’s rehabilitation and to prevent unnecessary additional carer burden

Micropalaeontology reveals the source of building materials for a defensive earthwork (English Civil War?) at Wallingford Castle, Oxfordshire

Microfossils recovered from sediment used to construct a putative English Civil War defensive bastion at Wallingford Castle, south Oxfordshire, provide a biostratigraphical age of Cretaceous (earliest Cenomanian) basal M. mantelli Biozone. The rock used in the buttress – which may have housed a gun emplacement – can thus be tracked to the Glauconitic Marl Member, base of the West Melbury Marly Chalk Formation. A supply of this rock is available on the castle site or to the east of the River Thames near Crowmarsh Gifford. Microfossils provide a unique means to provenance construction materials used at the Wallingford site. While serendipity may have been the chief cause for use of the Glauconitic Marl, when compacted, it forms a strong, almost ‘road base’-like foundation that was clearly of use for constructing defensive works. Indeed, use of the Glauconitic Marl was widespread in the area for agricultural purposes and its properties may have been well-known locally

The Foundations of Public Language: Words as Social Artefacts

This thesis brings together topics in philosophy of language, social ontology, and generative linguistic theory. The first main contribution is to develop a theory of artefacts, and to apply it to linguistic entities. The general account of artefacts I offer here draws heavily on Amie Thomasson’s work, but I go on to isolate a class of artefacts which I refer to as essentially communicative artefacts, ECAs, and I argue that words fall into this category. One benefit of this approach is that insights arising from social ontology can be used to remedy deficiencies in philosophical discussions of words: for example, I show why the failure of form-theoretic approaches to word individuation poses a significant obstacle to attempts to deploy Searleian assumptions about social ontology in a theory of words. The second main contribution is to provide an account of public language which is compatible with developments in generative linguistics. Too often, philosophical discussions of words ignore conceptions of language which are prevalent in linguistics, which means that fruitful connections between the disciplines are missed, and that worries expressed by linguists about philosophical conceptions of public language go unanswered. My account of words is intended not only to be compatible with generative linguistic theory, but also to be thoroughly embedded in the philosophy of science and mind which animates generative linguistic theorising. From this vantage point, I evaluate a range of sceptical arguments which have been levelled against public language views. I conclude that what the philosophy of generative linguistics recommends is not an eliminativist position with respect to public language, nor a naively scientistic one, but a practical, principled, methodological preference. A third contribution is to provide original objections to extant theories of words, including those due to David Kaplan, Herman Cappelen, and Zoltan Szabo

Factors influencing community case management and care hours for clients with traumatic brain injury living in the UK

Objective: To investigate the relationship between deficits associated with traumatic brain injury (TBI) and case management (CM) and care/support (CS) in two UK community samples. Research design: Prospective descriptive study. Method: Case managers across the UK and from a single UK CM service contributed client profiles to two data sets (Groups 1 and 2, respectively). Data were entered on demographics, injury severity, functional skills, functional-cognition (including executive functions), behaviour and CM and CS hours. Relationships were explored between areas of disability and service provision. Results: Clients in Group 2 were more severely injured, longer post-injury and had less family support than clients in Group 1. There were few significant differences between Groups 1 and 2 on measures of Functionalskill, Functional-cognition and Behaviour disorder. Deficits in Functionalskills were associated with CS, but not CM. Deficits in measures of executive functions (impulsivity, predictability, response to direction) were related to CM, but not to CS. Insight was related to both CM and CS. Variables related to behaviour disorder were related to CM, but were less often correlated to CS. Conclusions: The need for community support is related not only to Functionalskills (CS), but also to behaviour disorder, self-regulatory skills and impaired insight (CM)

Acute Neurologic Dysfunction in Critically Ill Children: The PODIUM Consensus Conference

CONTEXT Acute neurologic dysfunction is common in critically ill children and contributes to outcomes and end of life decision-making. OBJECTIVE To develop consensus criteria for neurologic dysfunction in critically ill children by evaluating the evidence supporting such criteria and their association with outcomes. DATA SOURCES Electronic searches of PubMed and Embase were conducted from January 1992 to January 2020, by using a combination of medical subject heading terms and text words to define concepts of neurologic dysfunction, pediatric critical illness, and outcomes of interest. STUDY SELECTION Studies were included if the researchers evaluated critically ill children with neurologic injury, evaluated the performance characteristics of assessment and scoring tools to screen for neurologic dysfunction, and assessed outcomes related to mortality, functional status, organ-specific outcomes, or other patient-centered outcomes. Studies with an adult population or premature infants (≤36 weeks' gestational age), animal studies, reviews or commentaries, case series with sample size ≤10, and studies not published in English with an inability to determine eligibility criteria were excluded. DATA EXTRACTION Data were abstracted from each study meeting inclusion criteria into a standard data extraction form by task force members. DATA SYNTHESIS The systematic review supported the following criteria for neurologic dysfunction as any 1 of the following: (1) Glasgow Coma Scale score ≤8; (2) Glasgow Coma Scale motor score ≤4; (3) Cornell Assessment of Pediatric Delirium score ≥9; or (4) electroencephalography revealing attenuation, suppression, or electrographic seizures. CONCLUSIONS We present consensus criteria for neurologic dysfunction in critically ill children

Serum lipid profiles among patients initiating ritonavir-boosted atazanavir versus efavirenz-based regimens

<p>Abstract</p> <p>Background</p> <p>Antiretrovirals used to treat HIV-infected patients have the potential to adversely affect serum lipid profiles and increase the risk of cardiovascular disease which is an emerging concern among HIV-infected patients. Since boosted atazanavir and efavirenz are both considered preferred antiretrovirals a head to head comparison of their effects on serum lipids is needed.</p> <p>Aim</p> <p>The primary objective of the study was to compare the effects of atazanavir (boosted and unboosted) and efavirenz based regimens on serum lipid profiles.</p> <p>Study Design</p> <p>Prospective cohort study nested within three ongoing cohorts of HIV-infected individuals.</p> <p>Study Population and Methods</p> <p>Participants initiating either atazanavir or efavirenz based regimens with documented pre- and post-initiation lipid values. Multivariate linear regression was conducted to estimate adjusted mean differences between treatment groups for high density lipoprotein cholesterol (HDL-c), non-HDL-c, and log total cholesterol (TC) to HDL-c ratio outcomes; log-linear regression models were used to estimate differences in prevalence of low HDL-c and desirable TC.</p> <p>Results</p> <p>The final study population was comprised of 380 efavirenz and 281 atazanavir initiators. Both atazanavir and efavirenz users had increases in serum HDL-c and decreases in TC/HDL ratio. In comparison to individuals initiating efavirenz, boosted atazanavir users on average had lower HDL-c (-4.12 mg/dl, p < 0.001) and non HDL-c (-5.75 mg/dl, p < 0.01), but similar declines in TC/HDL ratio.</p> <p>Conclusion</p> <p>Both efavirenz and atazanavir-based regimens (boosted and unboosted) resulted in similar beneficial declines in the TC/HDL ratio.</p

Marine Strategy Framework Directive - Task Group 11 Report Underwater Noise and Other Forms of Energy

The Marine Strategy Framework Directive (2008/56/EC) (MSFD) requires that the European Commis-sion (by 15 July 2010) should lay down criteria and methodological standards to allow consistency in approach in evaluating the extent to which Good Environmental Status (GES) is being achieved. ICES and JRC were contracted to provide scientific support for the Commission in meeting this obligation. A total of 10 reports have been prepared relating to the descriptors of GES listed in Annex I of the Directive. Eight reports have been prepared by groups of independent experts coordinated by JRC and ICES in response to this contract. In addition, reports for two descriptors (Contaminants in fish and other seafood and Marine Litter) were written by expert groups coordinated by DG SANCO and IFREMER respectively. A Task Group was established for each of the qualitative Descriptors. Each Task Group consisted of selected experts providing experience related to the four marine regions (the Baltic Sea, the North-east Atlantic, the Mediterranean Sea and the Black Sea) and an appropriate scope of relevant scien-tific expertise. Observers from the Regional Seas Conventions were also invited to each Task Group to help ensure the inclusion of relevant work by those Conventions. This is the report of Task Group 11 Underwater noise and other forms of energy.JRC.DDG.H.5-Rural, water and ecosystem resource

The Global Evolution of Giant Molecular Clouds II: The Role of Accretion

We present virial models for the global evolution of giant molecular clouds. Focusing on the presence of an accretion flow, and accounting for the amount of mass, momentum, and energy supplied by accretion and star formation feedback, we are able to follow the growth, evolution, and dispersal of individual giant molecular clouds. Our model clouds reproduce the scaling relations observed in both galactic and extragalactic clouds. We find that accretion and star formation contribute contribute roughly equal amounts of turbulent kinetic energy over the lifetime of the cloud. Clouds attain virial equilibrium and grow in such a way as to maintain roughly constant surface densities, with typical surface densities of order 50 - 200 Msun pc^-2, in good agreement with observations of giant molecular clouds in the Milky Way and nearby external galaxies. We find that as clouds grow, their velocity dispersion and radius must also increase, implying that the linewidth-size relation constitutes an age sequence. Lastly, we compare our models to observations of giant molecular clouds and associated young star clusters in the LMC and find good agreement between our model clouds and the observed relationship between H ii regions, young star clusters, and giant molecular clouds.Comment: 23 Pages, 9 Figures. Accepted to Ap

Physical Properties and Galactic Distribution of Molecular Clouds identified in the Galactic Ring Survey

We derive the physical properties of 580 molecular clouds based on their 12CO and 13CO line emission detected in the University of Massachusetts-Stony Brook (UMSB) and Galactic Ring surveys. We provide a range of values of the physical properties of molecular clouds, and find a power-law correlation between their radii and masses, suggesting that the fractal dimension of the ISM is around 2.36. This relation, M = (228 +/- 18) R^{2.36+/-0.04}, allows us to derive masses for an additional 170 GRS molecular clouds not covered by the UMSB survey. We derive the Galactic surface mass density of molecular gas and examine its spatial variations throughout the Galaxy. We find that the azimuthally averaged Galactic surface density of molecular gas peaks between Galactocentric radii of 4 and 5 kpc. Although the Perseus arm is not detected in molecular gas, the Galactic surface density of molecular gas is enhanced along the positions of the Scutum-Crux and Sagittarius arms. This may indicate that molecular clouds form in spiral arms and are disrupted in the inter-arm space. Last, we find that the CO excitation temperature of molecular clouds decreases away from the Galactic center, suggesting a possible decline in the star formation rate with Galactocentric radius. There is a marginally significant enhancement in the CO excitation temperature of molecular clouds at a Galactocentric radius of about 6 kpc, which in the longitude range of the GRS corresponds to the Sagittarius arm. This temperature increase could be associated with massive star formation in the Sagittarius spiral arm